Study On The Safe Of Portal Anatomy And Portal Choice Of Elbow Arthroscopy

Objective:Arthroscopic surgery is a very important in the sports medicine.As development of the technology,the arthroscopy and joint replacement have become the major progress in the orthopaedic of the 20th century. Around the joint of elbow there are important vessels and nerves, So when using elbow arthroscopy surgical portal should pass the complex anatomical structure is dangerous.and the complex of the elbow joint articular cavity which restricted the elbow arthroscopic surgery,thereby limiting the development of the elbow arthroscopic.So it is important to choice safe portal and the flexibility of operation.There are 9 portals applied to elbow arthroscopy, Consider the anatomic of the elbow joint the proximal anterolateral,anterolateral, anterosuperior lateral,the proximal medial and anteromedial portal is dangerous. Meanwhile the anterolateral portal has different location;one (anterolateral A) is 3cm distal and 1 cm anterior to the lateral epicondyle and second (anterolateral B) is 1cm distal and 1 cm anterior to the lateral epicondyle.but what is more safer is no last word.In order to find the safest portals we measured the distance from common arthroscopy portals to the nearst nerves into 10 cadavers elbows with formalin soaked in every portals.We can apply these conclusions to the clinic. Methods:10 adult cadaver elbows with formalin soaked and which without deformities and had never undergone surgery were used.At one time we apply a suit of standard arthroscopy,dissector and vernier caliper(accurate to 1 mm).Before operation we use gentian violet mark the anatomical marks and the portals,the joint was distended with 20-30ml saline.Then 3mm incisions were made in the skin,and a curved hemostat was used to deepen the portals through the subcutaneous tissue plane, and puncture through the central of the elbow joint. The saline is 2m high to keep the pressure during the experiment.The proximal anterolateral portal was standard established first. After the all portals were finished,the elbow specimen was dissection,all skin and subcutaneous tissue was removed from the midarm to the mid-forearm.The ulnar,median and radial nerves and brachial artery were then traced fom the midarm to the mid-forearm.Then the cannulas and arthroscopy was inserted into the cadaver elbow joint in every acess portals.The closest distances from the cannulas to the involved neurologic were measured with vernier caliper to the nearest 1mm when the elbow joint flexed to 900 and extension, then compare the safe of each portal.Consider the anatomic of the elbow joint we major measure the proximal anterolateral,anterolateral A,anterolateral B and anterosuperior lateral portal distances from the radial nerve,the proximal medial and anteromedial portal distances from ulnar and median nerves. Result:The distance from nervs to portals are concretely summarized in the Tables. The distance from the proximal medial portal to medial never is (9.6±2.36mm) when the elbows were extend to 0°and (13.4±2.63mm) when the elbows were flexed to 90°; The distance from the anteromedial portal to medial never is (6.8±1.93mm) when the elbows were extend to 0° and (10.4±2.22mm) when the elbows were flexed to 90°; The distance from the proximal medial portal to ulnar never is (11.7±2.58mm) when the elbows were extend to 0°and (15.4±2.63mm) when the elbows were flexed to 90°; The distance from the anteromedial portal to ulnar never is (17.4±1.64mm) when the elbows were extend to 0°and(21.6±1.57mm) when the elbows were flexed to 90°; The distance from the proximal lateral portal to radial never is (7.0±1.69mm) when the elbows were extend to 0°and (10.2±1.61mm) when the elbows were flexed to 90°; The distance from the anterolateral portal A to radial never is (2.6±1.07mm) when the elbows were extend to 0°and (5.6±2.06mm) when the elbows were flexed to 90°; The distance from the anterolateral portal B to radial never is (3.4±1.35mm) when the elbows were extend to 0°and (7.8±2.25mm) when the elbows were flexed to 90°;The distance from the anterosuperior lateral portal to radial never is (5.1±1.66mm) when the elbows were extend to 0°and (8.1±1.85mm) when the elbows were flexed to 90°; Coclusion: ?The anterolateral portal is the nearest to the radial nerve and is dangerous to operate. The anterolateral portal B (1cm distal and 1 cm anterior to the lateral epicondyle) is safer than A(3cm distal and 1 cm anterior to the lateral epicondyle),we advise choose B.?The proximal medial portal is the safest portal of the medial portals because the distance from the ulnar and median nerve is the farthest.?The proximal lateral portal is the safest portal of the lateral portals because the distance from the radial nerve is the farthest.?The elbow joint flexed to 900 is safer than extension.?The proximal medial portal is better than the proximal lateral portal when we start the elbow arthroscopy.