Basel University Hospital, Basel, Switzerland.
Schulthess Clinic, Zürich, Switzerland.
J Shoulder Elbow Surg. 2020 Dec;29(12):2626-2631. doi: 10.1016/j.jse.2020.03.039. Epub 2020 Jun 9.
Extra-articular fluid extravasation is a known complication during shoulder arthroscopy. The risk and amount of extravasation to a large degree is dependent on the fluid pressure delivered to the surgical site. Accurate measurement, knowledge, and control of the pressure delivered is thus important to surgeons, anesthetists, and the patient. The purpose of this study was to compare the pressure measurement accuracy of 3 arthroscopic fluid pumps, with 2 of them having 2 different settings.
Twenty-five patients (n = 5 per group) undergoing shoulder arthroscopy were selected. Three different arthroscopic fluid pumps (ConMed 24K, Stryker Crossflow, Arthrex Dual Wave) were tested in 5 different operational settings (Stryker, standard and dynamic mode; ConMed, with and without TIPS; Arthrex Dual Wave). In each operation, the set pump pressures and the subsequently delivered intra-articular surgical site fluid pressures were measured by a spinal needle connected to an anesthetic standard pressure transducer attached to the anesthetic machine. Independent measures of the surgical site pressures were obtained before multiple portals were created or extravasation had occurred. Measurements were taken at the beginning of surgery.
Measurements of the mean intra-articular pressure were found to not be significantly different from the set pressure for the ConMed 24K with TIPS (0.98 ± 0.02-fold) and Stryker Crossflow in standard mode (0.98 ± 0.02-fold). However, actual pressure was significantly greater than the set pressure for the ConMed 24K without TIPS (by 1.30 ± 0.13-fold), Stryker Crossflow in dynamic mode (by 1.82 ± 0.08-fold), and Arthrex Dual Wave (by 2.19 ± 0.06-fold).
Independently measured intra-articular pressure can be more than double the set pressure for some arthroscopic pumps. Measuring intra-articular pressure can thus aid in adjusting the set pressure. This could minimize the risk of intraoperative complications.
关节外液外渗是肩关节镜检查中已知的并发症。在很大程度上，外渗的风险和量取决于输送到手术部位的流体压力。因此，准确测量、了解和控制输送的压力对外科医生、麻醉师和患者都很重要。本研究的目的是比较 3 种关节镜下液体泵的压力测量准确性，其中 2 种有 2 种不同的设置。
选择了 25 名（每组 5 名）接受肩关节镜检查的患者。在 5 种不同的操作设置下（Stryker，标准和动态模式；ConMed，带和不带 TIPS；Arthrex Dual Wave）测试了 3 种不同的关节镜下液体泵（ConMed 24K、Stryker Crossflow、Arthrex Dual Wave）。在每次手术中，通过与麻醉标准压力换能器相连的椎管内针测量设定的泵压和随后输送到关节内手术部位的流体压力，该压力换能器连接到麻醉机上。在创建多个端口或发生外渗之前，对手术部位压力进行独立测量。在手术开始时进行测量。
发现 ConMed 24K 带 TIPS（0.98±0.02 倍）和 Stryker Crossflow 标准模式（0.98±0.02 倍）的实际关节内压力与设定压力无显著差异。然而，ConMed 24K 不带 TIPS（1.30±0.13 倍）、Stryker Crossflow 动态模式（1.82±0.08 倍）和 Arthrex Dual Wave（2.19±0.06 倍）的实际压力明显大于设定压力。
对于一些关节镜下的泵，独立测量的关节内压力可能是设定压力的两倍以上。因此，测量关节内压力可以帮助调整设定压力。这可以最大程度地降低术中并发症的风险。
