Name: knee arthrocentesis in adults
Uploaded: 2022-02-25T14:00:00
Description: Watch this Scientific Journal Video about Knee Arthrocentesis in Adults at JoVE.com

作者没有致谢。

该协议遵循BronxCare卫生系统的指导方针。需要患者的书面知情同意书。
1. 识别解剖结构
<ol><li>患者仰卧时，仔细触诊膝盖以定位髌骨，并使用皮肤标记在髌骨的四个角处做标记。</li>
	<li>使用皮肤标记在髌骨一指八度上外侧的部位放置“X”。避免感染皮肤和可见静脉。</li>
	<li>如果在检查中检测到大量积液，并且髌骨似乎位于液体上，请考虑在髌骨后方进行内?...

<ol>
	<li>Zhang, Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+two+positions+of+knee+arthrocentesis:+how+to+obtain+complete+drainage.">Comparison of two positions of knee arthrocentesis: how to obtain complete drainage.</a> American Journal of Physical Medicine &amp; Rehabilitation. 91 (7), 611-615 (2012).</li><li>Roberts, W. N., Hayes, C. W., Breitbach, S. A., Owen, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dry+taps+and+what+to+do+about+them:+a+pictorial+essay+on+failed+arthrocentesis+of+the+knee.">Dry taps and what to do about them: a pictorial essay on failed arthrocentesis of the knee.</a> The American Journal of Medicine. 100 (4), 461-464 (1996).</li><li>Weitoft, T., Uddenfeldt, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Importance+of+synovial+fluid+aspiration+when+injecting+intra-articular+corticosteroids.">Importance of synovial fluid aspiration when injecting intra-articular corticosteroids.</a> Annals of the Rheumatic Diseases. 59 (3), 233-235 (2000).</li><li>Thumboo, J., O'Duffy, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+study+of+the+safety+of+joint+and+soft+tissue+aspirations+and+injections+in+patients+taking+warfarin+sodium.">A prospective study of the safety of joint and soft tissue aspirations and injections in patients taking warfarin sodium.</a> Arthritis and Rheumatism. 41 (4), 736-739 (1998).</li><li>Salvati, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frequency+of+the+bleeding+risk+in+patients+receiving+warfarin+submitted+to+arthrocentesis+of+the+knee.">Frequency of the bleeding risk in patients receiving warfarin submitted to arthrocentesis of the knee.</a> Reumatismo. 55 (3), 159-163 (2003).</li><li>Ahmed, I., Gertner, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+arthrocentesis+and+joint+injection+in+patients+receiving+anticoagulation+at+therapeutic+levels.">Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels.</a> The American Journal of Medicine. 125 (3), 265-269 (2012).</li><li>Yui, J. C., Preskill, C., Greenlund, L. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arthrocentesis+and+joint+injection+in+patients+receiving+direct+oral+anticoagulants.">Arthrocentesis and joint injection in patients receiving direct oral anticoagulants.</a> Mayo Clinic Proceedings. 92 (8), 1223-1226 (2017).</li><li>Klauser, A. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+indications+for+musculoskeletal+ultrasound:+a+Delphi-based+consensus+paper+of+the+European+Society+of+Musculoskeletal+Radiology.">Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology.</a> European Radiology. 22 (5), 1140-1148 (2012).</li><li>Rolle, N. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extractable+synovial+fluid+in+inflammatory+and+non-inflammatory+arthritis+of+the+knee.">Extractable synovial fluid in inflammatory and non-inflammatory arthritis of the knee.