近指间关节关节镜手术的应用解剖学研究

Applied anatomy of arthroscopic surgery for proximal interphalangeal joints

目的研究人体近指间关节的解剖结构特点，探索关节镜的手术入路和术中牵引力，为近指间关节关节镜手术的开展提供解剖学基础。方法对5具国人新鲜尸体示、中、环、小指共40个近指间关节及10个拇指指间关节标本进行解剖学研究，找出合适的关节镜入路和术中牵引力。利用2个废弃指进行临床手术模拟实验研究。结果选择近指间关节的桡背侧或尺背侧作为关节镜的入路，以3．0k的牵引力最为合适。在手术模拟实验中，成功置入1．9mm的关节镜并清晰地观察到关节内各个结构。结论近指间关节关节镜手术用于明确关节内病变的诊断和辅助治疗是可行的。

Objective To provide the anatomical basis for arthroscopic surgery of the proximal interphalangeal （PIP） joints by studying the anatomical fcatures of human PIP joints, exploring suitable approaches and portals into the PIP joint and identifying the proper traction force. Methods Forty PIP joints of the 2 to 4 fingers and 10 interphalangeal joints of the thumb from five fresh cadavers were dissected. The portals for arthrescopo insertion and the traction forces for proper exposure were identified. Arthroscopic surgery of the PIP joint was simulated using two severed fingers that were uusalvagcable. Results The dorsoradial side and dorsoulnar side are the suitable arthroscopic portals into the PIP joints. The optimal traction force was 3.0 kg. In the surgical simulation arthrescope with 1.9 nan diameter was successfully inserted into the joint cavity and the structures of the joint were clearly visualized. Conclusion Arthrescopic surgery of the PIP joints is feasible for diagnosis and treatment of joint diseases.