Ellenbogenarthroskopie: Zugänge, Anatomie, Komplikationen

Zusammenfassung

Die Ellenbogenarthroskopie hat sich zu einem sicheren und wichtigen Verfahren zur Diagnostik und Therapie von Ellenbogenpathologien entwickelt. Zu den etablierten Indikationen gehören die diagnostische Arthroskopie, die Entfernung freier Gelenkkörper, die Osteophytenabtragung, die Synovektomie, die Behandlung der Osteochondrosis dissecans und die Arthrolyse bei Kontrakturen des Ellenbogens. Aufgrund der Nähe der neurovaskulären Strukturen zu den Zugangsportalen sind eine genaue Kenntnis der Anatomie und arthroskopische Erfahrung notwendig. Die Lagerung, Markierung der Landmarken und die korrekte Platzierung der Zugänge sind Voraussetzung, um eine zielgerichtete, schnelle und komplikationsarme Operation durchführen zu können. Die Komplikationsrate ist verglichen mit Knie- oder Schulterarthroskopien höher und liegt insgesamt bei ca. 10 %. Die gefürchteten Nervenläsionen sind meistens transient, treten sie aber permanent auf, haben sie weitreichende Folgen für die Patienten.

Abstract

Arthroscopy of the elbow has become a safe and reliable procedure for the diagnosis of and therapy for elbow disorders. Established indications include diagnostic arthroscopy, removal of loose bodies, removal of osteophytes, synovectomy, treatment of osteochondritis dissecans and capsular release. Especially the anatomic vicinity of the neurovascular structures to the portals requires a thorough knowledge of elbow anatomy and some experience with the procedure. The exact positioning of the patient, identification of the landmarks and knowledge of the correct portal placement are necessary to perform a safe and effective operation and to avoid complications. The overall complication rate with 10 % is higher when compared to knee or shoulder arthroscopy. Nerve lesions are transient most of the time; however, when permanent they cause substantial problems for the patient.

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