Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
BMC Surg. 2023 Feb 10;23(1):35. doi: 10.1186/s12893-023-01929-4.
Efficient and complete debridement of intra-articular deposits of monosodium urate crystals is rarely achieved by existing arthroscopic tools such as shavers or radiofrequency ablation, while cavitation technology represents a prospective solution for the non-invasive clearance of adhesions at intra-articular interfaces.
Simulation modeling was conducted to identify the optimal parameters for the device, including nozzle diameters and jet pressures. Gouty arthritis model was established in twelve rats that were equally and randomly allocated into a cavitation debridement group or a curette debridement group. A direct injection nozzle was designed and then applied on animal model to verify the effect of the cavitation jet device on the removal of crystal deposits. Image analysis was performed to evaluate the clearance efficiency of the cavitation device and the pathological features of surrounding tissue were collected in all groups.
To maximize cavitation with the practical requirements of the operation, an experimental rig was applied, including a 1 mm direct injection nozzle with a jet pressure of 2.0 MPa at a distance of 20 mm and a nitrogen bottle as high-pressure gas source. With regards to feasibility of the device, the clearance rates in the cavitation group were over 97% and were significantly different from the control group. Pathological examination showed that the deposition of monosodium urate crystals was removed completely while preserving the normal structure of the collagen fibers.
We developed a promising surgical device to efficiently remove intra-articular deposits of monosodium urate crystals. The feasibility and safety profile of the device were also verified in a rat model. Our findings provide a non-invasive method for the intraoperative treatment of refractory gouty arthritis.
现有的关节镜工具（如刨削器或射频消融）很少能有效地彻底清除单钠尿酸盐晶体的关节内沉积物，而空化技术代表了一种用于非侵入性清除关节内界面粘连的有前景的解决方案。
进行模拟建模以确定设备的最佳参数，包括喷嘴直径和射流压力。在 12 只大鼠中建立痛风性关节炎模型，这些大鼠被平均且随机分配到空化清创组或刮匙清创组。设计了一种直接喷射喷嘴，并将其应用于动物模型，以验证空化射流装置对晶体沉积物清除的效果。进行图像分析以评估空化装置的清除效率，并收集所有组的周围组织的病理特征。
为了在操作的实际要求下最大限度地产生空化，应用了一个实验装置，包括一个 1mm 的直接喷射喷嘴，在 20mm 的距离处具有 2.0MPa 的射流压力和一个氮气瓶作为高压气源。就设备的可行性而言，空化组的清除率超过 97%，与对照组有显著差异。病理检查显示，单钠尿酸盐晶体的沉积被完全清除，同时保留了胶原纤维的正常结构。
我们开发了一种有前途的手术设备，可有效地清除关节内的单钠尿酸盐晶体沉积物。该设备的可行性和安全性在大鼠模型中也得到了验证。我们的研究结果为难治性痛风性关节炎的术中治疗提供了一种非侵入性方法。
