Kane D, Veale D J, FitzGerald O, Reece R
Department of Rheumatology, St Vincent's University Hospital, Dublin 4, Ireland.
Rheumatology (Oxford). 2002 Feb;41(2):210-5. doi: 10.1093/rheumatology/41.2.210.
To determine the international distribution and practice of arthroscopy performed by rheumatologists and to evaluate proposed guidelines on minimum standards for training in arthroscopy in the context of current clinical practice.
A questionnaire was sent to all rheumatology centres identified as practising arthroscopy, by (i) searching Medline from 1966 to 1999, (ii) searching the abstract books of the annual general meetings of ACR, BSR and EULAR from 1980 to 1999, and (iii) correspondence with all the centres identified.
Thirty-six rheumatology centres were confirmed as performing arthroscopy (24 in Europe, 10 in USA and two in Australia) and 33 (92%) centres completed the questionnaire. Twenty-five (76%) of the 33 centres performing arthroscopy had started to perform it since 1990 and 72 rheumatologists are now trained in arthroscopy. A total of 16532 arthroscopies had been performed (median=220 arthroscopies/centre, range 20-5000); 50.5% of the arthroscopies had a primary clinical indication and 49.5% had a primary research indication. Most centres fulfilled the minimum standards for arthroscopic facilities and the proposed minimum standards in training were acceptable to 76% of respondents. Complication rates were calculated for 15682 arthroscopies where routine follow-up data were available [joint infection, 16 (0.1%); wound infection, 17 (0.1%); haemarthrosis, 141 (0.9%); deep venous thrombosis, 31 (0.2%); neurological damage, 3 (0.02%), thrombophlebitis, 12 (0.08%), other, 8 (0.06%)]. Irrigation volume correlated with wound infection rate (r=0.41, P=0.03) and centres performing cartilage biopsy had a higher rate of haemarthrosis (P=0.007).
The last decade has seen rapid growth in arthroscopy performed by rheumatologists in an out-patient setting under local and regional anaesthesia. Proposed minimum standards for training in rheumatological arthroscopy reflect current practice accurately and are acceptable to the majority of arthroscopists. Complication rates of rheumatological arthroscopy are similar to those reported in the orthopaedic literature.
确定风湿病学家进行关节镜检查的国际分布情况及实际操作，并在当前临床实践背景下评估关于关节镜检查培训最低标准的拟议指南。
通过以下方式向所有被确定为开展关节镜检查的风湿病中心发送问卷：（i）检索1966年至1999年的医学索引数据库；（ii）检索1980年至1999年美国风湿病学会、英国风湿病学会和欧洲抗风湿病联盟年度大会的摘要集；（iii）与所有确定的中心进行通信联系。
确认有36个风湿病中心开展关节镜检查（欧洲24个，美国10个，澳大利亚2个），33个（92%）中心完成了问卷。33个开展关节镜检查的中心中有25个（76%）自1990年起开始进行此项检查，目前有72名风湿病学家接受了关节镜检查培训。总共进行了16532例关节镜检查（中位数=每个中心220例，范围20 - 5000例）；50.5%的关节镜检查有主要临床指征，49.5%有主要研究指征。大多数中心符合关节镜检查设施的最低标准，76%的受访者认可拟议的培训最低标准。对15682例有常规随访数据的关节镜检查计算了并发症发生率[关节感染16例（0.1%）；伤口感染17例（0.1%）；关节积血141例（0.9%）；深静脉血栓形成31例（0.2%）；神经损伤3例（0.02%），血栓性静脉炎12例（0.08 %），其他8例（0.06%）]。灌洗量与伤口感染率相关（r = 0.41，P = 0.03），进行软骨活检的中心关节积血发生率较高（P = 0.007）。
在过去十年中，风湿病学家在局部和区域麻醉下的门诊环境中进行的关节镜检查迅速增长。拟议的风湿病学关节镜检查培训最低标准准确反映了当前实践，并且大多数关节镜检查医生可以接受。风湿病学关节镜检查的并发症发生率与骨科文献报道的相似。
