Gächter A, Staehlin P
Chirurgische Poliklinik und Handchirurgie, Orthopädische Universitätsklinik, Kantonsspital Basel.
Ther Umsch. 1993 Jul;50(7):509-17.
These joints are accessible, though technically demanding, by arthroscope. Above all, the evaluation of the lesions is not simple. Arthroscopy always represents the last diagnostical alternative. The extraction of loose fragments, the debridement, the shaving and the treatment of infections are excellent indications. Postoperative rehabilitation is favoured and shortened with the arthroscopic approach. Elbow arthroscopy did not greatly, develop during the last years. Posttraumatic situations, corpora libera and cartilage lesions represent the main indications. The arthroscopies of the ankle and the wrist, however, are increasing. Carpal instability and discus problems of the wrist are quite interesting. Lately, endoscopic carpal-tunnel decompression has been propagated, but is still in its experimental phase. At the ankle, osteochondrosis dissecans, flake fracture and fibrosed plica [discovered through arthroscopy, mostly in athletes] are suitable for arthroscopic removal or reconstruction. Interfering osteophytes at the anterior border of the tibia can also be removed arthroscopically. Percutaneous internal fixation and fusion of the ankle joint need first to be evaluated in a long-term follow-up. Arthroscopic debridement and rinsing against infections are quite successful for all the joints. The arthroscopy of a small joint is technically quite demanding; therefore, it should be practised only by a few specialized centres.
这些关节可以通过关节镜检查来进行评估,尽管技术要求较高。最重要的是,对病变的评估并不简单。关节镜检查始终是最后的诊断选择。取出游离碎片、清创、修整以及治疗感染都是很好的适应证。采用关节镜手术方法有利于术后康复且康复时间会缩短。在过去几年中,肘关节镜检查发展并不显著。创伤后情况、游离体和软骨损伤是主要适应证。然而,踝关节和腕关节的关节镜检查正在增加。腕关节的腕骨不稳定和盘状问题很值得关注。最近,内镜下腕管减压术已得到推广,但仍处于实验阶段。在踝关节,关节镜下切除或重建剥脱性骨软骨炎、片状骨折和纤维化皱襞(大多在运动员中通过关节镜检查发现)是可行的。胫骨前缘的干扰性骨赘也可以通过关节镜切除。踝关节的经皮内固定和融合术首先需要在长期随访中进行评估。对于所有关节,关节镜下清创和冲洗治疗感染都相当成功。小关节的关节镜检查在技术上要求很高;因此,应该只由少数专业中心进行操作。