| Objective : The article aims to dissection of the field of vision for analysis of elbow joint arthroscope approach by 30° and 70° arthroscopes respectively,and select the optimal angle of elbow flexion in each approach at the effective time(with good vision,easy to introduce,operation flexibility),so as to application to provide experimental anatomical basis of elbow joint arthroscopic surgery in clinics.Methods :(1)Frozen frozen elbow specimens were thawed.(2)Mark and fixed position:carefully touching the bony anatomical marks of body surface,the inside axes and the outside axes of upper arm and front arm,the olecranon of ulna,the medial epicondyle of humerus,the external epicondyle of humerus and so on were respectively marked,the unfreeze elbow joint specimens were fixed on the outer frame in a prone position.(3)Establishing the approach points:Accurately measure and mark the pathways required for elbow arthrography by means of a vernier caliper.(4)Establishing a channel:The direct lateral portal was injectde of 20 ml water was used to expand the elbow joint cavity.An incision about 3-4mm under the skin was made on the proximal anteromedial portal point.Then the subcutaneous soft tissues were separated with straight clamp.The lumbar puncture needle was advanced to the center of elbow joint,after water flowed out,the lumbar puncture needle was pulled out and the puncture of the puncture awl into the center of elbow joint was followed,finally,the puncture awl with sheath penetrated into the elbow joint cavity and left inside the elbow joint.With sheath stabilized,the puncture awl could be pulled out,after water flowed out,30° and 70° arthroscopes of 4.0 mm were separately inserted into elbow joint.During the whole process,3L normal saline bags were hung at about 3 meters height for holding the pressure.the anteromedial portal,the proximal anterolateral portal,the anterolateral portal,the front superolateral portal,the lateral vertical portal,the direct lateral portal,the direct posterori portal,the posterolateral portal could be established by establishing the proximal anteriormedal portal,while the related data could also be collected and recorded.Based on this,we explored the new approaches and recorded the relevant data.(5)Observeing the measurement:The effective time(with good vision,easy to introduce,operation flexibility)was observed through 30° and 70° arthroscopes by constantly flexing the elbow joint,and the optimal angle of elbow flexion was then measured at this effective time.When the elbow flexion position was maintained by a assistant,we collected the related data with 320° angle measuring device(precise to 1°)and recorded the imaging information.SPSS19.0 statistical software for data analysis,the data using the mean ± standard deviation(? ± s).Results : With the elbow joint flexed to 82.90±2.38°,84.80±5.41°,84.90±2.47° and 81.20±3.46° respectively,we were observed the anatomical structures inside the elbow joint cavity which were separately located at the opposite side of the proximal anteromedial portal,the anteromedial portal,the anterolateral portal and the lateral vertical portal by the 70° arthroscope from these corresponding approaches,it was found that,from those approaches,the arthroscope has excellent vision and flexible operation,and also can be easily introduced.With the elbow joint flexed to 82.90±4.46° and 79.40±2.46° respectively,we were observed the anatomical structures inside the elbow joint cavity which were separately located at the opposite side of the proximal anterolateral portal and the front superolateral portal by the 30° arthroscope from the corresponding approaches,it also was found that,from those approaches,the arthroscope has excellent vision and flexible operation,and also can be easily introduced.With the elbow joint flexed to 71.00±5.14°,61.10±3.70° and 64.30±2.67° respectively,we were observed the anatomical structures inside the elbow joint cavity which were separately located at the opposite side of the direct lateral portal,the direct posterori portal and the posterolateral portal by the 70° arthroscope from these corresponding approaches,it was found that,from those approaches,the arthroscopes also have excellent vision and flexible operation and also can be easily introduced.The special portal: the olecranon fossa was punctured from the direct posterori portal and establishing a bone tunnel size of about 5-6mm was drilled into olecranon fossa by using the abrasion drill;arthroscopy through the bone tunnel into the coronoid fossa.Under the 70° arthroscope,the front joint capsule,the partial capitulum radii,the coronoid process,the trochlea humeri and most trochlea humeri surfaces in the elbow joint cavity can be observed.Under the 30° arthroscope,the front joint capsule,the partial capitulum radii,the coronoid process and the trochlea humeri in the elbow joint cavity can be observed.Conclusion : 1.the proximal anteromedial portal is effective to observe the inside of elbow joint cavity from the proximal anteromedial approach by using the 70° arthroscope when the elbow joint is flexed to 82.90±2.38 °,the proximal anteromedial approach can be used as the first arthroscope entrance point.2.the proximal anterolateral portal is effective to observe the inside of elbow joint cavity from the proximal anterolateral approach by using the 30° arthroscope when the elbow joint is flexed to 82.90±4.46°.3.Elbow arthroscopy a single portal can not fully observe the entire elbow joint cavity,the need to establish a number of joint approach,including: the direct posterori portal,the proximal anterolateral portal,the direct lateral portal and the proximal anteromedial portal.4.the special approach: the olecranon fossa was punctured from the posterior middle approach to connect with fossa coronoidea by using the abrasion drill;this approach is Safe and effective.It can be used for patients having a need for ulnar nerve displacement or patients with limited approaches.5.Applying 70° arthroscopy to observe the structure of the elbow joint cavity is better,but it is necessary to explore all round with appropriate rotation and flexion,and easy to understand the anatomical structure in the inside of the elbow joint cavity reduce the blind area of the arthroscope. |
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