Indications and contraindications for arthroscopic surgery
Arthroscopy is a 5-mm diameter rod-shaped optical instrument that is used as an endoscope to diagnose and treat joint disorders. It has been used since 1970. The arthroscope is a thin tube with a lens at the end, which is inserted into the joint, and the internal structure of the joint is displayed on a monitor, so that the internal structure of the joint can be observed.
Arthroscopy is not only used for diagnosis of diseases, but also for treatment of joint diseases. Arthroscopic surgery is a minimally invasive procedure, mainly used on the knee joint, and later on the hip, shoulder, ankle, elbow, and small joints such as the fingers.
Arthroscopy can see almost all parts of the joint, which is more comprehensive than cutting open the joint, and is more accurate because of the magnification of the processed images, and the ideal incision is small, less traumatic, less scarring, faster recovery, and fewer complications. For the diagnosis of difficult joint diseases and the treatment of joint injuries that have plagued patients for years, arthroscopic surgery can often achieve immediate results.
(A) Indications
1. For the diagnosis of.
(1) Identification of non-infectious arthritis. It is possible to observe the congestion and edema of the synovial membrane, the degree of cartilage damage and the presence of crystalline material in the joint and other pathological changes, which can help distinguish rheumatoid arthritis, osteoarthrosis and crystal arthritis.
②To understand the site, extent and morphology of meniscal injury of the knee joint.
③Injury to the cruciate ligament and N tendon stop of the knee joint.
④To understand the intra-articular cartilage damage, presence of intra-articular free bodies, etc., to confirm the diagnosis of osteoarthrosis, especially chondromalacia patellae.
⑤ Analyze the etiology of chronic synovitis, such as pigmented villous nodular synovitis.
⑥Diagnosis of synovial crepitus syndrome and fat pad lesions of the knee joint.
(vii) The site of rotator cuff rupture, the degree and biceps tendon adhesions.
(8) Synovial biopsy.
2. For the study of changes in intra-articular lesions.
During the development of joint disease, arthroscopy can be performed several times. By taking pictures, videos or synovial biopsies, information that is difficult to obtain by other protocols of diagnostic methods can be obtained.
3.Used for treatment to resolve.
Knee. Some lesions of the shoulder joint, after a clear diagnosis, can be operated with special instruments under the microscopic view, and achieve satisfactory results. For example, joint lavage debridement, partial or complete excision of torn meniscus of knee, suture of torn meniscus edge, anterior cruciate ligament repair, synovial crease excision, intra-articular adhesion release, tibial plateau or intercondylar crest fracture revision, rotator cuff suture, biceps tendon adhesion release and intra-articular free body removal, etc. In addition, major synovectomy is feasible for rheumatoid arthritis of large joints of the extremities.
(B) Contraindications
The only absolute contraindication is joint stiffness, as it prevents arthroscopic manipulation. In patients who have had recent arthrography, there is a risk of secondary chemical synovitis consultation, and arthroscopy may yield false positive results if performed within 1 week of the imaging. Although bleeding in patients with bleeding disorders can be flushed with large amounts of saline, thus obtaining a good field of view for surgery, a large amount of joint blood accumulation can occur after surgery. These two points should be paid special attention when choosing arthroscopy.
(iii) Error rate of about 2%
Insufficient knowledge of local anatomy and gross pathological changes under direct arthroscopic view is the main reason for misdiagnosis. The missed diagnosis is often due to the fact that arthroscopy has a certain blind spot and cannot be observed comprehensively.