</a> Clinical Rheumatology. 38 (8), 2255-2263 (2019).</li><li>Yaqub, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Can+diagnostic+and+therapeutic+arthrocentesis+be+successfully+performed+in+the+flexed+knee.">Can diagnostic and therapeutic arthrocentesis be successfully performed in the flexed knee.</a> Journal of Clinical Rheumatology: Practical Reports on Rheumatic &amp; Musculoskeletal Diseases. 24 (6), 295-301 (2018).</li><li>Jennings, J. M., Dennis, D. A., Kim, R. H., Miner, T. M., Yang, C. C., McNabb, D. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=False-positive+cultures+after+native+knee+aspiration:+True+or+false.">False-positive cultures after native knee aspiration: True or false.</a> Clinical Orthopaedics and Related Research. 475 (7), 1840-1843 (2017).</li><li>Massey, P. A., Feibel, B., Thomson, H., Watkins, A., Chauvin, B., Barton, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Synovial+fluid+leukocyte+cell+count+before+versus+after+administration+of+antibiotics+in+patients+with+septic+arthritis+of+a+native+joint.">Synovial fluid leukocyte cell count before versus after administration of antibiotics in patients with septic arthritis of a native joint.</a> Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association. 25 (5), 907-910 (2020).</li><li>Polishchuk, D., Gehrmann, R., Tan, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Skin+sterility+after+application+of+ethyl+chloride+spray.">Skin sterility after application of ethyl chloride spray.</a> The Journal of Bone and Joint Surgery. 94 (2), 118-120 (2012).</li><li>Liu, K., Ye, L., Sun, W., Hao, L., Luo, Y., Chen, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+use+of+lidocaine+affect+culture+of+synovial+fluid+obtained+to+diagnose+periprosthetic+joint+infection+(PJI)?+An+in+vitro+study.">Does use of lidocaine affect culture of synovial fluid obtained to diagnose periprosthetic joint infection (PJI)? An in vitro study.</a> Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 24, 448-452 (2018).</li><li>Chen, L. X., Clayburne, G., Schumacher, H. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Update+on+identification+of+pathogenic+crystals+in+joint+fluid.">Update on identification of pathogenic crystals in joint fluid.</a> Current Rheumatology Reports. 6 (3), 217-220 (2004).</li><li>Boumans, D., Hettema, M. E., Vonkeman, H. E., Maatman, R. G., Avan de Laar, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+added+value+of+synovial+fluid+centrifugation+for+monosodium+urate+and+calcium+pyrophosphate+crystal+detection.">The added value of synovial fluid centrifugation for monosodium urate and calcium pyrophosphate crystal detection.</a> Clinical Rheumatology. 36 (7), 1599-1605 (2017).</li><li>Goldenberg, D. L., Reed, J. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bacterial+arthritis.">Bacterial arthritis.</a> The New England Journal of Medicine. 312 (12), 764-771 (1985).</li><li>Atkins, B. L., Bowler, I. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+diagnosis+of+large+joint+sepsis.">The diagnosis of large joint sepsis.</a> The Journal of Hospital Infection. 40 (4), 263-274 (1998).</li></ol>

