Feiwell L A, Frey C
Department of Orthopaedic Surgery, University of Southern California, Los Angeles.
Foot Ankle Int. 1994 Nov;15(11):614-21. doi: 10.1177/107110079401501107.
To this date, there have been no published studies correlating gross intra-articular anatomy and the compartments of the ankle that can be instrumented under arthroscopic visualization. The purpose of this study was to demonstrate which areas of intra-articular surface were accessible to the standard portals using a technique that allows direct anatomic correlation. Six fresh cadaver specimens and 12 fresh-frozen, below-knee amputations were used in this study. The 18 ankles were divided into six groups using only one arthroscopic portal site and one instrumentation site per group. Arthroscopic curettes were used to debride only the visualized talar, tibial, and fibular articular cartilage surfaces. After debridement, excision of the distal tibiofibular joint and the talus was performed. The total area of articular cartilage removed with each combination of arthroscope and instrument portal sites was noted, photographed, and recorded graphically. Use of the various combinations of the anteromedial, anterolateral, and posterolateral portals allowed complete access to all surfaces of the tibial plafond, anterior and posterior rims, and the talar dome. Areas that were not accessible by any portal combination were the distal half of the anterior colliculus of medial malleolus, the majority of the lateral talar articular surface, and the inferior half of the lateral malleolar articular surface.
截至目前，尚无已发表的研究将关节内大体解剖结构与踝关节在关节镜直视下可操作的间隙相关联。本研究的目的是使用一种能实现直接解剖关联的技术，来证明关节内表面的哪些区域可通过标准入路到达。本研究使用了6个新鲜尸体标本和12个新鲜冷冻的膝下截肢标本。将18个踝关节分为6组，每组仅使用一个关节镜入路部位和一个器械操作部位。关节镜刮匙仅用于清理可见的距骨、胫骨和腓骨关节软骨表面。清理后，切除胫腓远侧关节和距骨。记录、拍摄并用图形记录每种关节镜和器械入路部位组合所去除的关节软骨总面积。使用前内侧、前外侧和后外侧入路的各种组合可完全到达胫骨平台的所有表面、前后边缘以及距骨穹窿。任何入路组合均无法到达的区域是内踝前丘的远端一半、大部分距骨外侧关节面以及外踝关节面的下半部分。
