Lu Yan, Bogdanske John, Lopez Monica, Cole Brian J, Markel Mark D
Comparative Orthopaedic Research Laboratory, Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53706-11102, USA.
Arthroscopy. 2005 May;21(5):592-6. doi: 10.1016/j.arthro.2005.02.013.
To determine joint fluid temperatures at different time intervals during treatment with radiofrequency energy (RFE) applied in intermittent and continuous treatment manners under flow or no-flow conditions using a simulated shoulder joint model.
In vitro measurement of simulated joint fluid temperature during RFE treatment.
A custom-built jig with a chamber (volume size, 25 mL) was used to mimic the adult human shoulder. Three RFE systems: Vulcan EAS plus TAC-S probe (Smith & Nephew Endoscopy, Andover, MA); VAPR II plus End-Effect Electrode (Mitek, Westwood, MA); and ArthroCare 2000 plus TurboVac 90 degrees probe (ArthroCare, Sunnyvale, CA) were tested in the chamber with saline solution initially set at 23 degrees C. Each RFE probe was applied in a paintbrush pattern on the capsular tissue in the chamber and a fluoroptic thermometry probe was placed 1 cm above the RFE treatment probe to record the fluid temperature. Both intermittent and the continuous treatment manners were tested under flow and no-flow conditions. For each probe/manner/flow combination, 6 bovine capsular tissue specimens were tested (n = 6). All data were recorded using a HyperTerminal software program (Hilgraeve Inc, Monroe, MI) into a personal computer.
When using intermittent and continuous treatment manners with flow, all recorded chamber fluid temperatures for all tested RFE probes at each time interval were below 40 degrees C. Under no-flow conditions, with intermittent treatment, the ArthroCare probe caused joint fluid temperatures to exceed 50 degrees C after 70 seconds of RFE treatment. With the continuous treatment, the ArthroCare caused chamber fluid temperatures to exceed 65 degrees C after 2 minutes of treatment. The highest mean recorded chamber fluid temperature was caused by ArthroCare probe, which reached 80 degrees C at 3 minutes. For all probes, continuous treatment caused significantly higher chamber fluid temperatures than intermittent treatment.
The results of this study indicate that using flow during thermal capsulorrhaphy could lower joint fluid temperature to prevent heated joint fluid from killing chondrocytes of articular cartilage, and the intermittent treatment manner caused lower fluid temperature compared with continuous treatment within the RFE-treated shoulder joint.
Articular cartilage of the humeral head may suffer potential thermal injury from heating of joint fluid during RFE thermal capsulorrhaphy.
使用模拟肩关节模型，确定在有或无液体流动条件下，以间歇性和连续性方式施加射频能量（RFE）治疗期间不同时间间隔的关节液温度。
RFE治疗期间模拟关节液温度的体外测量。
使用一个带有腔室（容积大小为25毫升）的定制夹具来模拟成人的肩关节。测试了三种RFE系统：Vulcan EAS plus TAC-S探头（史赛克内窥镜公司，马萨诸塞州安多弗）；VAPR II plus End-Effect电极（Mitek公司，马萨诸塞州韦斯特伍德）；以及ArthroCare 2000 plus TurboVac 90度探头（ArthroCare公司，加利福尼亚州桑尼维尔），腔室内的盐溶液初始温度设定为23摄氏度。每个RFE探头以画笔涂抹的方式应用于腔室内的关节囊组织，并且在RFE治疗探头上方1厘米处放置一个荧光光学温度计探头以记录液体温度。在有液体流动和无液体流动条件下都测试了间歇性和连续性治疗方式。对于每个探头/方式/流动组合，测试了6个牛关节囊组织标本（n = 6）。所有数据都使用HyperTerminal软件程序（Hilgraeve公司，密歇根州门罗）记录到个人计算机中。
当在有液体流动的情况下使用间歇性和连续性治疗方式时，在每个时间间隔，所有测试的RFE探头记录的腔室液体温度均低于40摄氏度。在无液体流动条件下，采用间歇性治疗时，ArthroCare探头在RFE治疗70秒后导致关节液温度超过50摄氏度。采用连续性治疗时，ArthroCare探头在治疗2分钟后导致腔室液体温度超过65摄氏度。记录到的最高平均腔室液体温度是由ArthroCare探头引起的，在3分钟时达到80摄氏度。对于所有探头，连续性治疗导致的腔室液体温度显著高于间歇性治疗。
本研究结果表明，在热关节囊缝合术中使用液体流动可以降低关节液温度，以防止加热的关节液杀死关节软骨的软骨细胞，并且在RFE治疗的肩关节内，间歇性治疗方式导致的液体温度低于连续性治疗。
在RFE热关节囊缝合术中，肱骨头的关节软骨可能因关节液加热而遭受潜在的热损伤。
