El Hajj F, Hoteit M, Ouaknine M
Service de chirurgie orthopédique, hôpital Cochin, 47-83, boulervard de l'Hôpital, 75013 Paris, France.
Faculté de santé publique, université libanaise, Hadath, Lebanon.
Orthop Traumatol Surg Res. 2015 Jun;101(4):411-4. doi: 10.1016/j.otsr.2015.03.011. Epub 2015 Apr 21.
Elbow arthroscopy is considered to be a difficult procedure with a high complication rate. These two disadvantages are due to the proximity of neurovascular structures.
The aim of our study was to evaluate the efficacy and complication rate of a new elbow arthroscopy technique without anteromedial portals. This approach was taken because of the high rate of ulnar nerve damage using the medial portal, and the difficulty of performing triangulation of opposite portals in a patient in the lateral decubitus position.
Fifteen patients were operated on by the same surgeon between 2010 and 2012. Range of motion and the "MEPS" elbow score were calculated preoperatively and at the final postoperative follow-up. The average age of patients was 38.3 years. The follow-up was 11.1 months. Personal portals (high anterolateral and intermediate anterolateral portals) were used instead of the anteromedial portals.
Elbow flexion increased from 113° preoperatively to 129° at the final follow-up (P=0.009). Extension increased from -33° to -10° (P<0.0001). The preoperative and final postoperative "MEPS" scores were 56.3 and 94 respectively (P<0.0001). Two patients (13.3%) had radial nerve palsy with complete recovery 6 and 9 months after surgery.
The rate of nerve complications following elbow arthroscopy varies from 0 to 14%. The rate in our series (13.3%) is comparable to the results of the literature. This rate should be placed in perspective (since one patient had multiple open surgery elbow operations before arthroscopy). All complications were transient. Improved elbow range of motion in our study is consistent with the results in literature.
肘关节镜检查被认为是一项具有高并发症发生率的困难手术。这两个缺点是由于神经血管结构位置接近所致。
我们研究的目的是评估一种不使用前内侧入路的新型肘关节镜技术的疗效和并发症发生率。采用这种方法是因为使用内侧入路时尺神经损伤发生率高，以及在侧卧位患者中对侧入路进行三角定位困难。
2010年至2012年间，同一位外科医生为15例患者实施了手术。术前及术后最终随访时计算活动范围和“MEPS”肘关节评分。患者的平均年龄为38.3岁。随访时间为11.1个月。使用个人入路（高位前外侧和中间前外侧入路）替代前内侧入路。
肘关节屈曲角度从术前的113°增加到最终随访时的129°（P = 0.009）。伸展角度从 -33°增加到 -10°（P < 0.0001）。术前及术后最终“MEPS”评分分别为56.3和94（P < 0.0001）。两名患者（13.3%）出现桡神经麻痹，术后6个月和9个月完全恢复。
肘关节镜检查后神经并发症的发生率在0%至14%之间。我们系列研究中的发生率（13.3%）与文献结果相当。该发生率应综合考虑（因为一名患者在关节镜检查前曾多次接受肘关节开放手术）。所有并发症均为短暂性。我们研究中肘关节活动范围的改善与文献结果一致。