膝关节穿刺术是一种床边或诊所手术，其中将针头插入关节囊中，并抽吸滑液。在尝试关节穿刺术之前，应根据病史确认膝关节肿胀是体格检查中的积液。膝关节 X 线检查可发现积液，但在误吸前没有必要。如果体型使体格检查复杂化，超声检查可用于确认积液大小，并直接插入穿刺以进行抽吸8。如果患者膝关节肿胀、疼痛和温暖，运动受限，应立即进行诊断性关节穿刺术以评...

进行关节穿刺术以成功从关节（如膝盖，肩膀，肘部，手腕或脚踝）吸出滑液。新发现的膝关节积液的患者可以接受诊断性关节穿刺术，以确定积液的性质。在尝试关节穿刺术之前，必须通过体格检查确认病史引起的膝关节肿胀，以评估是否存在积液。对于患者仰卧位，可以在检查时比较膝盖，以查看肿胀是否是单侧的。积液的膝关节可能看起来比另一个膝关节大。大量积液（至少 20 mL）时，可见髌骨近端的凸起。使用少量积液（5-10 mL），用一只手超外侧按压液体可以让另一只手触诊液体隆起。触诊液体可以帮助确定是否有可能成功进行关节穿刺术。除仰卧位外，还可以对坐位的患者进行膝关节穿刺术，但抽吸较少滑液的可能性更高1.膝关节的滑液可通过内侧或外侧入路抽吸，但后者在复杂情况下是首选2.膝关节积液在检查时并不总是压痛，因此不一定引起止痛步态。如果怀疑化脓性关节炎，应在抗生素治疗前紧急进行关节穿刺术。整形外科医生可以进行膝关节抽吸术，以诊断膝关节置换术患者的假体关节感染。
除了评估感染外，关节穿刺术还有助于识别诊断，例如晶体诱发的关节炎（痛风或假性痛风）、类风湿性关节炎、脊柱关节炎、反应性关节炎、银屑病关节炎、关节积血或骨关节炎。滑液分析的结果可以导致适当的治疗。对于因积液而疼痛和膝关节活动受限的患者，抽吸液体可以改善这些症状。此外，在关节内注射类固醇之前对膝关节进行关节穿刺术已被证明可以降低类风湿性关节炎关节炎复发的风险3。膝关节穿刺术没有绝对的禁忌症，但针头应远离任何蜂窝织炎，以免将任何感染引入关节。此外，关节穿刺术已被证明对使用华法林或直接口服抗凝剂4，5，6，7 进行抗凝治疗的患者通常是安全的。通过适当的技术和临床适应症，患者可以以最小的风险进行此程序。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Alcohol prep pad</td>
			<td>Medline</td>
			<td>MDS090670Z</td>
			<td>sterile 2-ply pad</td>
		</tr>
		<tr>
			<td>Eclipse needle</td>
			<td>BD</td>
			<td>DGW60702</td>
			<td>25G x 5/8&#34;</td>
		</tr>
		<tr>
			<td>Ethyl Chloride instant topical anesthetic spray</td>
			<td>Gebauer&#39;s</td>
			<td>P/N 0386-0008-03</td>
			<td>non-flammable</td>
		</tr>
		<tr>
			<td>Lidocaine HCl injection</td>
			<td>Fresenius Kabi Usa, Llc</td>
			<td>NDC 63323-492-27</td>
			<td>1% single dose vial</td>
		</tr>
		<tr>
			<td>Plastic bandage</td>
			<td>Curad</td>
			<td>CUR02278RB</td>
			<td>4-sided seal</td>
		</tr>
		<tr>
			<td>Plastipak 3 mL syringe</td>
			<td>BD</td>
			<td>309651</td>
			<td>sterile</td>
		</tr>
		<tr>
			<td>Plastipak 5 mL syringe</td>
			<td>BD</td>
			<td>309649</td>
			<td>sterile</td>
		</tr>
		<tr>
			<td>Povidone iodine topical solution</td>
			<td>Major</td>
			<td>NDC 0904-1103-09</td>
			<td>topical antiseptic</td>
		</tr>
		<tr>
			<td>Precision glide needle</td>
			<td>BD</td>
			<td>305196</td>
			<td>18G x 1 1/2&#34;</td>
		</tr>
		<tr>
			<td>Sterile gauze sponge</td>
			<td>CARING</td>
			<td>PRM2208</td>
			<td>2 in. x 2 in.</td>
		</tr>
		<tr>
			<td>Sterile regular tip surgical skin marker</td>
			<td>MEDLINE</td>
			<td>DYNJSM01</td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical gloves</td>
			<td>TRIUMPH</td>
			<td>MSG2265</td>
			<td>sterile &#38; powder-free</td>
		</tr>
	</tbody>
</table>

knee arthrocentesis in adults

膝关节穿刺术是将针头插入膝关节并抽吸滑液的手术。关节穿刺术可以是诊断性的，也可以是治疗性的。可以取出滑液进行测试，以确定膝关节积液的性质。如果怀疑化脓性关节炎，应在开始抗生素治疗前紧急穿刺。此外，关节穿刺术还可以帮助诊断晶体诱发的关节炎，如痛风或假性痛风，或非炎症性关节炎，如骨关节炎。确定膝关节积液的病因可以指导治疗。此外，从膝关节排出液体可以降低关节内压力，从而减轻疼痛并改善运动范围。执行该手术没有绝对的禁忌症，但在选择针头进入部位时，应避免感染的皮肤区域。因此，当患者出现膝关节上疑似蜂窝织炎时，应谨慎行事，以避免引起医源性化脓性关节炎的潜在风险。接受过关节置换术的膝关节应由整形外科医生进行关节穿刺术评估。膝关节穿刺术通常在患者仰卧位进行。标记针头插入的部位，然后对皮肤进行消毒。施用局部麻醉剂后，沿着麻醉的途径插入针头。抽取滑液，然后抽出针头。施加压力，直到任何出血停止。滑液可以分析感染和炎症，但不能直接确认关节炎内部紊乱或自身免疫性病因的诊断。除病史和体格检查外，实验室检查结果和影像学检查可明确膝关节积液的病因。

