It is a minimally invasive treatment technology based on the anatomy and surgical operation of Western medicine and guided by the theory of Chinese medicine. This technology integrates modern medicine’s ultramicroscopy with traditional medicine’s small needle knife and minimally invasive surgical techniques, which does not destroy the overall structure during treatment, but only changes the microscopic tissue structure, and is a new technology that cannot be replaced by milli-needle and open surgery. The technical equipment includes electronic imaging system, optical imaging system and many patented medical devices, which are clinically applicable to most of the joints, spine and other soft tissue diseases. From blind operation to visual operation, so that the treatment is more accurate, playing an important role in the diagnosis and treatment of ankylosing spondylitis.
I. Introduction to the ultramicroscopic system
1.Main composition of the ultramicroscope equipment
The ultramicroscope mainly includes visual operation equipment and needle surgery instruments. The visual operation includes endoscope, cold light source, light guide beam, channel and liquid back pressure system, monitor, digital imaging system, etc. There are more than 20 kinds of needle surgery instruments, including micro-needles, detachable needle handles, special operating instruments, clamps and scissors, and about 10 kinds of channels for needle surgery, which can be selected according to specific conditions.
Endoscope part of the German technology and raw materials processing, sapphire lens solid and durable; excellent optical performance, high resolution, clear under the mirror, wide field of view, bright and full image, small deformation, depth of field, focal length adjustment is more convenient. The angle of view is 0°. The diameter is 2.0mm, respectively, the working channel is 1.0mm, (the channel can be under the 2, 3, 4 needle knife as well as video) can be soaked, fumigation disinfection. Digital image processing system includes camera and control host, camera with high resolution, conductivity makes better, camera system produces clear images, can realize the endoscopic surgery camera and surveillance, configuration 1/2 inch CCD, clarity 500 lines; through the Y/C transmission system to transmit the image to the video recorder and monitor, convenient for surgical operation and record the surgical process.
2.Features of ultramicroscopic treatment system
2.1 Minimally invasive operation: All the ultramicroscopic operating instruments and operating methods are based on tiny incisions. Unlike arthroscopic treatment, arthroscopic treatment usually requires 3 or more channels to be opened at the surgical site to facilitate the operation, and the treatment process is mainly based on cutting or exploitation of damaged mucosa, cartilage and other tissues, which is relatively more traumatic and has a relatively longer recovery time; ultramicroscopy in the treatment of painful orthopedic characteristics, the incision is less than 0.5cm, and at most 2 channels are opened, and sometimes a utilization channel can also complete the The entire treatment process, in the treatment process through the peeling and dredging of joints and diseased tissue and joint cavity irrigation, in order to release adhesions, eliminate inflammation and restore function. Intraoperative trauma is relatively small, and functional exercise can be performed the day after surgery.
2.2 Visual operation: The ultramicroscopic diagnosis and treatment technology uses imaging equipment for visual operation, and the operation channel is used for complex and dangerous parts, which reduces the risk of surgery and improves the success rate of surgery. For example, in the lateral saphenous fossa release of the spine, an incision of about 0.3-0.5 cm is made and an operating channel is placed under the observation of the monitor to reach the intervertebral space, avoiding direct puncture and making a complex and dangerous operation simple and safe.
2.3 Simplification of operation: Due to the small incision and less damage, intraoperative treatment with blood expulsion and tourniquet is generally not required, avoiding artifacts in the operative area caused by ischemia. The operation channel can be compatible with a variety of instruments, and a number of operations such as inspection, irrigation, injection, placement and ablation can be done in one channel, simplifying the complex operation.
2.4 Precise targeting and efficacy: For refractory ankylosing spondylitis, when there is localized stubborn swelling and pain in the joints and muscles and stiffness, the use of ultramicroscopy for local unblocking, stripping, irrigation and drug placement can often eliminate symptoms, relieve joint stiffness and restore the function of each joint within a short period of time, and can avoid damaging normal tissues. The ultramicroscopic technique uses local anesthesia and has a short hospital stay.
Pathological changes in ankylosing spondylitis joints.
(1) Synovitis: Synovitis is the earliest pathological change that occurs in joints involved in ankylosing spondylitis. Microscopically, inflamed synovial tissue can be seen to be hyperplastic and thickened, with villi formation and infiltration of plasma cells and lymphocytes around small blood vessels. This inflammatory synovial tissue can release inflammatory mediators, causing painful swelling of the joint; it can release a variety of enzymes, destroying joint cartilage and bone tissue and eventually causing joint destruction. The lesions mostly start from the sacroiliac joint and gradually invade upward to the lumbar, thoracic and cervical vertebrae. The shoulder joint, temporomandibular joint, transverse rib joint, cribriform joint, sternoclavicular joint, sternoclavicular stalk joint, and pubic symphysis are also often involved.
