Pagnamenta M, Kieser C
Schweiz Med Wochenschr. 1982 Oct 2;112(40):1369-75.
174 knee joints with non-traumatic effusion have been examined by arthroscopy. In 71 cases synovial biopsy was performed. 43% of the knees had cartilaginous damage of the patella or tibiofemoral joint, 19% had an old meniscal and/or ligamentous tear and 33% a "non-specific" synovitis. The remaining 5% comprise 5 patients with pigmented villonodular synovitis, 3 patients with gout, one with synovial tuberculosis and one with a hemangioma of synovial membrane. Arthroscopy serves for early recognition of degeneration of hyalin cartilage and meniscal lesions, while synovial biopsies are also largely non-traumatic. Endoscopic evaluation of synovial membrane is more difficult. Mechanical irritation produces proliferation of synovial villi, while bacterial and rheumatoid inflammation leads to exudative and necrotic changes. The differences are obvious in marked inflammation but difficult to recognize in the beginning of any process. Arthroscopic and histological examination determines the etiology of synovitis only in pigmented villonodular synovitis and synovial tuberculosis. In the other forms of synovitis it is only possible to determine the stage and intensity of inflammation but not the etiology. The diagnosis of rheumatoid arthritis in particular is seldom secured by arthroscopy.
对174例非创伤性膝关节积液患者进行了关节镜检查。其中71例进行了滑膜活检。43%的膝关节存在髌骨或胫股关节软骨损伤，19%存在陈旧性半月板和/或韧带撕裂，33%存在“非特异性”滑膜炎。其余5%包括5例色素沉着绒毛结节性滑膜炎患者、3例痛风患者、1例滑膜结核患者和1例滑膜血管瘤患者。关节镜检查有助于早期识别透明软骨退变和半月板损伤，而滑膜活检在很大程度上也是无创的。对滑膜进行内镜评估则较为困难。机械性刺激会导致滑膜绒毛增生，而细菌和类风湿性炎症会导致渗出性和坏死性改变。在明显的炎症中差异明显，但在任何过程开始时都难以识别。关节镜检查和组织学检查仅能确定色素沉着绒毛结节性滑膜炎和滑膜结核中滑膜炎的病因。在其他形式的滑膜炎中，只能确定炎症的阶段和强度，而无法确定病因。尤其是类风湿性关节炎，很少能通过关节镜检查确诊。
