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内側肘の露出。5つのアプローチの解剖学的比較
Medial Elbow Exposure: An Anatomic Comparison of Five Approaches.
PMID: 32650084 DOI: 10.1016/j.jse.2020.06.031.
抄録
目的:
肘の内側へのいくつかの外科的アプローチが記載されていますが、関連する肘の内側構造の最適なビューを提供する露出は不明のままです。この解剖学的研究の目的は、肘内側への5つのアプローチを通じて、冠状突起、上腕骨遠位部、橈骨頭の可視表面積を決定することでした。
PURPOSE: Several surgical approaches to the medial elbow are described, however it remains unclear which exposure provides the optimal view of relevant medial elbow structures. The purpose of this anatomic study was to determine the visible surface area of the coronoid process, distal humerus and radial head through five approaches to the medial elbow.
方法:
METHODS: Eight fresh frozen cadaveric upper extremity specimens were dissected. Five surgical approaches were performed on each specimen. The Smith muscle splitting approach to the ulnar collateral ligament was performed first (Smith), followed by the Hotchkiss medial "Over the Top" approach (Hotchkiss), the extended medial elbow approach (EMEA), the flexor carpi ulnaris splitting approach (FCU-Split), and the Taylor and Scham approach (T&S). Bony visualization was determined using laser surface scanning (Artec Space Spider, Artec 3D, Santa Clara, CA, USA). The scans were segmented using commercially available digital software (Geomagic Wrap, 3D Systems Corporation, Rock Hill, SC, USA) and the surface area visualized was determined. A descriptive analysis of the joint areas visible using the medial collateral ligament (MCL) as a clinical landmark was performed.
結果:
EMEAは肘関節全体の15±4%にあたる13.9±6.0cmを内側から可視化した。また、冠状骨（表面積3.2±1.7cm、または26±9%）と上腕骨遠位部（9.9±4.3cm、または15±4%）の最高の可視化を提供した。Hotchkiss法は橈骨頭の可視化に最も優れていた（0.8±0.3cm、7±3%）。EMEA、Hotchkiss、Smithでは主にMCLの前方束とその挿入部、およびその前方領域を示し、FCU-SplitではMCLの前方束とその前方および後方領域を示した。T&Sでは主にMCLの前部束よりも後方の領域を示した。
RESULTS: The EMEA visualized the highest proportion of the total elbow joint from the medial side showing 13.9±6.0cm, or 15±4% of the joint. It also provided the best visualization of the coronoid (3.2±1.7cm of surface area, or 26±9%) and distal humerus (9.9±4.3cm, or 15±4%). The Hotchkiss approach was best at visualizing the radial head (0.8±0.3cm, or 7±3%). The EMEA, Hotchkiss and Smith showed primarily the anterior bundle of the MCL, its insertion, and the regions anterior to it while the FCU-Split showed the anterior bundle of the MCL and regions both anterior and posterior to it. The T&S showed primarily the areas posterior to the anterior bundle of the MCL; the regions anteriorly were not visible. The FCU-Split and the T&S allowed visualization of the posterior bundle of the MCL. Intraobserver reliability was ICC, 0.997, ICC, 0.992 and ICC, 0.974 for the test distal humerus, test coronoid and test radial head, respectively. Interobserver reliability was ICC, 0.915 for the test distal humerus, ICC, 0.66 for the coronoid, and ICC, 0.583 for the radial head.
結論:
CONCLUSION: The EMEA provides the most visualization of the coronoid and distal humerus while the Hotchkiss showed the most radial head. However, these approaches mainly visualize structures anterior to the MCL. If exposure of structures posterior to the MCL are required, the FCU-split or T&S approaches are more appropriate.
Copyright © 2020. Published by Elsevier Inc.