Minimally invasive surgery is the leading development of surgery in the 21st century, and is one of the important events in the field of biomedicine that has produced historic changes. In the field of domestic and international medicine, minimally invasive technology has become the frontier and guiding technology for the development of various disciplines, effectively promoting the development of the discipline.
A. Arthroscopic surgery should be a disciplinary field of connotation
Minimally invasive arthroscopic surgical incision miniaturization, minimally invasive tissue damage, the purpose is to significantly improve the therapeutic effect, and therefore the purpose of the proposed treatment of joint injuries from tissue repair and healing to the development of joint function recovery. The change in the purpose of treatment cannot be achieved by a single improvement in surgical technique.
It involves.
1, the development of the basic theory of minimally invasive surgery, i.e. minimally invasive anatomy, minimally invasive physiology, minimally invasive pathology, etc., to provide the necessary biological basis for arthroscopic surgical treatment;
2, the new technology of minimally invasive surgery diagnosis, i.e., the wide application of advanced spiral CT, MRI, KT2000, surface electromyography, isokinetic test and other high-tech diagnostic and assessment equipment, so that the level of assessment of the bony structure of previous joint injuries has developed to the level of comprehensive assessment of the function of bone, ligament, joint capsule, bursa, cartilage, meniscus, glenoid labrum and the state of joint muscle strength, providing the arthroscopic surgical treatment diagnostic basis;
3. New technology and new viewpoint of arthroscopic minimally invasive surgical treatment, i.e. the application of modern treatment means such as arthroscopy, laser, radiofrequency, navigation, fixed anchor technology and perioperative rehabilitation, to achieve the goal of minimal tissue trauma, the closest repair to the anatomical state and the most perfect joint function recovery.
In terms of surgical treatment, the arthroscopic surgeon does not only repair the tissue damage in the joint according to the clinical and auxiliary examinations, but also determines the stability of the joint, the level of muscle strength around the joint, and the state of the articular cartilage to determine the specific surgical plan, the timing of the surgery, and the post-surgical rehabilitation. Arthroscopy has developed the joint fracture repositioning from the bony structure repositioning as shown by X-ray to the cartilage repositioning under direct view of arthroscopy, which truly achieves the anatomical repositioning and provides the necessary guarantee for the recovery of joint function.
Arthroscopic minimally invasive surgical operation technique minimizes tissue damage in the joint, preserves the integrity of the joint, and makes the restoration of joint function possible. However, the degree and duration of joint function recovery is dependent on rehabilitation training. The healing of the repaired and reconstructed tissues in the joint, the healing of the tendon-bone fixation, the circulation and nutrient supply of the joint fluid, the metabolism of the articular cartilage, the mobility of the joint, the coordination and domination of the muscles around the joint, and the strength of the muscles must all be restored through rehabilitation training.
Second, the characteristics of arthroscopic surgical treatment
1, orthopedic AO fixation technology, BO fixation technology, spinal plates and other new technologies are based on the original local anatomy, according to different concepts and different surgical operation techniques. The arthroscopic minimally invasive surgery technology, in addition to the original local anatomy, is mainly in the original local anatomy of the in-depth study, that is, minimally invasive anatomy of the basis of the new clinical surgical operation techniques, is the original open joint surgery failed to involve or completely different mode of operation.
Even if a physician does not have the relevant knowledge, it is difficult to complete the preoperative diagnosis, intraoperative determination, and the selection of the operating style even if he or she has mastered the basic operation of arthroscopy. For example, knowledge of the glenoid labrum (superior, inferior, anterior and posterior), capsular ligament (superior, middle and inferior glenohumeral) of the shoulder joint, blood supply partitioning of the knee meniscus, operational partitioning and the “equal length point” in anterior cruciate ligament reconstruction are all areas that are not covered by traditional surgery.
2. Joint injuries are much more complex than backbone injuries. When we promote arthroscopic surgery technology, we found that some hospitals have difficulty in developing arthroscopic surgery or even abandoning it, an important reason is that the treatment effect is far worse than the expected minimally invasive surgical treatment. Minimally invasive surgery is less invasive and highly precise, but if the preoperative judgment of the injury is wrong, it will lead to the failure of the treatment.
