The axillary pouch portal: a new posterior portal for visualization and instrumentation in the inferior glenohumeral recess.
The axillary pouch portal: a new posterior portal for visualization and instrumentation in the inferior glenohumeral recess.
复制标题
腋窝入口：一个新的后入口，用于在盂肱下隐窝中进行可视化和器械操作。
DOI：
10.1016/j.arthro.2006.12.016
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
J. D. de Beer
中科院分区：
文献类型：
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作者：
Deepak N. Bhatia;J. D. de Beer
关节镜下进入盂肱下隐窝在一些肩部手术中是必要的。用于进入该区域的后下入路可能对后部神经血管结构（由外向内技术）和关节软骨（由内向外技术）构成理论风险。第一作者（D.N.B.）设计了一种新的后部入路，允许直接进入整个下盂肱隐窝。与先前描述的入路相比，入路位置更高，更靠外侧;这使其远离后部神经血管结构，便于线性进入腋窝。通过由外向内技术创建入路，使用脊柱穿刺针确定正确的入路位置和角度。入路位于肩峰后外侧角下缘正下方平均20.45 ± 4.9 mm（范围15 - 35 mm）处，位于后观察入路外侧21.3 ± 2 mm（范围20 - 25 mm）处。脊柱穿刺针或套管在轴向平面内的角度平均为30.6° ± 4.7°（范围：25°至40°），略偏于内侧（平均2°;范围：20°以上至20°以下）。使用30°和70°关节镜通过腋窝入路，便于观察整个隐窝和下盂肱韧带复合体的肱骨附着，以评价盂肱韧带损伤的肱骨撕脱。该入路还允许与标准后或前上观察入路结合使用器械，以清除游离体、滑膜切除术、囊收缩术、囊切开术和后下关节盂边缘中的锚放置。
Arthroscopic access to the inferior glenohumeral recess is necessary in several surgical procedures on the shoulder. Posteroinferior portals described for access to this region may pose a theoretic risk to the posterior neurovascular structures (outside-in technique) and to the articular cartilage (inside-out technique). The first author (D.N.B.) has devised a new posterior portal that permits direct linear access to the entire inferior glenohumeral recess. The portal is placed higher and more lateral compared with the previously described portals; this places it further away from the posterior neurovascular structures and facilitates linear access to the axillary pouch. The portal is created via an outside-inside technique, with a spinal needle to ascertain the correct portal site and angulation. The portal is placed at a mean distance of 20.45 ± 4.9 mm (range, 15 to 35 mm) directly inferior to the lower border of the posterolateral acromial angle and 21.3 ± 2 mm (range, 20 to 25 mm) lateral to the posterior viewing portal. The spinal needle or cannula is angulated medially at a mean of 30.6° ± 4.7° (range, 25° to 40°) in the axial plane and slightly inferiorly (mean, 2°; range, 20° superiorly to 20° inferiorly). Use of 30° and 70° arthroscopes through the axillary pouch portal facilitates visualization of the entire recess and of the humeral attachment of the inferior glenohumeral ligament complex for evaluation of humeral avulsion of the glenohumeral ligament lesions. The portal also permits instrumentation in combination with the standard posterior or anterosuperior viewing portal for removal of loose bodies, synovectomy, capsular shrinkage, capsulotomy, and anchor placement in the posteroinferior glenoid rim.