Dirsek Artroskopisi
Özet
Dirsek anatomisinin anlaşılması ve teknik ilerlemeler, debridman, sinovektomi, serbest cisim çıkarma ve lateral epikondilit gevşetmesi gibi geniş endikasyonları olan dirsek artroskopisinin gelişimini hızlandırmıştır. Cerrahi öncesinde travma öyküsü, kilitlenme, hareket açıklığı ve detaylı nörovasküler durum muayene ve radyografiler, MRG gibi yöntemlerle dikkatlice değerlendirilmelidir. Operasyon sırasında standart 4.0 mm veya 2.7 mm artroskoplar ile nörovasküler yapıları koruyan künt uçlu kanül sistemleri tercih edilir. Hastalar supin, sırt üstü asılı, pron veya en sık tercih edilen lateral dekübit pozisyonlarında ameliyat edilebilir. Müdahale ve görüntüleme amacıyla lateral, proksimal-medial, anterolateral, anteromedial, posterolateral ve posterior olmak üzere farklı anatomik portaller kullanılır. Cerrahi teknikte komplikasyon riskini azaltmak için portal açılmadan önce eklem kapsülünün şişirilmesi ve dirseğin 90° fleksiyona getirilmesi kritik öneme sahiptir. En önemli komplikasyonlar arasında geçici veya kalıcı nörovasküler yaralanmalar, hareket kaybı ve enfeksiyon yer almaktadır. Günümüzde kuru artroskopi, pediatrik vakalar ve lateral kollateral ligaman onarımı gibi yenilikçi alanlara odaklanan bu yöntem, teknolojik gelişmeler, yapay zeka ve robotik cerrahi entegrasyonu sayesinde gelecekte iyileşme sürelerini daha da kısaltarak açık cerrahiye oranla daha fazla tercih edilen güvenli bir prosedür haline gelmektedir.
Advances in elbow anatomy and techniques have accelerated the development of elbow arthroscopy, which has broad indications such as debridement, synovectomy, loose body removal, and lateral epicondylitis release. Prior to surgery, trauma history, locking, range of motion, and detailed neurovascular status must be carefully evaluated using physical examination and radiological modalities like radiographs and MRI. During the operation, standard 4.0 mm or 2.7 mm arthroscopes and blunt-tipped cannula systems that protect neurovascular structures are preferred. Patients can be operated on in supine, suspended supine, prone, or the most commonly used lateral decubitus positions. Different anatomical portals, including lateral, proximal-medial, anterolateral, anteromedial, posterolateral, and posterior, are utilized for intervention and visualization. In the surgical technique, inflating the joint capsule before establishing portals and bringing the elbow to 90° of flexion are critical to reduce the risk of complications. The most significant complications include transient or permanent neurovascular injuries, loss of motion, and infection. Today, this method focuses on innovative areas such as dry arthroscopy, pediatric cases, and lateral collateral ligament repair; and with the integration of technological advancements, artificial intelligence, and robotic surgery, it will continue to be a more preferred, safe procedure that shortens recovery times compared to open surgery.
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