Penton Judson L, Flick Travis R, Savoie Felix H, Heard Wendell M, Sherman William F
Louisiana Orthopaedic Specialists, Lafayette, Louisiana, USA.
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Orthop J Sports Med. 2021 Oct 18;9(10):23259671211035454. doi: 10.1177/23259671211035454. eCollection 2021 Oct.
When compared with fluid arthroscopy, carbon dioxide (CO) insufflation offers an increased scope of view and a more natural-appearing joint cavity, and it eliminates floating debris that may obscure the surgeon's view. Despite the advantages of CO insufflation during knee arthroscopy and no reported cases of air emboli, the technique is not widely used because of concerns of hematogenous gas leakage and a lack of case series demonstrating safety.
PURPOSE/HYPOTHESIS: To investigate the safety profile of CO insufflation during arthroscopic osteochondral allograft transplantation of the knee and report the midterm clinical outcomes using this technique. We hypothesized that patients undergoing CO insufflation of the knee joint would have minimal systemic complications, allowing arthroscopic cartilage work in a dry field.
Case series; level of evidence, 4.
A retrospective chart review was performed of electronic medical records for patients who underwent arthroscopic osteochondral allograft transplantation of the knee with the use of CO insufflation. Included were patients aged 18 to 65 years who underwent knee arthroscopy with CO insufflation from January 1, 2015, to January 1, 2021, and who had a minimum follow-up of 24 months. All procedures were performed by a single, fellowship-trained and board-certified sports medicine surgeon. The patients' electronic medical records were reviewed in their entirety for relevant demographic and clinical outcomes.
We evaluated 27 patients (14 women and 13 men) with a mean age of 38 and a mean follow-up of 39.2 months. CO insufflation was used in 100% of cases during the placement of the osteochondral allograft. None of the patients sustained any systemic complications, including signs or symptoms of gas embolism or persistent subcutaneous emphysema.
The results of this case series suggest CO insufflation during knee arthroscopy can be performed safely with minimal systemic complications and provide an alternative environment for treating osteochondral defects requiring a dry field in the knee.
与液体关节镜检查相比，二氧化碳（CO₂）充气可提供更广阔的视野范围和更自然的关节腔外观，并且它能清除可能遮挡外科医生视野的漂浮碎屑。尽管在膝关节镜检查期间CO₂充气具有诸多优势且未报告空气栓塞病例，但由于担心血源性气体泄漏以及缺乏证明安全性的病例系列报道，该技术并未得到广泛应用。
目的/假设：研究膝关节镜下骨软骨异体移植术中CO₂充气的安全性，并报告使用该技术的中期临床结果。我们假设接受膝关节CO₂充气的患者全身并发症极少，从而能在无液体的视野下进行关节镜软骨手术。
病例系列；证据等级，4级。
对使用CO₂充气进行膝关节镜下骨软骨异体移植的患者电子病历进行回顾性图表审查。纳入2015年1月1日至2021年1月1日期间接受膝关节镜CO₂充气且年龄在18至65岁之间、至少随访24个月的患者。所有手术均由一名经过专科培训且获得委员会认证的运动医学外科医生进行。对患者的电子病历进行全面审查以获取相关人口统计学和临床结果。
我们评估了27例患者（14名女性和13名男性），平均年龄为38岁，平均随访39.2个月。在骨软骨异体移植放置过程中，100%的病例使用了CO₂充气。所有患者均未出现任何全身并发症，包括气体栓塞的体征或症状或持续性皮下气肿。
该病例系列结果表明，膝关节镜检查期间进行CO₂充气可安全进行，全身并发症极少，并为治疗膝关节需要无液体视野的骨软骨缺损提供了一种替代环境。
