Arthroscopy is the application of minimally invasive surgery in the field of orthopedics. Through minimally invasive incisions using small-diameter lenses and related instruments, the structures and lesions in the joints can be directly observed and treated, which is a development trend of modern surgery. Arthroscopic technology originated in Japan in the early 20th century, and has been developed and improved in Europe and the United States since the 1970s. As a modern diagnostic, examination and treatment tool, it has been introduced in China since the 1980s and has become quite mature in terms of surgical techniques, while its promotion rate in China has been increasing due to its advantages of less trauma, less pain, early landing, fast functional recovery and easy acceptance.
Arthroscopic structure and application areas
The basic structure of arthroscopy is an optical system with a central rod mirror system connected with optical fibers for image acquisition and a metal protective sheath with a diameter of about 5 mm, which is inserted into the joint through a small incision in the skin and allows direct observation of the structures and lesions in the joint through the image display device to diagnose the disease; at the same time, the corresponding surgical instruments can be used to treat the joint lesions. At the same time, the corresponding surgical instruments can be used to treat the joint lesion, avoiding the large trauma caused by arthroscopic surgery.
Arthroscopy was mainly used for the treatment of knee-related diseases in the early days. Since no joint incision is required, the relationship between the internal tissues and structures of the joints is basically not destroyed or changed, the internal structure of the joints can be reproduced in a more original way, and it is easier to accurately locate and treat the lesions of each part of the structure. At present, there is also a wide range of applications in the hip, shoulder and elbow joints, ankle joints and small finger joints.
Composition of the human knee joint and some common diseases
The normal human knee joint is composed of the thigh bone (femur), the lower leg bone (tibia-fibula), the knee bone (patella) and the surrounding soft tissues. There are also menisci and ligaments inside the joint. These structures are equivalent to the spacers and connecting rods inside the machine and are also important for the normal movement of the joint. The synovial membrane is the lining tissue of the joint and secretes joint fluid for lubrication.
Meniscal injuries occur in young people who love sports, and the chance of injury is high when they play basketball, soccer, running, etc. Some patients may have meniscal injuries after a minor collision in daily life or for no clear reason, which may cause joint pain, swelling and other discomfort and affect the normal function of the joint. Synovial nodular synovitis, rheumatoid arthritis synovial lesions, etc.), there will be localized heat and swelling, pain and other discomfort in the joint; synovial chondroma, intra-articular bone flab off and other formation of intra-articular free body, it will wander in the various gaps in the joint, causing joint pain, and sometimes the joint is stuck, resulting in short-term inability to move, and the symptoms will recur, affecting normal activities.
Indications.
The following let give us a specific understanding of what conditions are suitable for arthroscopic surgery.
1. Acute joint injury. Injuries caused by external impact, fall or strenuous exercise, such as joint swelling and blood accumulation in the joint, can be cleared by arthroscopy; if the examination reveals a meniscus tear or rupture, the disease can be relieved by arthroscopic meniscus repair and suture. Injuries to the cruciate ligament are commonly caused by sprains during strenuous exercise, including partial rupture and complete rupture; some patients may have ligament injuries, but the swelling and pain disappear after resting for a period of time, so they do not undergo further examination and do not pay attention to them, but they may feel joint instability during normal activities, etc. These are old injuries; regardless of acute or old ligament injuries, ligament reconstruction can be performed through autologous tendon transplantation to restore joint stability and function. To restore the stability and function of the joint.
3. Knee pain. If there is painful synovial tissue hyperplasia, it can be removed and the surrounding ligaments and adhesions can be released to relieve the pain and dysfunction caused by soft tissue tension and pulling.
4. Intra-articular infection. Through arthroscopy for examination and irrigation treatment, with the use of antibiotics can be completely cured and eliminate the symptoms of joint swelling and pain.
5.Arthritis. Traumatic arthritis or senile degenerative arthritis can be improved to a certain extent by appropriate cleaning within the joint; rheumatoid arthritis can be removed from the synovium under the microscope to improve the symptoms of swollen and painful joints.
