Arthroscopy

Arthroscopy is an endoscope applied to the internal examination of the joint cavity. It can directly observe the synovial membrane, cartilage, meniscus and ligament, especially through the arthroscopic technique to make the diagnosis of various arthritis. Provides a pathological basis. It plays an irreplaceable role in the diagnosis, treatment and research of various synovitis. It not only provides intuitive information for arthrosis, but also removes and repairs intra-articular lesions under non-open surgical conditions, with less pain, faster recovery, less postoperative complications and surgical costs. Basic Information Specialist classification: growth and development check classification: endoscope Applicable gender: whether men and women apply fasting: not fasting Analysis results: Below normal: Normal value: no Above normal: negative: No congestion, edema, villus hyperplasia, and oozing were found during the examination. Polypoid or massive hyperplasia, no cartilage damage. Positive: When the test result is positive, it indicates that other diseases require further diagnosis and treatment. Tips: Check your relaxation, you should face it positively and actively cooperate with the inspection. Normal value No edema, villus hyperplasia, and oozing were found during the examination. Polypoid or massive hyperplasia, no cartilage damage. Clinical significance Abnormal results: In the diagnosis of knee synovial lesions, the supraorbital sac synovial membrane is generally targeted, and the normal supraorbital sac synovial membrane is smooth and flat, and the small movements and veins parallel to the direction can be clearly seen. The synovial film is light red with a small amount of synovial fluff, which is film-like, slender and translucent. In the early stage of different rheumatic diseases, synovial changes are hyperemia, edema, villus hyperplasia, and even oozing. It is difficult to identify during arthroscopy, but it still has its own characteristics after development to a certain stage. Rheumatoid Arthritis Early rheumatoid synovitis is difficult to diagnose by arthroscopy. As with general synovitis, only non-specific lesions of the synovium appear, while other intra-articular tissues, such as articular cartilage, meniscus, etc., do not change significantly. When entering the exudation period, there may be turbid slender villi hyperplasia, redness, edema, filamentous, membranous or irregular massive exudation, called "cellulose", such as the naked eye Grayish yellow. When the disease progresses, the villi are membrane-like polypoid or massive hyperplasia, and the deposition of "cellulite necrotic" can be seen in the joint cavity. When entering the chronic phase, the synovial membrane has fibrous tissue repairing villi, new and old. The more characteristic manifestations are the internal and external iliac near the synovial cartilage, and even the normal cartilage of the medial and lateral meniscus, especially in the anterior and posterior horns, there are obvious vasospasm extension, forming an uneven cartilage erosion surface. Continued development, articular cartilage surface and meniscus gradually fibrosis, patellofemoral joint and patellofemoral joint fibrous tissue hyperplasia and adhesion, the joint cavity is closed, the arthroscope can not enter. Typical pathological changes in the synovial membrane 1 lymphoid follicle formation; grade 2 fibrin denaturation; 3 inflammatory granuloma formation. These three types can overlap and intersect. There may also be deposition of IgG, lgM, complement and rheumatoid factor (RF) in the synovium. Osteoarthritis Under the arthroscopy, the fluff is pale and slender, mostly tree-like or feather-like, with no obvious hyperemia and inflammatory cell infiltration, no cellulose-like necrotic deposition and vasospasm. Articular cartilage has obvious changes, the cartilage surface is dark, sometimes there is ulceration, cartilage is detached or exfoliated, and even some bones are exposed. This phenomenon is most obvious in the femoral condyle and medial tibial plateau, and the lateral patellofemoral joint generally occurs slowly. . The upper and lower ends of the humerus, the proximal synovial membrane of the femoral condyle, and the anterior and posterior femoral condyles have different degrees of osteophytes. The meniscus also undergoes denaturation, wear, or rupture. Crystalline arthritis (gout, pseudo-gout, etc.) Late onset of single arthritis in elderly patients should consider the possibility of crystal arthritis, arthroscopy can be seen in white shiny urate or pyrophosphate salt crystals, located in the synovial membrane, cartilage and On the wall of the joint cavity. The