What Are the Different Reasons to Perform a Arthrotomy?

Arthroscopy is a rod-shaped optical instrument with a diameter of about 5mm for observing the internal structure of joints. It is an endoscope used to diagnose and treat joint diseases. Arthroscopy is equipped with a lens at the end of a thin tube. Insert the thin tube into the joint and the structure inside the joint will be displayed on the monitor. Therefore, the structure inside the joint can be directly observed. Arthroscopy is not only used in the diagnosis of diseases, but has been widely used in the treatment of joint diseases.

Chinese name: Arthroscopy
Foreign name: Arthroscope

Category Name: Optical endoscope
Management category: Class III medical devices

History of Arthroscopy

Arthroscopy technology originated in Japan at the beginning of the 20th century, and it has been greatly developed in the United States and other countries since the 1970s. Over the past few decades, arthroscopy has revolutionized the diagnosis and treatment of intra-articular diseases. Through arthroscopy, the structure inside the joint can be observed comprehensively, which is more subtle than incision surgery. Many structures and lesions in the joint can be directly observed and treated. Some people call arthroscopy technology with fracture internal fixation and artificial joint replacement as the three major advances in the field of orthopaedics in the 20th century. Arthroscopy has been widely accepted, and was once called the "young man's toy", and it has now become the standard diagnostic and treatment technique. Arthroscopy is an important part of joint surgery, which fully reflects the development trend of minimally invasive surgery.

With the gradual popularization of endoscopic technology in China, arthroscopic surgery has become a routine diagnosis and treatment method of bone and joint surgery. Among the systemic endoscopes of the whole body, arthroscopic functions are the most comprehensive and widely used at present, and thus form independent arthroscopic surgery. The arthroscopic surgery business has become a growth point for hospital and department performance.

In 2008, a total of 790 hospitals in China had arthroscopic system facilities to perform arthroscopic surgery. These hospitals were mainly concentrated in the top three hospitals. By 2012, a total of 2640 hospitals in China had arthroscopic system facilities to perform arthroscopic surgery. On average, The annual growth rate is 35%, covering almost all tertiary hospitals and about 30% of second-tier hospitals. The hospital's budget for purchasing an arthroscopy system has not been affected by the economic crisis and China's economic slowdown. In some developed cities such as Beijing and Shanghai, the level of arthroscopy technology is comparable to that of developed countries. Arthroscopic surgery has begun to shift from the city's tertiary hospital to the grassroots level, which is suitable for China's national conditions and covers the crowd to the greatest extent.

The basic structure of an arthroscope is an optical system, with a rod mirror system for collecting images in the center, a light guide fiber introduced into the light source around it, and a metal protective sheath on the outside. By establishing a tiny incision of about 0.8mm ~ 1.0cm on the skin, placing the arthroscope into the joint, and connecting the camera and display equipment behind it, you can directly observe the morphology and lesions in the joint, and use special instruments to control the joint The disease is treated internally, thus avoiding many joint incisions.

Arthroscope basic structure

The basic structure of an arthroscope is an optical system, with a rod mirror system for collecting images in the center, a light guide fiber introduced into the light source around it, and a metal protective sheath on the outside. It consists of arthroscope lens, camera, host, display and cold light source. The arthroscopy lens is a thin rod with a length of more than 20 cm and a thickness of 4-5 mm. It is used to insert the joint cavity. The rod contains a set of optical fibers and a group of perspectives. The optical fibers introduce light into the joints, and the perspectives transfer the light in the joints. The image comes out. Outside the joint, a fiber optic cable connects the optical fiber with a cold light source so that the cold light source can illuminate the joint; a camera connects the lens to the host and the display to reflect the image inside the joint onto the display. By establishing a tiny incision of about 0.8mm ~ 1.0cm on the skin, placing the arthroscope into the joint, and connecting the camera and display equipment behind it, you can directly observe the morphology and lesions in the joint, and use special instruments to control the joint The disease is treated internally, thus avoiding many joint incisions.

Arthroscopic indication

Applicable to meniscus injury, anterior cruciate ligament rupture, articular cartilage injury, intra-articular free body (also known as articular rat), osteoarthritis, inflammatory joints, pigmented villous nodular synovitis, crystal arthropathy, Diagnosis and treatment of various diseases such as infectious arthritis and traumatic arthritis.

Arthroscopic contraindications

The patient has a systemic or local infectious disease;
Have severe hypertension, heart disease, diabetes and other diseases;
The patient cannot tolerate anesthesia and surgery.

Common Arthroscopic Complications

Complications of knee arthroscopic surgery: postoperative infection, neurovascular damage behind the knee joint, joint adhesion, deep vein thrombosis of the lower extremity, etc.

Complications of shoulder arthroscopic surgery: tracheal compression caused by extravasation of joint irrigation fluid, upper airway obstruction; cerebral ischemic injury; arrhythmia caused by abnormal absorption of adrenaline into blood in lavage fluid; tension pneumothorax; lung Air plugs and so on.

Complications of elbow arthroscopy: hematoma, delayed wound healing, continuous exudate, superficial infection, transient nerve injury, deep infection, and no recovery from persistent nerve injury, etc. ^[1] .

Arthroscopy advantages

Arthroscopy can see almost all parts of the joint, which is more comprehensive than the cut switch section. Because the image is enlarged, it can be seen more accurately, and the incision is small, the trauma is small, the scar is small, the recovery is fast, and the complications are small. In some cases, after anesthesia, you can go to the ground, which is very helpful for patients to increase their confidence in fighting the disease. For the diagnosis of difficult joint diseases and the treatment of joint injuries that have troubled patients for many years, arthroscopic surgery can often achieve immediate results.

