Inflammatory arthritis includes various types of joint diseases such as rheumatoid arthritis and ankylosing spondylitis. Effectively controlling the development of synovitis is an important measure to reduce pain, delay the destruction of articular cartilage, and maximize joint function.
We believe that the indications that synovectomy should be mastered, as long as one of the following items should be operated:
1. Strict systemic formal medical treatment for 3 to 6 months is ineffective, persistent joint swelling, exudation and severe pain, X-ray examination of bone destruction is not obvious, synovectomy should be performed as soon as possible.
2. Although the course of the disease is less than half a year, the drug is treated, but the joint swelling and pain are obvious. The clinically palpable hypertrophic synovium indicates that the synovial lesion has a serious degree of hyperplasia, and synovectomy should also be performed.
3. Joint lesions for more than 1 year, joint swelling, pain, X-ray examination showed obvious osteoporosis or mild joint space narrowing, but no obvious bone destruction and deformity, indicating articular hyaline cartilage or fibrocartilage between joints (half month Boards, etc.) have been destroyed to varying degrees. At this time, synovectomy has not been able to protect the articular cartilage, but it can also play a role in preventing further destruction of articular cartilage, reducing pain, and delaying the time of joint replacement. In addition to synovectomy, joint removal and cartilage defect drilling can be performed at the same time.
Seen under RA arthroscopy:
Arthroscopic glial resection requires the surgeon to have patience and skillful arthroscopic technique, familiar with the local anatomy of the posterior approach of the knee, and then complete the resection in sequence from each approach. Surgery usually requires multiple approaches, keeping the water flowing smoothly in the joint during operation. The lens and planer alternately enter each approach, and the synovial membranes of each part are cleaned in sequence, including the superior sac, the lateral sulcus, the anterior lateral chamber, and the intercondylar fossa. , attached to the synovial membrane on the anterior cruciate ligament, the medial compartment, the planer enters the lower part of the meniscus, can clear the meniscus sliding membrane, the medial groove, and then enter the supraorbital sac. If the posterior synovial membrane is severely hyperplasia, the approach can be increased from the posterior or posterior or posterior aspect, and the synovial membrane in the posterior joint capsule can be removed. When there are many synovial membranes on the upper sac, even nodular or mass-like hyperplasia can enlarge the upper and upper anterior approach, and use the rongeur to bite off, which is beneficial to the complete resection of the diseased synovial tissue and shorten the operation time.
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