Diagnostic arthroscopy of the hip joint

Objective  Refinement of diagnosis of hip disorders with the possibility of adding minimally invasive surgical procedures. Indications  Hip symptoms and effusions not yet diagnosed. Disorders where a decision has to be taken whether to continue conservative care or to proceed with surgery. Intraarticular loose bodies. Labral lesions. Biopsies to establish a diagnosis. Synovial diseases. Localized articular cartilage defects. Purulent arthritis. Contraindications  Recent fracture of acetabulum. Advanced osteoarthritis. Impossibility to distract the joint. Surgical Technique  Supine. Arthrography for imaging of labrum and femoral head. Joint distension. 3-portal technique for arthroscopy of the central compartment of the joint under traction on a fracture table. 2-portal technique for viewing of the peripheral compartment without traction. Both techniques make use of 30° and 70° arthroscopes. Results  Between October 1997 and end of 2000, we performed 60 hip arthroscopies: 34 of the central and peripheral compartments, 16 of only the central and ten of only the peripheral compartment. Besides synovial reactions in all, 15 of 33 hips with early or moderate osteoarthritis showed additional intraarticular lesions. These findings justified an early total hip replacement in six patients. In four out of six patients with unclear hip symptoms, a final diagnosis could be established. In another five patients the diagnosis could be confirmed (4× chondromatosis, and 1× free body). In five patients indication for correctional osteotomy was validated and in one rejected due to advanced articular cartilage damage. Complications: transient hypoesthesia (4×), superficial cartilage damage (7×), instrument breakage (2×), small labral tears (4×), soft tissue edema and early termination of operation (2×).     

Equipment for arthroscopy of the knee joint

Summary Experience with more than 1000 arthroscopies during six years has determined the selection of a basic set of instruments for the procedure which is described in this paper.The equipment comprises two telescopes, with 30° and 70°·angles of vision. The outer sheaths have a diameter of 5 mm. Joint irrigation is performed using an infusion pump and a specially made outflow cannula. Small hooks are used to manipulate the intraarticular structures. Removal of loose bodies has also been performed under direct vision using the arthroscope.

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Résumé L'expérience de plus de 1000 arthroscopies pratiquées en six ans a permis de sélectionner un jeu d'instruments de base pour réaliser la technique décrite dans cet article.L'équipement comporte deux optiques avec un angle de vision de 30° et de 70°. La gaine extérieure a un diamètre de 5 mm. L'irrigation articulaire est effectuée à l'aide d'une pompe à perfusion et d'un trocart de sortie spécialement destiné à cet usage.On utilise de petits crochets pour mobiliser les structures intraarticulaires. On peut également pratiquer l'ablation de corps étrangers sous contrôle de la vue grâce à l'arthroscope.

     

568例膝关节镜检查软骨损伤情况的回顾性分析

[目的]统计膝关节镜检查患者的软骨损伤情况,分析关节软骨损伤的发病率以及分布情况,为临床治疗方案的选择提供依据.[方法]回顾性分析解放军总医院骨科2004年11月-2005年9月间568例膝关节镜检查患者的病例资料,对软骨损伤发生的部位、损伤程度及不同性别、年龄段患者的分布情况进行总结.[结果]389例患者总计存在923处软骨损伤,发病率高达68%,其中以股骨内髁和髌骨关节面损伤最为常见,分别为233、230处,占软骨损伤总数的26%、25%.40岁以上和40岁以下患者的软骨损伤发病率存在明显差异,分别为88%、36.5%(P<0.01).软骨损伤患者中有56.5%年龄处于40～60岁之间,是关节镜检查软骨损伤的主要人群,其中男44例,女168例,此年龄段女性明显多于男性.[结论]膝关节软骨损伤是一种十分普遍的现象,需要引起骨科医师的高度重视,对存在临床症状的患者早期进行关节镜检查并治疗可延缓病情进展,使病人获益.     

Diagnostic arthroscopy of the knee in children and adolescents

There is a definite role for arthroscopy in the diagnosis and treatment of problem knees in children and adolescents. In this series, the largest reported to date, significant intraarticular pathology frequently existed in both preadolescent and adolescent groups. Three hundred ten knee arthroscopies in 285 children were reviewed. Preoperative clinical diagnoses were correlated with arthroscopic findings. In preadolescents (12 years old and younger), only 55% of preoperative clinical diagnoses were confirmed at surgery. Thirty-five percent of this group were found to have additional pathology not anticipated preoperatively. In adolescents (13 to 18 years old), 70% of clinical diagnoses were confirmed arthroscopically. Additional pathology was also found on arthroscopic examination in 25% of this group.     

双切口手术入路在膝关节镜中的应用

目的 探讨应用双切口人路进行关节镜诊治膝关节疾病的疗效。方法 对36例单纯半月板损伤、膝关节内游离体或滑膜皱襞综合征患者应用双切口人路进行治疗。结果全部病例随访8．15个月。按Lysholm膝关节评分标准：优（〉90分）27例,良（80-90分）6例,可（〈80分）3例,优良率91．7％。结论 双切口人路在治疗单纯半月板损伤、膝关节内游离体或滑膜皱襞综合征的关节镜手术中同样可以达到满意的诊断和治疗目的。     

MRI preferable to diagnostic arthroscopy in knee joint injuries a double-blind comparison of 47 patients

We compared the findings of low-field MRI of the knee with those of subsequent arthroscopy. in a double-blind set-up, 47 patients with knee joint injuries were enrolled. Two radiologists independently interpreted the MRI examinations and consensus was obtained in case of discrepancy. Arthroscopy was performed without knowledge of the MRI findings.

