医学精品课件：关节穿刺(1).pptx

1、Arthrocentesis 关节穿刺,2012-4-13 吴迪,总论,Kelleys 8th,few procedures as diagnostically definitive as arthrocentesis with analysis of synovial fluid few modalities as effective as the injection of corticosteroids in achieving symptomatic relief of painful or swollen articular structures,Arthrocentesis,Holl

2、ander: 1951: injected knees with cortisone in RA 1970: 400,000 safe and simple 1/5 visits to a rheumatology practice 60-70% after residency need training,Indications: Arthrocentesis,Indications: Injection,Contraindications,Complications,Preparations,得宝松 Beta-methasone (Dexa-methasone): 10 1ml：二丙酸5mg

3、，磷酸钠2mg ￥50 阿尔治 Hyaluronate 玻璃酸钠（预充） 2.5ml：25mg ￥200 益赛普 rhTNFR:Fc：12.5mg ￥400,分论,NEJM Vidoe: Arthrocentesis of the Knee,术前,Mark topical anesthesia? nonsterile gloves drapes and sterile gloves unnecessary,术中,Needle: 18G 粉色 20ml, 21G 绿色 10ml, 22G 灰色 5ml, 25G 橙色 1ml articular cartilage has no pain fib

4、ers articular cartilage unlikely to be damaged,术后,postinjection “flare”: 48h restricted activities atrophy, hypopigmentation,PPD,P: posture P: point，解剖或肿胀 D: depth，垂直皮面,Knee,Easiest, Commonest lateral (medial) approach P 仰卧，腿伸直，垫腘窝 P 髌骨上1/31/2，距髌骨缘1cm D 3cm,Knee,Sitting approach P 仰卧，屈膝，垫腘窝 P 髌骨下缘，髌

5、下韧带隐窝 D 3cm,Elbow,P 屈肘90度 P 肱骨外上髁、桡骨头、鹰嘴之三角形中心 D 2cm,Wrist,P 屈腕30，垫腕子，轻度尺屈 P 舟骨、月骨、桡骨远端之三角形中心 拇长伸肌腱尺侧、食指伸肌腱桡侧、lister结节远端 D 1cm,Ankle,P 跖屈15 P 内踝下缘上1.5cm外侧，胫前肌腱内侧 外踝下缘上2cm外侧，小趾伸肌腱外侧 D 2.5cm,MCP/PIP,MTP,Indirect method,Temporomandibular joint,P 侧卧，尽力张嘴 P 耳屏前1cm凹陷处，颧弓下，避开颞浅动脉 D 1cm,Shoulder,P 坐位，肩外展 P 喙突与肱骨头之间略低1cm D 3-6cm,Synovial fluid,clear enough to read newsprint through will not clot, straw-colored “string sign” : hyaluronate, 5 to 10 cm protein and glucose highly inaccurate markers of inflammation Stain & culture,Polarizing Microscope,