Gross R M, Fitzgibbons T C
Arthroscopy. 1985;1(3):156-9. doi: 10.1016/s0749-8063(85)80002-5.
This paper proposes a modification of the classical position for shoulder arthroscopy. Two changes are proposed to improve visualization, accentuate pathology, and give better access to the inferior one half to one third of the shoulder joint. The direct lateral position is changed to a semilateral position in which the patient is allowed to rotate 30 to 40 degrees posteriorly, thus putting the shoulder joint on a horizontal plane. This allows for more comfortable arthroscopy and instrumentation. Also, if capsulorrhaphy is desired, better penetration of the scapula is possible since the scapula is vertical; thus, the angle of the approaching staple is less severe. The second change is to apply traction in a plane perpendicular to the long axis of the humerus rather than parallel to it. This modification elevates the humerus out of the glenoid rather than distracts the humerus into a subluxed position. The result accentuates labral pathology and gives a significantly improved view of the inferior one half to one third of the glenoid capsule. This new plane of traction allows excellent visualization with very little traction; thus, the problem of traction neuropraxia has been eliminated.
本文提出了一种对肩关节镜检查经典体位的改良方法。提出了两项改变，以改善视野、突出病变，并更好地进入肩关节下半部至三分之一区域。直接外侧位改为半侧卧位，患者可向后旋转30至40度，从而使肩关节处于水平面上。这使得关节镜检查和器械操作更加舒适。此外，如果需要进行关节囊缝合，由于肩胛骨呈垂直状态，更容易穿透肩胛骨；因此，缝合钉接近的角度不那么陡峭。第二项改变是在垂直于肱骨长轴的平面上施加牵引，而不是平行于肱骨长轴。这种改良将肱骨从关节盂中抬起，而不是将肱骨牵至半脱位位置。结果突出了盂唇病变，并显著改善了对关节盂囊下半部至三分之一区域的观察。这种新的牵引平面只需很少的牵引就能实现极佳的视野；因此，牵引性神经失用症的问题得以消除。
