Tuijthof G J M, Dusée L, Herder J L, van Dijk C N, Pistecky P V
Man-Machine Systems and Control, Department of Design, Engineering, and Production, Delft University of Technology, Delft, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2005 Apr;13(3):238-46. doi: 10.1007/s00167-004-0573-x. Epub 2005 Jan 4.
In the literature, no consensus exists about optimal irrigation of joints during arthroscopic operations. The goal of this paper is to study the behavior of irrigation systems resulting in the proposal of guidelines for optimal irrigation. To this end, optimal irrigation is defined as the steady state of irrigation of a joint in which a sufficient positive intra-articular pressure and a sufficient flow are maintained. A model of the complete irrigation system was created to schematically elucidate the behavior of pump systems. Additionally, clinical experiments were performed during arthroscopic knee operations in which the pressure at different locations and the irrigation flow were measured. The combination of model prediction and clinical results could well be used to derive guidelines, since the clinical results, which showed considerable variation, were used to verify the model, and the model could be used to explain the typical trends. The main findings are twofold the set pressure is always higher than the intra-articular pressure, and the scope-sheath combination has a significant influence on irrigation control, because of its large restriction. Based on the results, we advice to increase the set pressure during active suction, and to include the sheath-scope combination in the control loop.
在文献中，关于关节镜手术期间关节的最佳冲洗方法尚无共识。本文的目的是研究冲洗系统的性能，从而提出最佳冲洗的指导原则。为此，将最佳冲洗定义为关节冲洗的稳定状态，即在该状态下维持足够的关节内正压和足够的流量。创建了完整冲洗系统的模型，以示意性地阐明泵系统的性能。此外，在关节镜膝关节手术期间进行了临床实验，测量了不同位置的压力和冲洗流量。模型预测和临床结果的结合可很好地用于得出指导原则，因为临床结果显示出很大差异，可用于验证模型，而模型可用于解释典型趋势。主要发现有两点：设定压力始终高于关节内压力，并且鞘管组合因其较大的阻力而对冲洗控制有重大影响。基于这些结果，我们建议在主动抽吸期间提高设定压力，并将鞘管组合纳入控制回路。