The accuracy rates of MRI for evaluating the medial meniscus, lateral meniscus and anterior cruciate ligament were 77%, 91% and 96%, respectively, when arthroscopy was considered the “golden standard”. When MRI was considered the standard, the figures for arthroscopy were 74%, 91% and 96%. MRI found the indication for treatment in 18 of 21 patients who were treated at the arthroscopy. in 17 patients, neither MRI nor arthroscopy detected any lesion. in the remaining 9 patients, MRI demonstrated a lesion, but no lesion was found at the subsequent arthroscopy.

Our conclusion is that low-field MRI can be used as a first-line diagnostic examination in patients with suspected meniscus or cruciate ligament injuries and thus a substantial number of negative diagnostic arthroscopies can be avoided.     

Missile injuries of the knee joint

The results of the treatment of missile injuries of 170 knees in 162 patients are analyzed. The injuries were caused by infantry weapon missiles in 52(32.1%) and by fragments of mine or explosive devices in 110(67.9%) patients. The most frequent were penetrating injuries of the joint with multifragment fractures which in 15.8% cases were associated with injuries of the neurovascular bundle. Stabilization of bone fragments was required in 111(65.3%) knees. Stabilization was done by external fixation in 42(37.8%) and by plaster of Paris in 69(62.2%) knees. Additional mini osteosynthesis was required in 13(30.9%) knees stabilized by external fixation and in 3(4.3%) knees stabilized by plaster of Paris. Amputations were performed in 13(7. 6%) injured knees. During the postoperative period local and general complications occurred in 27(16.6%) patients. The most frequent local complications were suppurative articular infections requiring repeated surgery. Soft tissue defect covering was necessary in 53(33. 1%) patients. The poor late results were present in missile fractures of the knee. The most frequent were degenerative changes with bone defects. The possible surgical solutions in such cases are arthrodesis or total endoprosthesis implantation.     

关节镜在膝关节疾患中的应用体会

目的 总结关节镜诊断和治疗膝关节疾患的临床经验。方法 应用关节镜诊治膝关节疾患87例（93膝）。结果 93膝通过关节镜检查和镜视下手术进一步明确了诊断，综合评分由术有3．8分改善了9．3分，总有效率达94．6％。结论 关节镜对膝关节内疾患的诊断直观，明确，镜视下手术创伤小，并发症少，疗效好。     

The diagnostic value of arthroscopy of the knee joint

One-hundred and fourteen arthroscopies were carried out on 103 patients suffering from injuries of the knee joint. The diagnostic accuracy of the procedure was compared with other diagnostic methods, such as physical examination, arthrography, and arthrotomy. It was found that arthroscopy was as good as arthrotomy and superior to the other methods. Arthroscopy was a safe procedure, and no complications occurred, but it must be stressed that considerable experience is necessary for correct interpretation of the arthroscopic picture.     

关节镜对膝关节训练伤的诊断与治疗

[目的]探讨关节镜对急慢性膝关节损伤的诊断与治疗效果.[方法]对132例急慢性膝关节损伤患者通过关节镜诊断并治疗,分析急慢性膝关节损伤的临床诊断误诊率和治疗效果的差异程度.[结果]急性损伤(受伤3周以内)83例,临床诊断误诊率:ACL 10.8%,PCL 6.0%,半月板损伤15.7%,二联征3.6%,三联征2.4%.慢性损伤49例,临床诊断误诊率:ACL 41%,PCL 2.0%,半月板损伤8.2%,二联征2.0%,三联征2.0%.急性膝关节损伤合并关节软骨损伤7例,损伤软骨面积均在2 cm2以内,程度为Ⅰ～Ⅱ度,占8.4%,慢性损伤合并软骨退变损伤31例,损伤软骨面积从1 cm2到全髁软骨剥脱不等,Ⅰ～Ⅲ度,占63.3%.[结论]急性膝关节损伤应早期行关节镜的检查和治疗,提高诊断正确率,若诊治不及时,演变为慢性关节损伤.对关节不稳定的患者应尽早手术使关节稳定,以减少继发性软骨损伤.     

Diagnostic arthroscopy of the hip joint in pigmented villonodular synovitis

A case of pigmented villonodular synovitis of the hip is presented. The delay between the onset of symptoms and the histopathologic confirmation of this condition generally accounts for the massive local bone invasion, frequently necessitating a total hip arthroplasty. Earlier diagnosis through arthroscopy and subsequent chemical synoviorthesis might reduce the need for more aggressive surgery and improve the prognosis of this rare condition.     

关节镜下治疗膝关节内肿物

正2010年1月~2015年1月,我们采用关节镜下治疗58例膝关节内肿物患者,疗效良好,报道如下。1材料与方法1.1病例资料病例资料来源于沈阳军区总医院骨科。本组58例(68膝),男35例,女23例,年龄19~60岁。其中滑膜软骨瘤病15例(18膝);半月板囊肿15例(15膝);色素沉着绒毛结节性滑膜炎17例(24膝);腱鞘巨细胞瘤11例(11膝)。1.2治疗方法全身麻醉或腰硬联合