The incision is small and beautiful, which can avoid the irritation caused by scars on the joint surface and moving parts in the late stage;
It is a minimally invasive surgery with less pain and less postoperative response, which is easy for patients to accept;
You can move and use your limbs early after surgery to avoid long-term bed complications and reduce nursing staff and costs;
Relatively few complications
It basically does not affect the muscle structure around the joints, and can perform functional exercises early after surgery to prevent disuse and complications caused by long-term joint fixation;
It is possible to observe and inspect intra-articular lesions in a near-physiological environment. It is known as "putting eyes and fingers in joints". It can perform dynamic inspection of joints, which improves the diagnosis ability. Some diseases such as synovial fold Symptoms were established through arthroscopy;
Arthroscopy can perform operations that were previously difficult to complete with open surgery, such as partial meniscectomy.

Comparison of Arthroscopic Arthroscopy and Traditional Surgery

project	Arthroscopy	Traditional surgery
effect	Dual role of diagnosis and treatment	Only for therapeutic purposes
Wound size	3-4 2-5mm skin incisions	Different types of skin incisions have different sizes, generally more than 5mm
Recovery Time	Can be discharged 3-5 days after surgery	Hospital stay is generally more than half a month
treatment effect	Thorough, safe, and small scars	Thorough treatment, high risk and obvious scars
Clinical application	First choice for famous athletes with knee and naked joint injuries	Gradually replaced
spend	Generally around 8000-10000	More than 10,000 yuan
complication	Few complications and high safety	Many complications and poor safety

Clinical application of arthroscope

Diagnostic role

First, arthroscopy can be used to check various lesions in the articular cavity, to evaluate and record the status of various tissue structures in the joint in detail. Certain joint diseases, such as pigmented villous nodular synovitis, have characteristic arthroscopic manifestations. Almost a diagnosis. At the same time, joint fluid or diseased tissue can be obtained, and pathological tissues can be biopsied under arthroscopic surveillance for further laboratory and pathological examinations.

However, in recent years, various non-invasive examinations have continued to develop, especially the development of imaging examinations such as B-ultrasound, CT, and MRI. Arthroscopy, which is purely used for diagnosis purposes in clinical practice, has been used less and less. However, arthroscope can observe and explore the lesion under direct vision, and has a certain magnifying effect. It can also perform dynamic observation, which has irreplaceable advantages. Therefore, patients who have not been able to determine the cause for a long time after clinical physical examination and various auxiliary examinations are still Has application value.

Therapeutic effect

In addition to its therapeutic effect on a variety of sports injuries, arthroscopy can also play an important role in the surgical treatment of arthritis. According to the literature, arthroscopic technology can be applied to the diagnosis and diagnosis of various arthritis such as osteoarthritis, inflammatory joints, pigmented villous nodular synovitis, crystal arthropathy, infectious arthritis and traumatic arthritis. treatment. For example, for various types of synovitis, arthroscopic synovectomy can be performed, and the knee joint can be removed through the posterior approach to remove the synovial tissue in the posterior joint capsule to achieve the purpose of synovectomy of the total joint capsule. For bony joints, joint cleansing is possible, removing free bodies, removing torn menisci, and trimming the cartilage surface.

3. Applications outside the joint

Arthroscopic technology is particularly suitable for patients with high requirements on the shape of the lesion due to the advantages of small damage and fast recovery, so it has gradually expanded to the treatment of extra-articular cavity diseases in recent years. Following the removal of the steel plate under the microscope, cleaning out the epicondylitis of the humerus and gluteal fascia contracture, one after another came out, he had anterior iliac bursitis, anterior iliac bursal hematoma, subcutaneous hematoma, trochanteric bursitis, superior ganglia calcification, Popliteal cysts, torticollis, and cystic masses on the outer surface of the joints are increasingly treated with arthroscopic surgery. The follow-up results show that this therapy is simple and easy to perform, with small scars, light response, and fast recovery. Not only can it achieve the same results as open surgery, but it also avoids the disadvantages of traditional treatment methods ^[2] .

Arthroscope Maintenance and Care

Before use, you must carefully check whether the structure of the metal part of the arthroscope is smooth, whether the outer tube is tight with the interface, and whether there is water leakage; whether the gap between the metal core and the sheath, the arthroscope and the sheath is even; whether the core rod is in the middle; What is the locking ability of the scope and the sheath; whether the surgical forceps can be opened and closed freely under the protection of the sheath; whether the mirror surface of the arthroscope is damaged or hidden ^[3] .
After each operation, use a soft cloth dipped in soft soap and water to gently scrub the metal parts and rinse with water. The joints of the endoscope and surgical instruments should be wiped with gauze strips or cotton swabs and rinsed. The mirror and lens should be gently wiped with wet cotton. Do not wipe with force. Then, after soaking the enzyme for 10-30 minutes, all instruments were rinsed with distilled water. Arthroscopic metal parts and surgical instruments need to be lubricated with silicone oil after use for the purpose of lubrication and rust prevention. Wipe off the silicone oil with 75% alcohol before disinfection ^[3] .
Use and maintenance of lighting system: In order to ensure the normal operation of arthroscopy during inspection, diagnosis and operation to ensure medical safety, a safety ground wire must be provided in accordance with the specific requirements of lightning protection and disaster reduction, and a regulated power supply must be provided. Safety inspection. The cold light source turns on from weak to strong, and immediately turns off after use. The diameter of the fiber-optic cable coil cannot be less than or equal to 5cm, and it must not be twisted to prevent breakage. After the charger is used up, it should continue to charge for 4-6 hours, and charge it for 30min to 1h before use, in case the battery is exhausted and the planer does not work properly, which affects the operation ^[3] .