一项前瞻性随机研究比较了膝关节滑液完全抽吸和关节内注射与单独使用皮质类固醇。它表明，在用关节内皮质类固醇治疗类风湿性关节炎患者时，尽可能多地抽吸滑液可以降低关节炎症状复发的风险。 图1 显示了关节穿刺术组3中复发比例的降低。
一项关于关节穿刺术和关节注射的回顾性图表回顾比较了接受华法林治疗的患者（国际?...

Watch this Scientific Journal Video about Knee Arthrocentesis in Adults at JoVE.com

Knee Arthrocentesis in Adults

在这里，方案描述了膝关节穿刺术，这是一种将针插入膝关节并抽吸滑液的过程。可以取出滑液进行测试，以确定膝关节积液的性质。膝关节穿刺术通常在患者仰卧位进行。

成人膝关节穿刺术

Arthrocentesis of the knee is a procedure in which a needle is inserted into the knee joint, and synovial fluid is aspirated. An arthrocentesis can be ...

该协议描述了膝关节穿刺术，这是一种将针头插入膝关节并抽吸滑液的过程。关节穿刺术可以是诊断性的，也可以是治疗性的。可以取出滑液进行测试，以确定积液的性质。从膝盖上取出液体可以减轻疼痛。当患者处于仰卧位时，仔细触诊膝盖以定位髌骨，并使用皮肤标记在髌骨的四个角处做标记。在单指呼吸部位使用皮肤标记物放置X，髌骨上外侧，避免感染皮肤和可见静脉。如果在检查中检测到大量积液，并且髌骨似乎位于液体上，请考虑在髌骨后方进行内侧入路。用三根碘浸泡的针头进入部位清洗，两块用两英寸纱布海绵清洗。让防腐剂干燥。将非优势手放在髌骨上消化区域，然后轻轻地手动横向压缩液体。沿着麻醉通路插入一根1.5英寸18至22号针头，连接到注射器上。缓慢推进针头，轻轻地将柱塞向后拉，直到滑液可视化。如果第一个注射器充满并且需要进一步吸入液体，请切换到另一个注射器。以一个平滑的撤退动作取下针头和注射器，然后将无菌敷料放在该部位并施加压力，直到任何出血停止。一旦达到止血，在用酒精垫擦拭皮肤标志物和碘后使用绷带。一项针对膝关节滑液完全抽吸和关节内注射单独皮质类固醇的比较研究表明，在关节内皮质类固醇治疗类风湿性关节炎患者时，尽可能多地抽吸滑液可以降低关节炎症状复发的风险。一项关于关节穿刺术和关节注射的回顾性图表回顾比较了接受华法林治疗的患者和抗凝调整为国际标准化比值（小于 2.0）的患者的临床显著出血发生率，但未显示出血有统计学意义差异。要记住的最重要的事情是缓慢推进针头，同时将柱塞拉回，直到滑液可视化。手应该稳定。按照该程序，可以将滑液送去进行细胞计数，晶体，革兰氏染色和培养。这可以帮助诊断膝关节积液的病因。该技术能够在显微镜下观察滑液中的细胞，晶体或细菌，以评估炎症和感染。通过从膝盖抽吸滑液，我可以减轻患者的疼痛并诊断肿胀的病因。这可以帮助防止关节炎复发。

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Using a Rabbit Model to Explore the Efficacy of Tuina in Treating Knee Osteoarthritis (Video) | JoVE

推拿干预膝骨关节炎兔模型

Knee osteoarthritis (KOA) is mainly characterized by degenerative changes in the knee joint's cartilage and surrounding soft tissues. The efficacy of ...

Gastric Ultrasound Technique for Mitigating Peri-Procedural Aspiration Risk

Gastric Point of Care Ultrasound in Adults: Image Acquisition and Interpretation

Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care (Video) | JoVE

成人胃旁超声：图像采集和解释

Over the past two decades, diagnostic point-of-care ultrasound (POCUS) has emerged as a rapid and non-invasive bedside tool for addressing clinical ...