NEW DEVELOPMENT OF ARTHROSCOPE WITH A CHANNEL FOR MINIMUM INVASIVE TMJ SURGERY AND CLINICAL APPLICATION

最近研制了一种新的关节镜，它具有内窥镜手术的通道，以及手术所需的器械。以往的TMJ内窥镜手术主要采用单次穿刺法和双穿刺法，单次穿刺法又可分为盲法和直视法。盲法有一个缺点，那就是不可能进行精确的手术。直接目视技术的缺点是，用于该技术的关节镜镜片系统需要用于手术的通道，并且该内窥镜的直径较厚(3.8X2.0 mm)，造成较高的手术损伤。双重穿刺法的缺点在于，将手术器械(通过单独的插管插入)操作到通过另一个插管插入的关节镜的视野中需要很多技巧。继最近研制出具有高像素数(15,000像素)的极小直径纤维内窥镜之后，我们最近又开发了一种新的关节内窥镜，旨在解决以前的问题。该关节镜结合了纤维内窥镜和手术通道(phi1.1 mm)。这种纤维内窥镜插管的长度和直径(phi2.9 mm)与最常用的前锋关节镜插管相同。同时，我们已经开发出适合通过关节镜手术通道的手术器械(探头、钳子、刀、烧灼刀等)。与传统技术相比，这种关节镜的使用造成的手术损伤更小，并且可以进行更可靠的关节镜手术。

A new arthroscope, which has a channel for endscopic surgery of the temporomandibular joint (TMJ), and the instruments needed for this surgery have been recently developed. In the past, two techniques (single puncture and double puncture techniques) were used for endoscopic surgery of TMJ.The single puncture technique can be subdivided into the blind technique and the direct visual technique. The blind technique has a disadvantage in that a precise surgery is not possible. The direct visual technique has disadvantage in that because the arthroscopic lens systems used for this technique need a channel for surgery, and the diameter of this endoscope is thick (3.8X2.0 mm) and causes a relatively high surgical damages. The double puncture technique has a disadvantage in that much skill is needed for maneuvering the surgical instruments (inserted through a separate cannula) into the visual field of the arthroscope inserted through another cannula. Following the recent development of a very small diameter fiberscope with a high pixel number (15,000 pixel), we have recently developed a new arthroscope, designed to resolve the previous problems. This arthroscope combines a fiberscope with a surgical channel (phi1.1mm). The length and diameter (phi2.9mm) of this fiberscope cannula are identical to those of the most frequently used Striker's arthroscope cannula. At the same time, we have developed the instruments for use in surgery that would fit through the surgical channel of this arthroscope (probe, forceps, knives, cautery knives, etc.). The use of this artroscope causes less surgical damage and allows more reliable arthroscopic surgery, when compared with conventional techniques.