Thaveepunsan Sutee, Shields Maegan N, O'Driscoll Shawn W
Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Orthop J Sports Med. 2019 Jan 11;7(1):2325967118817232. doi: 10.1177/2325967118817232. eCollection 2019 Jan.
Safe and effective portal placement is crucial for successful elbow arthroscopy. Various techniques for anterolateral portal placement in elbow arthroscopy have been described, yet radial nerve injuries are commonly reported.
To report on the technique and safety of anterolateral portal placement by the needle-and-knife method and its clinical applications.
Case series; Level of evidence, 4.
A retrospective review was completed of patients who underwent an arthroscopic procedure in the anterior compartment of the elbow and anterolateral portal placement. Patients were evaluated immediately postoperatively and at subsequent visits and were monitored for signs of radial nerve injury.
A total of 460 patients met the inclusion criteria, of which 309 (67%) underwent the needle-and-knife technique. There was 1 case (0.3%) of temporary radial nerve palsy. For the remaining 151 patients who underwent anterolateral portal placement by other techniques, there were 2 cases of temporary radial nerve palsy (1.3%). There were no cases of the needle-and-knife technique being unsuccessful or abandoned in lieu of a different technique. Use of the needle-and-knife technique increased over time with experience and practice. Initially, contraindications to this technique included impaired view of the lateral side of the anterior compartment of the elbow caused by severe intra-articular scar (65%), extensive synovitis (10%), or large osteophytes or loose bodies (10%). For the remaining patients (15%) who did not have portals placed via the needle-and-knife technique, alternate techniques were used for teaching purposes.
The needle-and-knife technique is reproducible and easy to perform by a clinician instructed in its use and trained in elbow arthroscopy. Its main advantage is that it permits the surgeon to safely slide the knife along the lateral supracondylar ridge, releasing the scarred capsule and thereby increasing the available space in which to work. Enlarging the working space inside scarred and contracted elbows cannot be accomplished by distending the capsule.
安全有效的入路放置对于成功进行肘关节镜检查至关重要。已经描述了肘关节镜检查中外侧前入路放置的各种技术，但桡神经损伤的报道很常见。
报告针刀法外侧前入路放置的技术、安全性及其临床应用。
病例系列；证据等级，4级。
对在肘关节前侧间室进行关节镜手术并放置外侧前入路的患者进行回顾性研究。术后立即及随后的随访中对患者进行评估，并监测桡神经损伤的体征。
共有460例患者符合纳入标准，其中309例（67%）采用针刀法。有1例（0.3%）出现暂时性桡神经麻痹。对于其余151例采用其他技术放置外侧前入路的患者，有2例（1.3%）出现暂时性桡神经麻痹。没有针刀法不成功或因改用其他技术而放弃的情况。随着经验和实践的积累，针刀法的使用逐渐增加。最初，该技术的禁忌证包括因严重关节内瘢痕（65%）、广泛滑膜炎（10%）或大的骨赘或游离体（10%）导致肘关节前侧间室外侧视野受限。对于其余未通过针刀法放置入路的患者（15%），为教学目的采用了替代技术。
针刀法可重复操作，由接受过该技术使用指导并经过肘关节镜培训的临床医生操作起来很容易。其主要优点是允许外科医生沿着外侧髁上嵴安全地滑动手术刀，松解瘢痕化的关节囊，从而增加操作的可用空间。对于瘢痕化和挛缩的肘关节，不能通过扩张关节囊来扩大工作空间。
