Spahn G, Felmet G, Baumgarten G, Plettenberg H, Hoffmann M, Klinger H M, Hofmann G O
Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach.
Z Orthop Unfall. 2013 Feb;151(1):31-7. doi: 10.1055/s-0032-1327873. Epub 2013 Jan 17.
Damage to hyaline cartilage is the most important pathophysiological tool in the development of osteoarthritis. Cartilage lesions are the most frequent pathological findings during arthroscopic operations. Arthroscopies as well as magnetic resonance tomography are gold standards for detection of cartilage lesions. But the arthroscopic evaluation of cartilage lesions is descriptive and subjective only. The surgeon is able to differentiate between intact cartilage surface, softening, superficial or deep fissure or flake and finally a complete defect. In routine arthroscopy the grading mostly is made by use of different scores [e.g. ICRS (International Cartilage Repair Society), Outerbridge, Insall, Jäger-Wirth or others]. Because the arthroscopic evaluation is subjective the reliability of this method is poor. Spectroscopic methods are established for evaluation of different tissue diseases in different indications. NIRS (near infrared spectroscopy) has become an important method for medical diagnostics in the last years. NIR is very energy-rich and suitable for glass fibre transport without relevant reduction. Insofar this technology may be ideal for endoscopic procedures. Our systematic literature review reveals that NIRS is a sufficient method for an objective diagnosis of cartilage lesions. In the current work we demonstrate an NIRS-based device for intraoperative, real-time cartilage evaluation. Furthermore, we discuss the possible clinical consequences from such measurements.
透明软骨损伤是骨关节炎发展过程中最重要的病理生理因素。软骨损伤是关节镜手术中最常见的病理表现。关节镜检查以及磁共振成像都是检测软骨损伤的金标准。但是对软骨损伤的关节镜评估仅仅是描述性的且主观的。外科医生能够区分完整的软骨表面、软化、浅表或深部裂隙或碎片，最终是完全缺损。在常规关节镜检查中，分级大多使用不同的评分系统（如国际软骨修复协会（ICRS）、Outerbridge、Insall、Jäger-Wirth等）。由于关节镜评估是主观的，所以这种方法的可靠性较差。光谱方法已被确立用于评估不同适应症下的各种组织疾病。近红外光谱（NIRS）在过去几年已成为医学诊断的重要方法。近红外能量非常丰富，适合通过玻璃纤维传输且能量无显著衰减。就此而言，这项技术可能非常适合内镜手术。我们的系统文献综述表明，近红外光谱是客观诊断软骨损伤的一种充分方法。在当前工作中，我们展示了一种基于近红外光谱的术中实时软骨评估设备。此外，我们还讨论了这些测量可能产生的临床后果。
