【摘要】：目的：評估改進的踝關節(jié)后方“共軸入路”的安全性和可操作性。類型：解剖研究和臨床應用。方法：20具防腐冷凍踝關節(jié)標本平分為兩組；用克氏針在其中一組建立文獻報道的“共軸入路”、傳統(tǒng)后方入路和改進的踝關節(jié)后方“共軸入路”；另一組分別在距離外踝尖端近側1.5cm高度水平2.5cm建立改進的“共軸入路”。測量克氏針與踝關節(jié)后室重要解剖結構的距離。使用2.7mm，，30°關節(jié)鏡在5具新鮮標本上模擬實際手術建立改進的踝關節(jié)后方“共軸入路”。臨床應用于3例病例(4個踝關節(jié))。結果：改進的“共軸入路”與小隱靜脈、足拇長屈肌腱和脛神經的距離分別是22.07mm、5.39mm和6.27mm；原“共軸入路”與小隱靜脈、足拇長屈肌腱和脛神經的距離分別是8.54mm、3.62mm和4.40mm。不同高度的“共軸入路”的靜態(tài)安全性接近。測量數(shù)值經統(tǒng)計學分析得出：改進的踝關節(jié)后方“共軸入路”同其它后方入路相比，器械距離踝關節(jié)后方重要解剖結構是最大的。通過模擬手術過程，確定足拇長屈肌腱和足趾長屈肌腱為踝關節(jié)鏡操作的安全性“內標志”。無神經血管的穿破和觸碰。臨床病例平均5個月隨訪未見并發(fā)癥。結論：與原“共軸入路”相比，改進后的踝關節(jié)后方“共軸入路”具有安全性更高、操作更簡單和易重復的優(yōu)勢。
[Abstract]:Objective: to evaluate the safety and maneuverability of the modified posterior ankle coaxial approach. Type: anatomical study and clinical application. Methods: 20 antiseptic frozen ankle joint specimens were divided into two groups: "coaxial approach", traditional posterior approach and modified posterior "coaxial approach" with Kirschner needle. In another group, the improved "coaxial approach" was established at the height of 1.5cm at the proximal lateral malleolus. The distance between Kirschner's needle and the important anatomical structure of the posterior chamber of ankle joint was measured. The modified posterior "coaxial approach" of ankle joint was established by using 2.7 mm 30 擄arthroscope on 5 fresh specimens simulated by actual operation. Clinical application was performed in 3 cases (4 ankle joints). Results: the distance between the improved "coaxial approach" and small saphenous vein, flexor pollicis longus tendon and tibial nerve was 22.07 mm 5.39 mm and 6.27 mm respectively, and the distance between the original "coaxial approach" and small saphenous vein, flexor pollicis longus tendon and tibial nerve was 8.54 mm ~ 3.62 mm and 4.40 mm respectively. The static security of different heights of the "coaxial approach" is close. The results of statistical analysis show that the modified posterior "coaxial approach" is the most important anatomic structure in the posterior of ankle joint compared with other posterior approaches. The flexor pollicis longus tendon and flexor digitorum longus tendon were determined to be the internal marks of ankle arthroscopic operation. No piercing or touching of nerve and blood vessels. The clinical cases were followed up for an average of 5 months without complications. Conclusion: compared with the original "coaxial approach", the improved posterior "coaxial approach" has the advantages of higher safety, simpler operation and easier repetition.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2005
【分類號】：R322;R687.3

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