Gynther G W, Holmlund A B, Reinholt F P
Karolinska Institutet, Huddinge Hospital, Sweden.
J Oral Maxillofac Surg. 1994 Sep;52(9):913-7; discussion 918. doi: 10.1016/s0278-2391(10)80066-7.
To define arthroscopic criteria for synovitis (SYN) reflecting specific histologic changes. Arthroscopic observations in the temporomandibular joint of patients with internal derangement were compared with histologic patterns in synovial biopsies obtained during arthroscopy.
Arthroscopic biopsies were obtained in 31 joints of 31 patients using an oriented semiblind technique. The histologic changes in the biopsies were compared with those in age-matched reference material obtained at autopsy.
Microscopic examination of the reference material showed inflammation in three specimens (18%), whereas it showed inflammation in 22 patient specimens (71%). Biopsies from the patients also exhibited more pronounced inflammation. According to conventional criteria, arthroscopy showed mild SYN (increased vascularity) in 51%, moderate changes in 39%, and more pronounced changes in 10% of the joints. The presence of moderate or pronounced arthroscopic signs of SYN (capillary hyperemia and synovial hyperplasia), correlated well with the histologic diagnosis of SYN. This was in contrast to patients with mild arthroscopic SYN (increased vascularity).
Increased vascularity seen during arthroscopy must be questioned as a sign of SYN. More reliable criteria seem to be capillary hyperemia and synovial hyperplasia.
确定反映特定组织学变化的滑膜炎（SYN）的关节镜检查标准。将颞下颌关节内紊乱患者的关节镜观察结果与关节镜检查期间获得的滑膜活检组织学模式进行比较。
采用定向半盲技术对31例患者的31个关节进行关节镜活检。将活检组织学变化与尸检时获得的年龄匹配参考材料中的变化进行比较。
参考材料的显微镜检查显示3个标本（18%）有炎症，而22例患者标本（71%）有炎症。患者的活检也表现出更明显的炎症。根据传统标准，关节镜检查显示51%的关节有轻度滑膜炎（血管增多），39%有中度变化，10%有更明显变化。滑膜炎的中度或明显关节镜征象（毛细血管充血和滑膜增生）的存在与滑膜炎的组织学诊断密切相关。这与关节镜检查轻度滑膜炎（血管增多）的患者形成对比。
关节镜检查时看到的血管增多作为滑膜炎的征象必须受到质疑。更可靠的标准似乎是毛细血管充血和滑膜增生。