presence of the corresponding crystals can be found in the synovial fluid and in the pathological section of the synovial membrane. In the acute phase, the villi can also be in a state of congestion and swelling. Tuberculous arthritis There is no obvious change in early tuberculous synovitis. Later, there may be redness and swelling of the synovial membrane, unevenness, hypertrophy of the villi, turbidity, and some granulous tissues with edema and redness may be covered on the surface of the synovial membrane. Finally, the synovial membrane is severely fibrotic and necrotic tissue is exfoliated. Filled in the joint cavity, the discovery of a large number of regular soft free bodies is a special disease change. The synovial pathology is more granulation tissue formation, scattered in Langhansian cells, and the surface of the synovial membrane is more cheese-like. Necrotic. Infectious arthritis Infectious arthritis can be seen in the naked eye, synovial adhesion, necrosis, cartilage discoloration, pathological examination can be found in pathogenic bacteria and a large number of polymorphonuclear leukocyte infiltration. Pigmented villonodular synovitis The early changes along the membrane are not obvious, because the synovial membrane and the villus of the lesion contain hemoside, so after the lesion develops, the synovial membrane and the color of the villus in the joint cavity are different from the general synovial membrane, with a yellow-brown color, and the villi are obviously proliferated. More sticks. Positive results may be diseases: arthritis, rheumatism, periarthritis of the shoulder, supracondylar fracture of the humerus, external humeral fracture, bone and joint syphilis, ossifying myositis, hip osteoarthritis, Gai's fracture, carpal tunnel Syndrome considerations Taboo before inspection: In arthroscopic examination, since only a small part of the joint can be seen, it is not easy to judge which part of the intra-articular image belongs to at the beginning of the examination, and the supine synovial fold between the upper sac and the upper crypt is A good logo that is easy to locate. During arthroscopy, physical stimulation can affect the visual field, and fluid temperature and hydraulic pressure can also affect blood flow. Therefore, synovial congestion should be considered normal after 10 minutes of arthroscopic insertion. Requirements for inspection: Check the feelings of relaxation, should face positively, and actively cooperate with the inspection. Inspection process Under continuous epidural anesthesia, the affected limb was placed on the operating table, the epidural puncture needle was used for joint puncture in the supraorbital sac, the exudate was withdrawn, and saline was injected into the joint to expand the joint cavity (the saline bottle suspension height) Generally it is about 1m above the knee joint). The puncture point was selected on the lateral edge of the ankle, the anterior border of the femoral condyle, and the center of the triangle formed by the upper edge of the humerus. First cut a small mouth about 0.5cm in the skin, then puncture with a trocar matched with the diameter of the arthroscope, remove the sharp occlusion device, replace it with a blunt occlusion device, insert the arthroscope into the joint cavity, and observe the sequence as follows: Upper synovial fold - patellofemoral joint - medial crypt (inner inner wall, medial synovial fold, medial crypt surface) - medial patellofemoral joint (medial meniscus, anterior and posterior femoral condyle and opposite tibial articular surface) ) - to the supraorbital sac - lateral patellofemoral joint (lateral meniscus, anterior and posterior femoral condyle and opposite cavity bones written) - lateral crypt (outer wall, crypt surface of the femoral condyle, muscle health). The above can be photographed. Finally, it can be used for biopsy. After washing, the filling liquid is drained, the trocar is pulled out, and the skin incision is sutured. Not suitable for the crowd Inappropriate crowd: 1. Absolute contraindications: 1 sepsis. 2 joint activity is obviously limited, severe joint stiffness, narrow joint space, can not cooperate with the examination. 3 abnormal blood coagulation mechanism. 4 The skin of the surgical field is infected. 2. Relative contraindications: 1 synovial proliferative inflammation, extreme swelling of the joint and negative floating sputum test, suggesting that the proliferative synovium has filled the joint cavity, at this time it is not easy to inject water to expand, can not observe the structure of the joint, forcibly applying arthroscopy may cause Intra-articular bleeding. 2 viral hepatitis. Adverse reactions and risks Nothing.