広範囲鏡視による手関節痛の病態把握―橈骨－手根関節に対する掌背側鏡視＋手根中央関節，遠位橈尺関節に対する背側鏡視

An Analysis of Wrist Pain with Broad Wrist Arthroscopy : Dorsal and Volar Approaches for Radiocarpal Joint Combined with a Dorsal Approach for the Midcarpal Joint and Distal Radioulnar Joint

　抄録：手関節鏡は1980年代後半よりめざましい進歩をとげ，現在では手関節痛の診断，治療においてgold standardな手技とまでいわれるようになった．従来そのアプローチは背側からの橈骨手根関節の鏡視が主体であったが，われわれは掌側鏡視，手根中央関節および遠位橈尺関節への背側鏡視を行い，広く手関節内を鏡視し手関節痛の病態把握に努めてきた．これにより，特に慢性手関節痛を主体として様々な病態が把握できた．注意すべき点は症状と関連しない鏡視上の異常所見，いわゆる偽陽性所見であり，繊細かつ詳細な理学所見の採取と鏡視所見との対比の重要性を強調した．

　Wrist arthroscopy has been developed as a major diagnostic and therapeutic procedure. The standard arthroscopic portals are on the dorsal side of the radiocarpal joint. However, multiple portals are often needed to evaluate and treat the various pathological condition underlying wrist pain. We perform broad wrist arthroscopy consisting of dorsal and volar approaches for the radiocarpal joint combined with a dorsal approach for the midcarpal and distal radioulnar joints to analyze wrist pain. This article describes the benefits of broad wrist arthroscopy.