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[膝关节损伤的诊断性关节镜检查]

[Diagnostic arthroscopy in injuries of the knee joint].

作者信息

Glinz W

机构信息

Klinik für Unfallchirurgie, Department Chirurgie, Universitätsspital Zürich.

出版信息

Zentralbl Chir. 1989;114(17):1121-32.

PMID:2686286
Abstract

Diagnostic arthroscopy is indicated, if other methods of diagnosis have reached their limits. It has become indispensable to proper assessment of injuries of the menisci, cartilage, synovial folds, and plicae and for suspicion of isolated cruciate knee ligament rupture. The practicability or impracticability of an arthroscopic operation in a given case, of course, has bearings upon indication for diagnostic arthroscopy. Patients are usually examined in general anaesthesia, with the joint filled with liquid, using a 30-degree widle-angle lens and a video system. Probing of intra-articular structures is absolutely necessary. The following two specific groups of indications have gained particular importance in knee injuries: Acute arthroscopy is imperative in any case of hemarthrosis with unknown aetiology (ligament injuries were found in 67 per cent of these patients), and it is the diagnostic and therapeutic procedure of choice in acute locking of the knee. Diagnostic arthroscopy should be followed by re-arthroscopy, if the further clinical course cannot be explained by the findings already recorded or in case of new symptoms or additional symptoms in the wake of arthroscopic operation or if major symptoms persist. In the latter case, re-arthroscopy should be performed not later than four to six months from first treatment. Re-arthroscopy revealed a need for another arthroscopic operation after earlier diagnostic arthroscopy in 48 per cent of all cases and after previous arthroscopic operation in 63 per cent.

摘要

如果其他诊断方法已达到其极限,则需进行诊断性关节镜检查。对于半月板、软骨、滑膜皱襞和滑膜襞襞损伤的正确评估以及怀疑孤立性膝关节韧带断裂时,它已变得不可或缺。当然,在特定病例中关节镜手术的可行性或不可行性与诊断性关节镜检查的指征有关。患者通常在全身麻醉下进行检查,关节内充满液体,使用30度广角镜头和视频系统。对关节内结构进行探查是绝对必要的。在膝关节损伤中,以下两组特定的指征尤为重要:对于任何病因不明的关节积血病例(这些患者中有67%发现韧带损伤),急性关节镜检查是必不可少的,并且它是膝关节急性绞锁的诊断和治疗首选方法。如果进一步的临床病程无法用已记录的检查结果解释,或者在关节镜手术后出现新症状或额外症状,或者主要症状持续存在,则诊断性关节镜检查后应进行再次关节镜检查。在后一种情况下,再次关节镜检查应在首次治疗后不迟于四至六个月进行。在所有病例中,48%的患者在早期诊断性关节镜检查后以及63%的患者在先前关节镜手术后,再次关节镜检查显示需要再次进行关节镜手术。

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