Joint aspiration and injection and synovial fluid analysis
Joint aspiration and injection and synovial fluid analysis
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DOI：
10.1016/j.berh.2013.02.005
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发表时间：
2013-04-01
影响因子：
5.2
通讯作者：
Doherty, Michael
中科院分区：
文献类型：
--
作者：
Courtney, Philip;Doherty, Michael
关节抽吸/注射和滑液(SF)分析都是诊断和治疗关节疾病的宝贵手段。本章讨论(1)关节内吸入和注射皮质类固醇的适应症、技术原理、预期收益和风险，以及(2)与SF分析有关的实用方面，特别是与晶体鉴定有关的方面。关节内注射长效不溶性皮质类固醇是一种公认的方法，能迅速缓解大多数注射的关节的疼痛和消退炎症。膝关节是最常见的需要抽吸的部位，尽管任何非中轴关节都可以获得SE，但这项技术只涉及基本的解剖学知识，对患者来说不应该是过度痛苦的。只要使用无菌设备和合理的无菌方法，它是非常安全的。抽吸SF的分析有助于关节炎的鉴别诊断，是诊断化脓性关节炎和结晶性关节炎的可靠方法。SF的大体表现可以提供有用的诊断信息，以判断关节炎症的程度和是否存在关节出血。SF的微生物学研究是确定感染条件的关键。关节炎症的增加伴随着SF体积的增加、粘度的降低、浊度和细胞计数的增加以及多形核/单核细胞比率的增加，但这些变化是非特异性的，必须在临床环境中解释。然而，检测SF尿酸单钠和二水焦磷酸钙结晶，即使在临界期的非炎症关节，也可以准确诊断痛风和焦磷酸钙结晶相关的关节炎。(C)爱思唯尔有限公司出版的2013年。
Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. This chapter addresses (1) the indications, technical principles, expected benefits and risks of aspiration and injection of intra-articular corticosteroid and (2) practical aspects relating to SF analysis, especially in relation to crystal identification. Intraarticular injection of long-acting insoluble corticosteroids is a well-established procedure that produces rapid pain relief and resolution of inflammation in most injected joints. The knee is the most common site to require aspiration although any non-axial joint is accessible for obtaining SE The technique involves only knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used, it is very safe. Analysis of aspirated SF is helpful in the differential diagnosis of arthritis and is the definitive method for diagnosis of septic arthritis and crystal arthritis. The gross appearance of SF can provide useful diagnostic information in terms of the degree of joint inflammation and presence of haemarthrosis. Microbiological studies of SF are the key to the confirmation of infectious conditions. Increasing joint inflammation associates with increased SF volume, reduced viscosity, increasing turbidity and cell count and increasing ratio of polymorphonuclear:mononuclear cells, but such changes are nonspecific and must be interpreted in the clinical setting. However, detection of SF monosodium urate and calcium pyrophosphate dihydrate crystals, even from un-inflamed joints during intercritical periods, allows a precise diagnosis of gout and calcium pyrophosphate crystal-related arthritis. (C) 2013 Published by Elsevier Ltd.