Altman R D, Gray R
Am J Med. 1983 Oct 31;75(4B):50-5. doi: 10.1016/0002-9343(83)90328-5.
Both the technique and the technology involved in knee arthroscopy have undergone considerable development over the last 10 years. Diagnostically, the procedure allows visualization of synovium, hyaline cartilage, fibrocartilage (menisci), and ligaments (cruciate, patellofemoral alignment). Synovitis of rheumatoid arthritis is suspected by boggy, hyperemic, and edematous hypervilli that may undergo necrosis. In osteoarthritis, the synovium is often mildly inflamed and the cartilage demonstrates ulcerations, yellowing, softening, and areas of denuded bone. Synovectomy for rheumatoid arthritis was first performed about 1900. The apparent reduction in morbidity resulting from performing synovectomy through the arthroscope accounts for the resurgence of interest in this procedure. Removal of loose bodies, fragments of cartilage, or synovium helps to reduce synovitis and symptoms in both rheumatoid arthritis and osteoarthritis. Shaving of articular cartilage is often performed in patients with osteoarthritis. There is a suggestion that coring or shaving osteoarthritic denuded bone stimulates repair of a type of fibrocartilage that may be functional. Surgical technology and technique in the field of arthroscopy are advancing faster than the clinical studies necessary to prove their value. Guidelines for the use of these potentially destructive techniques are still needed. Arthroscopy is a rapidly developing field in medicine. The next 10 years will almost assuredly provide enhanced diagnostic and surgical capabilities with reduced morbidity in the rheumatic diseases, and particularly in rheumatoid arthritis and osteoarthritis.
在过去10年里，膝关节镜检查所涉及的技术和工艺都有了长足的发展。在诊断方面，该手术可观察滑膜、透明软骨、纤维软骨（半月板）和韧带（十字韧带、髌股关节对线）。类风湿关节炎的滑膜炎表现为滑膜肿胀、充血、水肿及绒毛增生，严重时可发生坏死。骨关节炎时，滑膜常轻度发炎，软骨可见溃疡、变黄、软化及骨质裸露区。类风湿关节炎的滑膜切除术最早于1900年左右开展。通过关节镜进行滑膜切除术，其发病率明显降低，这使得人们对该手术重新产生了兴趣。清除游离体、软骨碎片或滑膜有助于减轻类风湿关节炎和骨关节炎的滑膜炎及症状。骨关节炎患者常进行关节软骨刨削术。有观点认为，对骨关节炎的裸露骨质进行钻孔或刨削可刺激一种可能具有功能的纤维软骨修复。关节镜领域的手术技术和工艺发展速度超过了证明其价值所需的临床研究。目前仍需要关于这些具有潜在破坏性技术使用的指南。关节镜检查是医学中一个快速发展的领域。未来10年几乎肯定会在风湿性疾病，尤其是类风湿关节炎和骨关节炎方面，提供增强的诊断和手术能力，同时降低发病率。
