Wright I M, Smith M R W, Humphrey D J, Eaton-Evans T C J, Hillyer M H
Reynolds House Referrals, Greenwood Ellis & Partners, 166 High Street, Newmarket, Suffolk CB8 9WS, UK.
Equine Vet J. 2003 Sep;35(6):613-9. doi: 10.2746/042516403775467225.
Contamination and infection of synovial cavities are a common occurrence in clinical practice and, if inadequately treated, may have career or life threatening consequences for affected horses.
The objectives in treating contamination and infection of joints, tendon sheaths and bursae are most effectively met by endoscopic surgery.
Over a 6 year period, cases of synovial contamination and infection admitted to a referral clinic were evaluated and treated endoscopically. The horses received local and systemic antimicrobial drugs with minimal nonsteroidal anti-inflammatory medication but no other medical or surgical treatment. All arthroscope and instrument portals and, whenever possible, all traumatic wounds were closed. Diagnostic information, endoscopic observations and results of treatment were evaluated retrospectively.
A total of 140 affected animals were referred and 121 cases were treated endoscopically. These involved 70 joints, 29 tendon sheaths, 10 bursae and in 12 cases a combination of synovial cavities. The most common aetiologies were open wounds (n = 54) and self-sealing punctures (n = 41). Foreign material was identified endoscopically in 41 but predicted prior to surgery in only 6 cases. Osteochondral lesions were evident at surgery in 51 and recognised before surgery in 25 cases; 32 horses had intrathecal tendon or ligament defects. Follow-up information was obtained for 118 animals; 106 (90%) survived and 96 (81%) returned to their preoperative level of performance. The presence of osteitis/osteomyelitis, other osteochondral lesions and marked deposits of pannus were associated with nonsurvival. For those animals which survived, non-Thoroughbred horses, a combination of synovial structure involvement and regional i.v. antimicrobial administration were associated with reduced post operative performance. Marked pannus, regional i.v. antimicrobial administration and duration of systemic antimicrobial administration were associated with a group combining nonsurviving animals and those with reduced post operative performance.
Endoscopic surgery makes a valuable contribution to the management of synovial contamination and infection.
The information obtained from and therapeutic options offered by endoscopy justify its early use in cases of synovial contamination and infection.
滑膜腔的污染和感染在临床实践中很常见，若治疗不当，可能会对患病马匹造成危及职业生涯或生命的后果。
通过内镜手术能最有效地实现治疗关节、腱鞘和滑囊污染及感染的目标。
在6年期间，对转诊至一家专科诊所的滑膜污染和感染病例进行评估并实施内镜治疗。马匹接受局部和全身抗菌药物治疗，同时尽量减少非甾体抗炎药的使用，未接受其他药物或手术治疗。所有关节镜和器械入口以及所有创伤性伤口尽可能进行缝合。对诊断信息、内镜观察结果和治疗效果进行回顾性评估。
共转诊140只患病动物，其中121例接受了内镜治疗。这些病例涉及70个关节、29个腱鞘、10个滑囊，12例为多个滑膜腔合并感染。最常见的病因是开放性伤口（n = 54）和自封性穿刺伤（n = 41）。内镜检查发现41例存在异物，但术前仅预测到6例。手术中发现51例存在骨软骨损伤，术前诊断出25例；32匹马存在鞘内肌腱或韧带缺损。获得了118只动物的随访信息；106只（90%）存活，96只（81%）恢复到术前的运动水平。存在骨炎/骨髓炎、其他骨软骨损伤和明显的血管翳沉积与死亡相关。对于存活的动物，非纯种马、滑膜结构受累和局部静脉注射抗菌药物与术后运动水平下降有关。明显的血管翳、局部静脉注射抗菌药物和全身抗菌药物使用时间与死亡动物及术后运动水平下降的动物组合有关。
内镜手术对滑膜污染和感染的治疗有重要贡献。
内镜检查所获得的信息及提供的治疗选择证明其在滑膜污染和感染病例中应尽早使用。
