| Objective: To study the establishment method and application of the new approach from olecranon fossa to coronoid fossa based on the 9 clinically common approaches of arthroscopy of elbow and the Outerbridge-Kashiwagi method,discuss the anatomical safety and reliability of the new approach,and at the same time discuss the observability and operability while operating the arthroscopy through the new approach.Method: a.10 adult elbow joint specimens(right elbows,6 of male and 4 of female)preserved by anti-corrosion preservation were studied.The morphological structure of olecranon fossa and coronoid fossa were studied from the perspective of applied anatomy to determine the size,position,direction and safety of the approached bone tunnel to be established;b.10 frozen fresh adult elbow joint specimens(right elbows,7 of male and 3 of female)were applied to the practical operation of the arthroscopy of elbow.Based on the measured angle of bone tunnel,the new approach of arthroscopy of elbow was established under the monitoring of the arthroscope from olecranon fossa to coronoid fossa,and the position and direction of the bone tunnel were explored again according to the Xray iconography system after the establishment of the tunnel;the observability(observation scope and convenience)and operability(operation scope and convenience)were explored through practical operation of specimens with the arthroscope;the effects of some relevant applications were studied as well.SPSS19.0 statistical software was employed for data analysis,and variance analysis was employed for material analysis.The data was represented in the form of mean±standard deviation(x±s).When the P value was smaller than 0.01,the results had statistical significance.Results: the diameter size of olecranon fossa(23.37±2.01)mm,olecranon fossa of longitudinal diameter size of(18.80±1.65)mm,the depth of the olecranon fossa is(12.83±1.76)mm,chick to the olecranon fossa low(14.28±1.08)mm,chick to the olecranon fossa bone of fixedpoint distance(19.28±1.08)mm,the shortest distance to the internal epicondyle olecranon fossa edge for(16.45±0.55)mm,olecranon fossa edge to the external condyle of the shortest distance for(18.90±1.05)mm olecranon fossa lows the shortest distance to the ulnar nerve is(16.04±1.04)mm,coronoid process of the transverse diameter of size(12.95±1.43)mm,coronoid process of the longitudinal diameter of size(14.05±1.61)mm,the depth of the coronoid process nest for(4.56±0.64)mm,coronoid process nest inside edge to epicondyle of shortest distance(21.11±1.15)mm,coronoid process nest edge to the external condyle of the shortest distance(24.28±1.01)mm;Elbow straight 0 °,coronoid process nest to the radial nerve for a horizontal distance of at least(16.90±0.54)mm,coronoid process nest to the minimum horizontal distance of the median nerve(4.04±0.36)mm,coronoid process nest to the median nerve for a vertical distance of at least(20.80±0.64)mm,coronoid process nest to brachial blood group of the minimum horizontal distance of 0.00 mm,coronoid process nest to brachial blood group for a vertical distance of at least(20.44±0.66)mm;New bone into the road and sagittal position to shaft of humerus into Angle for(17.50 ±3.63)°,new bone into the road and coronary position to shaft of humerus into Angle for(77.42 ± 3.07)°;Bone after the construction of the road,X-ray radiography testing new bone into the road and sagittal position to shaft of humerus into Angle for(23.38±2.77)°,new bone into the road and coronary a bit to shaft of humerus into Angle for(80.95± 3.95)°;30 ° elbow joint activities in all directions,before arthroscopy the proximal medial approach can be observed that most of the coronoid process,most of the radial capitulum,part of the humerus feet joint surface,most of the humerus oar joint surface,most of the coronoid process nest,partial medial joint capsule,part of the lateral joint capsule,most of the joint capsule,in front of 30 ° arthroscopy anterolateral approach to the proximal can be observed that the vast majority of the coronoid process,most of the radial capitulum,most of the humerus feet joint,most of the humerus oar joint surface,for the most part,part of the medial coronoid process nest joint capsule,part of the lateral joint capsule,most of the joint capsule,in front of 30 ° arthroscopy by bone passage diameter of 7.00 mm can be observed in part of the coronoid process new approach,a small percentage of radial capitulum,part of the humerus feet joint surface,a small number of humerus oar joint surface,for the most part in front of the joint capsule,30 ° arthroscopy by bone passage diameter of 8.50 mm can be observed in most of the coronoid process,a new approach of radial capitulum,parts of humerus feet joint surface,part of the humerus oar joint surface,all in front of the joint capsule,30 ° arthroscopy by bone passage diameter of 10.00 mm can be observed in most of the new approach of coronoid process,most of the radial capitulum,most of the humerus feet joint surface,most of the humerus oar joint surface,all in front of the joint capsule;When new road as operation into the road,the activities of elbows in all directions,planing machine by the diameter of 7.00 mm of new bone on the part of the coronoid process,can be part of the humerus feet joint surface,most of the front of the joint capsule,planing machine by the diameter of 8.50 mm of new bone for most of the coronoid process,can be a small number of radial capitulum,part of the humerus feet joint surface,a small number of humerus oar joint surface,most of the front of the joint capsule,planing machine by bone passage diameter of 10.00 mm of the new approach can be part of the coronoid process,and the most of radial capitulum,part of the humerus feet joint surface,part of the humerus oar joint surface,nearly all operated in front of the joint capsule;2 cases of elbow joint rigidity,before the trial for(38.00±11.31)° elbow straight Angle,buckling Angle(101.00±12.72)°,the experimental set up new road and in regard to the 7.00 mm bone of elbow arthroscopy release,for(15.50±7.79)° elbow straight Angle,buckling Angle(133.50±10.61)°,the experiment set up 8.50 mm line way new to elbow after release,is:(13.50 ± 13.50)° elbow straight Angle,buckling Angle(137.50±4.95)°,the experiment set up 10.00 mm line way new to elbow after release,is:(13.00 ±13.00)° elbow straight Angle,buckling Angle(144.50±4.95)°,because it's less samples,before and after the experiment of the elbow straight,than flexion mobility is statistical significance is not big.Conclusion: 1.The new approach had little influence on the stability of elbow joint,and had fair safety;2.The new approach of elbow arthroscope from olecranon fossa to coronoid fossa started from the post-middle approach;a stable angle was formed between the bone tunnel of the new approach and the humerus vertical plane and coronal plane.The maximum diameter of the bone tunnel should not be larger than the minimum diameter of the olecranon fossa to ensure the stability of the bony structure;3.When the new approach was used for observation,there was a good view for the articular cavities backward and forward,and it was better for viewing the front joint capsule.For the observation of coronoid process and capitulum radii,the new approach was not ideal enough compared with the near front inside approach and near front outside approach;4.When the new approach was used for operation,effective operation could be conducted at the articular cavities backward and forward,and better at the front as the approach enabled sufficient operation of coronoid process,which other approaches failed to do;but for the operation of capitulum radii,the new approach was not ideal enough compared with the near front inside approach and near front outside approach;5.After the bone tunnel of the new approach was established and the elbow joint was released with the arthroscope,the ankylosis of elbow species might be relieved to some extent. |
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