Joyce M J, Mankin H J
J Bone Joint Surg Am. 1983 Mar;65(3):289-92.
In the period from 1977 to 1981, eleven patients with a primary bone neoplasm and one with a bone abscess, located in the shaft or distal end of the femur or the proximal part of the tibia, were referred to the Massachusetts General Hospital Orthopaedic Oncology Unit. All had had diagnostic or therapeutic arthroscopy. For one of the patients no roentgenograms had been made prior to arthroscopy. For another, roentgenograms had been made but were not repeated prior to the arthroscopy three months later. In six patients the lesions were clearly evident on the roentgenograms; they were not reported in four patients, while in two patients the lesions were not considered to be a contraindication to arthroscopy. Two lesions were located in the femoral shaft and one was in the popliteal space, but they had not been noted by the surgeon or radiologist. In four patients the lesion arising from the bone was biopsied through the arthroscope, introducing tumor cells into the joint and theoretically causing synovial seeding of the lesion. The problems raised by this study are obvious to all orthopaedic surgeons who perform arthroscopy. Any patient who is thought to have an intra-articular lesion must first be fully evaluated by history, physical examination, and, most importantly, appropriate biplane roentgenograms prior to the performance of any procedure. If a lesion arising from the bone is encountered during an arthroscopic procedure, the lesion must be biopsied not transsynovially, but through a separate extracapsular approach.
在1977年至1981年期间，11例原发性骨肿瘤患者和1例骨脓肿患者被转诊至麻省总医院骨科肿瘤病房，病变位于股骨干或远端或胫骨近端。所有患者均接受了诊断性或治疗性关节镜检查。其中1例患者在关节镜检查前未进行X线检查。另一例患者曾进行过X线检查，但在三个月后的关节镜检查前未再次进行。6例患者的病变在X线片上清晰可见；4例患者未报告病变情况，而2例患者的病变未被认为是关节镜检查的禁忌证。2处病变位于股骨干，1处位于腘窝，但外科医生或放射科医生未注意到。4例患者通过关节镜对骨源性病变进行了活检，将肿瘤细胞引入关节，理论上导致了病变的滑膜播散。这项研究提出的问题对于所有进行关节镜检查的骨科医生来说都是显而易见的。任何被认为有关节内病变的患者，在进行任何手术之前，都必须首先通过病史、体格检查，最重要的是通过适当的双平面X线片进行全面评估。如果在关节镜手术过程中遇到骨源性病变，必须通过单独的关节外途径而不是经滑膜进行活检。
