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肘关节炎镜检查中肱骨小头骨软骨病变的可及性:一项解剖学研究。

Accessibility of osteochondral lesion at the capitellum during elbow arthroscopy: an anatomical study.

机构信息

Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

OCM (Orthopädische Chirurgie München) Clinic, Steinerstr. 6, 81369, Munich, Germany.

出版信息

Arch Orthop Trauma Surg. 2024 Mar;144(3):1297-1302. doi: 10.1007/s00402-023-05172-7. Epub 2024 Jan 3.

Abstract

INTRODUCTION

Osteochondrosis dissecans (OCD) at the capitellum is a common pathology in young patients. Although arthroscopic interventions are commonly used, there is a lack of information about the accessibility of the defects during elbow arthroscopy by using standard portals.

MATERIALS AND METHODS

An elbow arthroscopy using the standard portals was performed in seven fresh frozen specimens. At the capitellum, the most posterior and anterior cartilage surface reachable was marked with K-wires. Using a newly described measuring method, we constructed a circular sector around the rotational center of the capitellum. The intersection of K-wire "A" and "B" with the circular sector was marked, and the angles between the K-wires and the Rogers line, alpha angle for K-Wire "A" and beta angle for K-wire "B", and the corridor not accessible during arthroscopy was digitally measured.

RESULTS

On average, we found an alpha angle of 53° and a beta angle of 104°. Leaving a sector of 51° which was not accessible via the standard portals during elbow arthroscopy.

CONCLUSION

Non-accessible capitellar lesions during elbow arthroscopy should be considered preoperatively, and the informed consent discussion should always include the possibility of open procedures or the use of flexible instruments.

摘要

简介

肱骨小头剥脱性骨软骨炎(OCD)是年轻患者中常见的病理。尽管关节镜干预是常用的,但在标准入路关节镜下检查肘部时,关于缺陷的可及性的信息仍然缺乏。

材料与方法

对七个新鲜冷冻标本进行了标准入路的肘关镜检查。在肱骨小头处,用 K 线标记最靠后的和最靠前的可触及软骨表面。使用新描述的测量方法,我们在肱骨小头的旋转中心周围构建了一个扇形区域。标记 K 线“A”和“B”与扇形区域的交点,并测量 K 线与 Rogers 线之间的角度、K 线“A”的 alpha 角和 K 线“B”的 beta 角,以及关节镜检查时无法进入的通道。

结果

平均而言,我们发现 alpha 角为 53°,beta 角为 104°。在肘关镜检查期间,有 51°的扇形区域无法通过标准入路进入。

结论

在术前应考虑肘关镜检查时不可触及的肱骨小头病变,并且知情同意讨论应始终包括开放性手术或使用灵活器械的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f02d/10896769/c8120d7c0313/402_2023_5172_Fig1_HTML.jpg

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