Episode Transcript
Dr. Miller: You've injured your knee, what's the next step? Should you have it scoped? 大发娱乐接下来将在Scope Radio讨论这个问题.
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Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Bruce Thomas. 他是犹他大学整形外科的一名整形外科医生. 他还在大发娱乐法明顿的诊所实习. And Bruce, what's the story? There's been a lot of changes. 我认为那些膝盖受伤，有肿胀，咔哒声或疼痛的人, 过去很多人会去找整形外科医生做关节镜检查. 也就是说，他们会在膝盖里面放一个小范围，然后环顾四周. 最近，这种想法发生了一些变化.
Dr. Thomas: That's true. There's more of a collaborative effort. In the old days, 医生告诉病人治疗方法, 现在医生会和他们分享信息并提出建议. Not every meniscus tear requires surgery. 许多人可以进行正常的生活活动，疼痛就会消退, and it's not clear, in those patients, that knee arthroscopy will help them.
Dr. Miller: It's interesting to me because, I mean, 在做关节镜检查之前他们知道自己有半月板撕裂吗, 或者大发娱乐做关节镜检查看看他们是否有半月板撕裂? 或者患者对关节镜检查的目的有误解.
Dr. Thomas: For many meniscus tears, 你可以通过病人的病史和身体检查来判断它是否存在. 如果有疑问，核磁共振成像预测半月板撕裂的准确率是96%.
Dr. Miller: So now we have way, radiologically, to look at the joint, find out if you have a tear, without doing a surgical procedure?
Dr. Thomas: That's correct.
Dr. Miller: So, 如果你有半月板撕裂，你要么通过检查，要么通过核磁共振成像来判断, what role would arthroscopy play nowadays?
Dr. Thomas: 如果病人有明显的症状，不能通过保守措施解决，这使他们无法进行正常的活动, 关节镜检查可以大发娱乐功能恢复和减轻疼痛. It's a small out-patient surgery with, usually, two or three very small incisions, 半月板要么修复，要么切除受损部分, depending on the findings at surgery.
Dr. Miller: So, what you said I think is important, is that you don't do the arthroscopy immediately, you try some conservative measures first.
Dr. Thomas: That's true.
Dr. Miller: Is that the standard now?
Dr. Thomas: 我相信这是标准的，因为很多人在半月板撕裂后仍能正常工作. 较早的文献表明，未经治疗的半月板撕裂会导致早期关节炎. Subsequent studies are less clear on that, and it depends much on the size, location, geometry of the tear, as well as the patient's activity level.
Dr. Miller: You know, many years ago they used to go in, when you had a meniscal tear, and they just took out a lot of the meniscus, a large percentage of it, 我认为那是当时的标准. Is that right?
Dr. Thomas: That's true. Before the invention of arthroscopy, 一个开放的程序将进行，整个半月板将被移除. 有一些论文表明这些病人会在手术后的七年内患上晚期关节炎.
Dr. Miller: So they don't do that anymore?
Dr. Thomas: We don't do that anymore.
Dr. Miller: So the concept was, if you used an arthroscope, 你可以在半月板受损的地方取一小块, and that that might result in improved function, less pain.
Dr. Thomas: True. That's true. It will decrease their pain, improve their function, and if we can save even a rim of 3mm or 4mm, 这已经被证明对病人预防关节炎仍然有效.
Dr. Miller: 在不太遥远的过去，病人接受关节镜检查的原因是什么? 例如，我知道有些病人用关节镜冲洗膝关节. 他们现在还这么做吗，这有治疗价值吗?
Dr. Thomas: That really, probably, has no therapeutic value. Arthroscopy is not a treatment for arthritis. 你使用关节镜检查来治疗半月板撕裂或, infrequently, loose fragments of cartilage. 比如抓人，锁死，呕吐之类的症状.
Dr. Miller: 做了关节镜检查后，病人多久能恢复正常活动?
Dr. Thomas: 如果没有意外和关节软骨是良好的形状, 大发娱乐通常鼓励他们在手术当天开始走路. Swelling takes longer to go away. 可能四到八周，取决于环境. 许多患者可以在八周内恢复大部分生活活动.
Dr. Miller: Now, are there any risks with arthroscopy? 显然，任何外科手术或侵入性手术都有风险. 我认为这些风险比开放式手术要小, an open, standard surgical procedure.
Dr. Thomas: That's true. 例如，关节镜手术的感染风险远低于2%. 有证据表明一旦你一侧的半月板撕裂, 你更有可能是在另一侧的膝盖上. And with removal of meniscal tissue, the loads on your joint surface are higher, 所以你的软骨磨损得更快，可能会更容易得关节炎.
Dr. Miller: So, bottom-line, basically, 如果你有膝盖疼痛和可能的半月板撕裂, 你可能需要先进行保守治疗, 在进行关节镜手术之前, 你和你的整形外科医生一起工作你可以确定最好的时间, if that needs to occur.
Dr. Thomas: That's true.
Dr. Miller: Thank you very much, Bruce.
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