6. Other. Such as intra-articular free body, acute joint sprain, patellar subluxation, etc., can also be dealt with through the corresponding surgical operation techniques under arthroscopy.
Advantages of arthroscopic surgery
1. Light reaction. Minimally invasive surgery, postoperative pain and other reactions are small, easily tolerated by patients, and easy to accept.
2.Aesthetic. The surgical incision is small and can be completed through an incision of about 1cm in length, which can significantly reduce the surgical scar without affecting the aesthetics, and generally does not require removal of stitches, reducing the trouble of patients coming to the hospital again to remove stitches.
3.Less interference. The interference with the intra-articular structure is small, and there is no effect on the surrounding muscles, ligaments and other soft tissues, and the post-operative traumatic reaction is light, which greatly reduces the impact of post-operative scar tissue on joint function.
4.Fast recovery. Especially for elderly patients, getting up early and getting out of bed can avoid various serious complications caused by long-term bed rest. The hospitalization time is short (most patients stay in hospital for about one week), which greatly saves the time of patients.
5. The operation is more precise and reasonable. Arthroscopic surgery can complete some surgical operations that cannot be done under open surgery due to the limitation of observation and operation space. For example, partial meniscectomy and suturing of certain parts of the meniscus, hemimelia of disc cartilage, etc. can only be completed under arthroscopy. And open surgery is bound to remove the meniscus, which has been considered by many people as an unreasonable operation, because total meniscus removal will inevitably lead to joint instability and joint degeneration.
6. Fewer complications. Complications of arthroscopic surgery are relatively few and mostly not serious. Some patients may experience mild dizziness and headache, and most patients will recover about 1 day after surgery. Postoperative pain is generally mild and can be tolerated by most patients without pain relief. Slight localized swelling of the joint after surgery in some patients does not affect the function of the joint and will return to normal within a short period of time after surgery. Joint adhesions after arthrotomy are also rare in arthroscopic surgery.
Anesthesia and surgical operation
Arthroscopic surgery is usually performed with semi-body anesthesia (below the waist), and the patient is awake during the procedure. The patient has some communication with the surgeon during the procedure and can see the inside of the joint and the procedure with his own eyes through a monitor.
One incision is used to insert the arthroscope to observe the joint, and there is an inlet tube connected to inject sterile fluid into the joint to open up the joint and provide a clearer view for operation; another incision is used to insert other necessary instruments for examination and operation; a third incision may be added if necessary.
The general operation time is about 30 minutes to 1 hour, such as joint exploration, free body removal, synovial cleaning, etc. The operation time is relatively short; the operation time is slightly longer for more complicated diseases, such as cruciate ligament injury, etc.
Through the above some understanding of arthroscopy, let’s further understand through a few real cases.
Ms. Li, 24 years old, had an arthrotomy for synovial debridement 6 years ago due to hyperpigmented villous nodule synovitis, and now there is a scar of about 15 cm in front of her knee; due to the nature of the disease, it has recurred again, and she underwent arthroscopic debridement in our hospital this time, and resumed normal activities soon after the operation. If the previous surgery had been done arthroscopically, the unsightly scars would not have been left behind.
Mr. Wang, 26 years old, likes all kinds of ball games. 2 months ago, he sprained his right knee while playing basketball, felt pain at that time, and gradually developed joint swelling, uncomfortable activities, after resting for a period of time, although the pain was reduced, but felt that the knee was unstable when walking, came to the hospital for examination and diagnosed anterior cruciate ligament rupture, under arthroscopic reconstruction of the cruciate ligament, one and a half months after surgery, the patient recovered well, from mobility, muscle Mr. Wang was satisfied with the good recovery in terms of mobility, strength and knee stability.
Ms. Fu, 31 years old, sprained her right knee at home 15 days ago, and felt pain in her knee and was afraid to move around, so she came to the hospital for an MRI examination suggesting meniscal damage, and physical examination also showed pain on the outside of her knee.
In conclusion, arthroscopy, with its advantages of minimally invasive, low pain, low cost and easy acceptance by patients, has gradually become an indispensable means of diagnosis and treatment in the medical field at home and abroad, with positive efficacy and generally at the level of patients’ affordability.