训练用单针/双针带线【出售】-->外科训练模块总目录
0.5、1、2、3.5、5mm仿生血管仿生体 - 胸腹一体式腹腔镜模拟训练器
仿气腹/半球形腹腔镜模拟训练器
[单端多孔折叠]腹腔镜模拟训练器
「训练教具器械汇总」管理员微信/QQ12087382[问题反馈]
开启左侧

[骨外] 单孔关节镜(SPA) - 史赛克平行门式套管 - 关节镜膝关节手术

[复制链接]
发表于 2018-1-12 19:04:03 | 显示全部楼层 |阅读模式
 楼主| 发表于 2018-1-12 19:04:26 | 显示全部楼层

                               
登录/注册后可看大图

Single-portal arthroscopy has been most useful with the treatment of knee pathology such as meniscus tears, chondral lesions, plicas and loose bodies. It is a targeted surgical approach for limited pathology, but can be used to access all regions of knee joint and treat more than one lesion in different compartments of the same knee, just like 2 or 3 portal techniques. As with all arthroscopic knee surgery it is easier in knees without post-surgical scaring and more difficult in obese knees.

In this case, the MRI of the sagittal view of the knee shows a flipped lateral meniscus and posterior horn flap tear. This type of pathology is ideally suited for single-portal arthroscopy.

The patient positioning is supine on the operating table with the thigh held in a commercially available holder and with the end of the table flexed. A positioning assistant is used to apply the necessary knee stress to allow surgical access and instrument passage. Under tourniquet control a standard 11 blade scalpel is used to make a 9 to 10mm transfers medial infrapatellar portal incision at a level midway between the distal pole of the patella and  the tibial joint line. It is important for the surgeon to carefully palpate the bony landmarks in order to accurately place the portal incision.

The scalpel should penetrate the joint and should be used to ensure adequate opening into the joint. A kelly clamp or hemostat is used to gentle dilate this opening. Using a Stryker Blunt Obturator the 4.6mm Arthroscope Cannula is preloaded with the desired Stryker Parallel Portal Cannula, which is available in three lengths: 0mm, 25mm and 55mm.

The arthroscope cannula is gentle inserted into the intercondylar region of the knee and then swung into the suprapatellar pouch as the knee is extended. The new high-definition 2.9mm Stryker arthroscope is inserted and the knee is distended using a fully integrated fluid pump.

The 4.6mm cannula with the 2.9mm Stryker Arthroscope provides similar fluid flow as previously used 5.8mm cannulas with 4.0mm Stryker arthroscopes. The 2.9mm Stryker arthroscope is optically optimized to present a crisp image with on screen size equivalent to the 4.0mm Stryker arthroscope.

A diagnostic tour of the knee is now performed. After repositioning the arthroscope to visualize an area of pathology such as a meniscus tear, appropriate knee stress is applied by the assistant. The Stryker Parallel Portal Cannula is advanced on the axis of the arthroscope cannula to the desired depth and rotation. It is desirable to have the parallel portal plastic hub in direct contact with the skin when the arthroscope is in the ideal viewing position.

Using the parallel portal cannula a probe may be used to further evaluate pathology. Once the meniscus tear is well visualized, working instruments including hand-held biters and powered cutters may be inserted directly into the filed of view without any need for triangulation.

This passage method eliminates the possibility of damaging the end of the arthroscope with working instruments. The parallel portal cannula is sealed with a slotted rubber diagram to prevent fluid outflow. In order to obtain optimal instrument trajectory the parallel portal can be unlocked and rotated on the axis of the arthroscope cannula. When in the desired position it is then locked again.

For the first time in the history of arthroscopic surgery this new technique allows for the surgeon to rest the weight of the scope and camera against the skin at the desired depth. This prevents pushing the leading edge of the arthroscope cannula forward and into the femoral chondyle while working. These improvements compared to traditional arthroscopic triangulation should reduce the technical demands on the surgeon.

Once the procedure is completed the fluid can be drained from the knee. The small 1cm incision can simply be glued together without sutures or staples. The patient activity is restricted and knee flexion is limited to 90° for the first 2 weeks to allow for complete portal healing.
您需要登录后才可以回帖 登录 | 注册

本版积分规则

丁香叶与你快乐分享

微信公众号

管理员微信

服务时间:8:30-21:30

站长微信/QQ

← 微信/微信群

← QQ

Copyright © 2013-2024 丁香叶 Powered by dxye.com  手机版 
快速回复 返回列表 返回顶部