(2) Inflammation of ligaments and tendon bone attachment points
This is a characteristic pathological change in ankylosing spondylitis, i.e., aseptic inflammation at the attachment sites of ligaments, tendons, and joint capsules, and the granulation tissue generated during the inflammatory process can destroy cancellous bone. During the process of bone tissue repair, the inflammatory process stimulates excessive bone production, and the new bone tissue not only fills the bone defects, but also extends into the nearby ligaments, tendons, and joint capsule, forming a violaceous bone flab. This characteristic inflammation of the tendon ends is mostly seen in the sciatic tuberosity, heel tuberosity, pubic symphysis, iliac crest, and greater trochanter of the femur.
(3) Osteomalacia and osseous fusion
In the late stages of ankylosing spondylitis, the osteophytes of the affected joints become increasingly obvious, especially the calcification or ossification of the joint capsule and ligaments is very prominent, and eventually the affected joint space completely disappears, and bony ankylosis occurs, this bony ankylosis often occurs in the sacroiliac joint, spine and hip, less often in the knee and ankle, this change occurs in the spine that forms the x-ray bamboo-like changes. The pathological basis of this change in the spine is the formation of bamboo-like changes on X-ray.
Ultramicroscopic operation
2, operation experience: ultramicroscopic treatment operation incision is small, little side injury, less intraoperative bleeding, generally can be carried out under local anesthesia, no blood transfusion and tourniquet, treatment can be injected into the joint through the tube saline (containing Zhengqing Feng pain Ning and other injections) to make the joint cavity expansion (saline bottle hanging height is generally higher than the knee joint about 1m), to maintain a clear surgical field. After routine disinfection and towel laying, a small incision of about 0.5 cm was made in the skin, and then a trocar needle matching the diameter of the ultramicroscope was used to puncture, remove the sharp occluder and replace it with a blunt occluder, insert the ultramicroscope into the joint cavity, adjust the operative field, and perform observation in sequence. Taking the knee joint as an example, the sequence was as follows: suprapatellar synovial crease – patellofemoral joint – medial crypt (medial medial wall, medial patellar synovial crease, crypt surface of medial ankle) – medial tibiofemoral joint (medial meniscus, anterior underside of medial femoral ankle and relative tibiofemoral articular surface) – then to suprapatellar capsule – lateral tibiofemoral joint (lateral meniscus, anterior underside of lateral femoral ankle and relative crypt surface) – lateral crypt (medial wall of lateral The lateral tibiofemoral joint (lateral meniscus, anterior aspect of the lateral femoral ankle, and the opposite cavernous joint) – the lateral crypt (lateral medial wall, crypt surface of the lateral femoral condyles, and musculature). The above observations can be photographed or videotaped. While observing, treatment such as stripping, loosening and cutting of injured tissues is carried out, while the joint cavity is continuously lavaged with saline containing Chinese herbal injection, and finally biopsy can be made. After lavage and draining of the filled fluid, the preparation of retardant can be left in place, the trocar needle is withdrawn, and the skin incision is sutured.
Within 12 to 24 hours after ultramicroscopy treatment, there is a heavy feeling and mild pain, which gradually disappears later. Some patients develop reactive effusion, which is related to the original lesion and usually disappears within 2 to 7 days; if the treatment tissue is extensive, it may cause bleeding;, the microscopic surgery for more than 2 hours may produce symptoms similar to traumatic arthritis, but it can disappear within a short time. Strenuous activities should be avoided for 24 hours after surgery, and functional recovery activities can be performed after 24 hours.
In the period of synovitis and inflammation of the ligament and tendon bone attachment points: Target Cui Target Cui ultramicroscopy can achieve more than 95% relaxation, and in the late stage of ankylosing spondylitis, ultramicroscopy with holmium laser can also achieve full has been relaxed,. The ultramicroscopic treatment technology has introduced and improved the arthroscopic technology of modern medicine in the external treatment of Chinese medicine, visualizing and minimizing the external treatment, which is another tool for clinical diagnosis and treatment of difficult and serious ankylosing spondylitis bone diseases. The method is the culmination of a long period of practice by Cui Zhiqiang, director of Tsinghua University.