Arthroscopic use of arthroscopy

The miniaturization of arthroscopy has made it possible to simplify the operation to outpatient and local anesthesia, but we still use ordinary knee arthroscopy, which is performed in the operating room. The steps are briefly described below.

Under continuous epidural anesthesia, place the affected limb on the operating table, perform joint puncture in the suprapatellar bursa with an epidural needle, extract the exudate, and inject normal saline into the joint to expand the joint cavity (the suspension height of the saline bottle). Generally, it is about 1m higher than the knee joint). The puncture point was selected at the center of the triangle formed by the lateral border of the patellar tendon, the anterior border of the lateral malleolus of the femur, and the upper border of the tibia. First, make a small incision of about 0.5cm in the skin, then puncture with a trocar that matches the diameter of the arthroscope, remove the sharp obturator, replace it with a blunt obturator, and insert the arthroscope into the joint cavity. The order of observation is as follows: Superior synovial fold - patellofemoral joint - medial recess (medial wall, medial patellar synovial fold, recess surface of medial malleolus) - medial tibiofemoral joint (medial meniscus, anterior inferior aspect of medial malleolus and opposite tibial articular surface ) - to the suprapatellar capsule - lateral tibiofemoral joint (lateral meniscus, anterior and inferior lateral femoral malleolus and the opposite cavity bone) - lateral recess (lateral medial wall, recess surface of lateral femoral condyle, muscle health). The above can be photographed. Finally, a biopsy can be done. After washing, drain the filling fluid, pull out the trocar, and suture the skin incision. There are different opinions on whether to use a tourniquet during arthroscopy. The author believes that it is better not to use a tourniquet at the beginning of the microscopic examination, so that the structure of the intra-articular tissue can maintain a normal appearance, and it is easy to judge the normal or abnormal tissue. For arthroscopic surgery (including membrane biopsy) for diagnosis, about one hour of operation is sufficient; if the therapeutic operation is to be continued, a tourniquet is required.

Synovial pathological examination is an important step in the diagnosis of joint disease. After the joint examination is completed, synovial biopsy is generally performed at the same time. There are three methods for synovial biopsy: (1) Blind inspection: when the arthroscopy is completed, withdraw the mirror from the cannula, insert the biopsy forceps, feel the head of the biopsy forceps through the skin with the other hand, and do the biopsy. ② If a special lesion area has been seen under the microscope, the original scope can be withdrawn from the casing, and a small arthroscope with biopsy forceps can be replaced, and the operation can be performed under direct vision. ③ If the operator wants to keep the observed lesions in the visual field, he can insert the biopsy through the second puncture port.

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