This in turn relates to the current problem of some young physicians in the field of surgery neglecting the basic training of clinical examination and relying too much on auxiliary examination reports. In a patient with knee pain, the examination reveals that the joint pressure pain and abnormal meniscus mobility are on the medial side, while the MRI report mainly describes the abnormal signal of the lateral meniscus (I°, II°, or even III° signal), if the physician performs partial resection of the lateral meniscus based on this report, the patient’s symptoms will not disappear after surgery.
In the case of middle-aged and elderly knee osteoarthritis, if the physician does not consider the degree and extent of articular cartilage destruction and patellar fixation, and does not specifically analyze the peripatellar muscle strength and the condition of the contralateral joint, and simply performs a complete joint cleanup, the patient’s symptom relief will not last long, and may even worsen.
3. Arthroscopic surgery and open surgery are not only different in terms of operating instruments, but also in terms of hand strength and mode of operation. Arthroscopic surgery is characterized by small incisions and light injuries. However, if the local anatomy in and around the joint is not clear and the arthroscopic operation is not standardized, it is not only easy to damage the extremely expensive surgical instruments, but also may lead to injury of important neurovascular, causing impaired blood supply and neurological dysfunction of important structures of the joint and distal limbs, which is more damage than that caused by incisional surgery. The standard training mode should be based on certain orthopedic operation skills, and then enter a base with arthroscopic training qualification for special skills training.
Third, arthroscopic surgery – the establishment of a truly minimally invasive concept
China has become one of the countries with the largest number of arthroscopes, but the popularity of arthroscopic surgery is lagging behind, which makes the application of this advanced surgical concept in clinical practice not really achieve significant improvement in treatment results.
The core of the concept of minimally invasive arthroscopic surgery should be based on the principles of minimally invasive joint anatomy, pathology and physiological function (joint proprioception, joint kinematics), and the use of advanced diagnostic tools to achieve maximum functional recovery in the treatment of joint injuries and diseases. This philosophy challenges the use of cumbersome treatment for joint injuries.
For example, the use of double plate fixation for tibial plateau fractures has resulted in joint stiffness or damage to the contralateral collateral ligaments; the use of clavicle hook plates for clavicle fractures and acromioclavicular dislocations has resulted in effects on the rotator cuff; and the use of transarticular intramedullary nailing for trunk humerus and tibial trunk fractures has resulted in a comprehensive assessment of the postoperative effects on joint function, so that trunk fractures, which are not difficult to treat, are not treated in a cumbersome manner that results in intractable joint stiffness In addition, it is important to ensure that the fractures of the backbone, which are not difficult to treat, do not cause serious complications such as joint stiffness, joint instability and even damage to important structures of the joint.
The goal of minimally invasive arthroscopic surgery is to improve the outcome of joint injuries, and the normal function of the joint is a direct indicator of treatment. The complex stability structure, motion mechanism, synovial synovial nutrient mechanism, and cartilage function of the joint make the recovery of the joint after injury a complex systemic project. In recent years, the rapid development of rehabilitation medicine and the widespread application of new theories and technologies have led to remarkable achievements.
Rehabilitation assessment, rehabilitation training programs, bracing techniques, and physical therapy techniques for joints after arthroscopic surgery are important ways to address imperfect functional recovery after minimally invasive arthroscopic surgery. We even use radical rehabilitation training in the treatment process of competitive athletes, which not only restores normal function to the joint injury quickly, but also achieves to meet the requirements of competitive level within a certain time limit, which is the best example.
In conclusion, the development of minimally invasive arthroscopic surgery proves that the concept of minimally invasive joint surgery has gone far beyond the scope of surgical operations. The purpose of using minimally invasive joint surgery operations is to improve the level of treatment of joint injuries and diseases. To achieve this goal, preoperative evaluation, precise localization and qualitative diagnosis of the injury, surgical planning, standardized minimally invasive surgery and perioperative rehabilitation are the five major elements of the minimally invasive concept of arthroscopic surgery. The minimally invasive concept of arthroscopic surgery and its related basic theoretical research, high-tech equipment, development of surgical operating instruments, and clinical evaluation of rehabilitation training constitute a complete disciplinary field.