Arthroscopy of the knee joint

The emergence of arthroscopic techniques has made joint surgery a big step forward. Due to the application of arthroscopy, pathological changes that can not be observed by other methods in the joint can be directly observed, which greatly improves the diagnosis and treatment of joint diseases. Arthroscopy helps clinicians diagnose some undiagnosed cases and find specific lesions that can be identified under arthroscopy, such as wrinkle syndrome. Because the arthroscopic incision is small, the interference to the joint is light, the complications are few, and the patient recovers significantly faster than the general surgery after the operation, so it is highly praised in the treatment of joint diseases. With the advancement of technology, arthroscopy equipment and instruments will also be constantly updated, theoretical research will continue to deepen, the diagnostic and therapeutic level of arthroscopy will continue to improve, and has extremely broad application prospects. Due to the particularity of pediatric joint diseases, it is difficult to diagnose and treat. Von Rueden believes that arthroscopic technique has at least four aspects of joint disease in children: 1 correcting preoperative diagnosis; 2 avoiding cutting and cutting; 3 revised the plan for the operation of the switch section; 4 supplemented the diagnosis and considered that arthroscopy is the best diagnostic and therapeutic tool among adolescents and children. Domestic Sun Caijiang found that the coincidence rate of clinical diagnosis and microscopic diagnosis of sick children is less than 50%, which also proves the importance of arthroscopic technique in the diagnosis and treatment of children's joint diseases. Curing disease: Indication 1. Knee pain can not be located or to determine the presence or absence of lesions. 2. The main complaints and physical signs are contradictory or have few signs. 3. Patients who have undergone more than one operation and still have symptoms. 4. A microscopic biopsy is necessary to help determine the diagnosis. 5. For all persistent or recurrent knee swelling and pain, no improvement after 3 months of non-surgical treatment, and the condition can continue to develop can be performed diagnostic examination of arthroscopy. Special attention should be paid to the knee joint pain caused by non-organic lesions in children. After rest and braking, it can be improved after symptomatic treatment. It should be excluded. Contraindications 1. There is suppurative inflammation in the soft tissue around the joint. 2. The joint activity is obviously limited. 3. Joint capsule rupture is incomplete. Preoperative preparation 1. Identify the affected limb again before surgery. 2. The scope of disinfection is the same as knee surgery but should include the foot. 3. Use waterproof drape, the surgeon wears a waterproof surgical gown. 4. Hang the lavage bag containing 3000ml isotonic saline or Ringer's solution at a height of 1~1.5m from the affected limb or use an arthroscopic special perfusion pump. 5. Connect various pipes and cables, turn on the power supply, and check that all parts of the instrument are running normally before surgery. 6. Beginners should first use the purple purple to make a skin mark. Surgical procedure 1. The inner and outer approaches of the ankle are most commonly used, respectively 2mm above the innermost and outer "knee eyes". Flexion of the knee joint 45°, a 0.8mm incision was made on the lateral knee eye with a 2mm sharp knife. The sharp puncture cone pierced the joint capsule in the direction of the intercondylar fossa, and the blunt puncture cone was inserted into the joint cavity. The medial approach is the same as the lateral approach. The anterior lateral approach is inserted into the mirror, and the joint can be expanded by injecting the lavage fluid through the inner or outer channel of the sheath sheath or another iliac crest. The inside is inserted into the probe and other instruments. The examination should be carried out in order: from the upper sac of the iliac crest the patellofemoral joint surface the medial groove the medial compartment the intercondylar fossa the lateral sulcus the supraorbital sac. Special emphasis should be placed on checking in order to prevent omissions. The lesion was found to be photographed, video recorded or biopsied. 2. A small incision is made in the middle or outer side of the humerus in the middle or the lateral iliac crest, and a blunt puncture cone is inserted into the joint cavity. The knee flexion 20°30° can better observe the underarm fat pad and the medial and lateral meniscus anterior horn. . 3. The internal and external approaches of the iliac crest are located 2.5 cm inside and outside the humerus, which can better observe the trajectory of the patellofemoral joint and the tibia and can be used for cutting and synovectomy of the tibial cartilage. 4. Posterior and posterior approach of the knee The posterior medial approach of the knee is located on the posterior margin of the femoral condyle, the posterior margin of the tibial plateau and the semi-membrane semitendinosus. The posterior cruciate ligament and the posterior horn of the medial meniscus were observed with a 70° arthroscope; the posterolateral approach of the knee was located in the lateral joint space, and the posterior margin of the iliac crest and the leading edge of the biceps femoris were observed. The posterior margin of the meniscus, the diaphragmatic tendon, and part of the anterior cruciate ligament. When establishing the second approach, the joint should be firstly expanded, and the knee should be bent at 90°. First, the trocar should be used to puncture and position. The core of the needle should be removed. The table can be cut into the blunt puncture cone in the back of the joint. It is forbidden to use violence. Damage to the cartilage surface. In addition, the direction of the puncture cone should be slightly inclined forward to avoid damage to the axillary vascular nerve. 5. The central approach bends 90° to the knee, and makes a skin incision in the midline of the patellar ligament and 1 cm below the lower pole of the humerus. The sharp puncture cone penetrates the ligament and expands up and down, and becomes a blunt puncture cone to penetrate into the intercondylar fossa. The internal and external joint space was observed, and the posterior joint cavity was entered through the intercondylar fossa. The posterior joint capsule was examined with a 70° lens. It was also used for the meniscus in the meniscus when the meniscus was removed. 6. After the endoscopy examination, the joint cavity is flushed, and the lavage fluid is aspirated. The needle can be sutured by the absorption line, and the dermis is subcutaneously sutured and pressure-wrapped.