Vergleichende experimentelle Untersuchungen zur mechanischen und Holmiumlaser-Synovektomie
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Zusammenfassung
Diese Untersuchungen hatten das Ziel, die Gewebereaktion nach Laser-Synovektomie mit einem Holmium:YAG-Laser (Wellenlänge: 2,1 μm) an Kaninchen zu untersuchen und mit jener nach konventionell-mechanischer Therapie zu vergleichen. Bei 48 Kaninchen wurde immunologisch eine chronische Synoviitis in einem Kniegelenk induziert. Zwölf Tiere dienten zur Modellkontrolle. Jeweils 12 weitere Tiere wurden einer Scheinoperation, der Laserbehandlung oder der konventionell-mechanischen Abtragung unterzogen. Bei den Lasereingriffen wurden Pulsenergien vin ca. 600 mJ bei einer Pulsdauer vin 1 ms und einer Wiederholrate von 3 Hz appliziert. Nach Laufzeiten vin einem Tag, einer Woche, einem Monat und 3 Monaten wurden jeweils 3 Tiere jeder Gruppe getötet und die Synovialis makroskopisch, licht- und elektronenmikroskopisch untersucht. Unmittelbar nach der Laserbehandlung entstanden Koagulationsnekrosen, Entzündungen und Ödeme. Nach einer Woche zeigte sich im Stratum synoviale eine der Modellkontrollgruppe vergleichbare leichte Fibrose und nach einem Monat erschien die Oberfläche der Synovialis glatt. Nach der konventionell-mechanischen Abtragung traten Blutungen und Nekrosen auf. Eine vorbestehende Fibrose verstärkte sich in allen Kapselschichten. Nach 3 Monaten erschien die Oberfläche der Synovialis plumpzottig. Aufgrund dieser Ergebnisse könnte die Holmiumlaser-Synovektomie eine Alternative zu bestehenden Verfahren bei der operativen Behandlung der rheumatoiden Arthritis darstellen, gleichzeitig ware bei arthroskopischem Einsatz eine Fibrosierung der Gelenkkapsel durch die mechanische Irritation vermeidbar.
Experimental study on holmium: YAG-laser synovectomy versus mechanical abrasion treatment
Abstract
The goal of this study was to evaluate tissue reactions in rabbit knees following laser synovectomy using a holmium:YAG laser (wavelength: 2.1 μm) and to compare these results with those found after conventional mechanical abrasion treatment. Chronic arthritis was immunologically induced in one knee joint each of 48 rabbits. Twelve served as controls, 12 were sham-operated, 12 were exposed to laser radiation, and 12 others were treated according to conventional methods. In the laser group, a pulse length of 1 ms at a repetition rate of 3 Hz resulted in a pulse energy of 600 mJ. After periods of 1 day, 1 week and 1 and 3 months, respectively, three animals from each group were sacrificed and the synovialis was examined macroscopically and histologically using light and electron microscopy. Edema, acute inflammation, and coagulation necrosis occurred immediately following laser therapy. After 1 week, the synovial layer showed slight fibrosis, which was comparable to that found in the controls. One month later the surface appeared to be smooth. The mechanical abrasion caused hemorrhage and necrosis. Fibrosis was pronounced in all capsular layers, and after 3 months the surface appeared coarse and villous in this group. Based on these preliminary findings, holmium-laser synovectomy may offer an alternative to existing therapeutic techniques in the treatment of rheumatoid arthritis. The arthroscopic approach could prevent additional capsular fibrosis associated with mechanical irritation.
Key words
Synovitis Rabbits Knee joint Holmium:YAG-laser Laser surgeryPreview
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Literatur
- 1.Becker T, Huber G, Heide HJ von der, Mitzscherlich P, Struve B, Duczynski EW (1990) 30 Hz operation of 2 μm-Ho and Tm-lasers. Optics Commun 80:47–51Google Scholar
- 2.Black J, Sherk H, Smith R, Meller M, Uppal G (1991) Anterior cervical discectomy using Holmium:YAG laser. Lasers Surg Med [Suppl] 3:54Google Scholar
- 3.Black J, Uppal GS, Rhodes ALB, Smith R, Sherk H, Hermatin F (1991) Percutanous lumbar discectomy using Holmium:YAG laser. Lasers Surg Med [Suppl] 3:54Google Scholar
- 4.Combe B, Krause E, Sany J (1989) Treatment of chronic knee synovitis with arthroscopic synovectomy after failure of intraarticular injection of radionuclide. Arthritis Rheum 32:10–14Google Scholar
- 5.Consden R, Doble A, Glynn LE, Nind AP (1971) Production of a chronic arthritis with ovalbumin. Its retention in the rabbit knee joint. Ann Rheum Dis 30:307–315Google Scholar
- 6.Glick JM, Harmon S (1991) The application of CO2 laser and arthroscopy of the knee. Lasers Surg Med [Suppl] 3:52Google Scholar
- 7.Hefti F, Morscher E (1984) Anwendung von Laser-Strahlen in der Orthopädie. Orthopäde 13:119–124Google Scholar
- 8.Henderson B, Revell PA, Edwards JCW (1988) Synovial lining cell hyperplasia in rheumatoid arthritis: dogma and fact. Ann Rheum Dis 47:348–349Google Scholar
- 9.Hermann JH, Khosla RC (1989) Nd:YAG laser modulation of synovial tissue metabolism. Clin Exp Rheumatol 7:505–512Google Scholar
- 10.Jensen KU, Klein W (1988) Die arthroskopisch-chirurgische Synovektomie am Kniegelenk. Z Orthop 126:513–518Google Scholar
- 11.Jensen CM, Poulsen S, Östergren M, Hansen KH (1991) Early and late synovectomy of the knee in rheumatoid arthritis. Scand J Rheumatol 20:127–131Google Scholar
- 12.Klein W, Jensen KU (1988) Arthroscopic synovectomy of the knee joint: Indication, technique, and follow-up results. Arthroscopy 4:63–71Google Scholar
- 13.Kopchok G, Gottlob C, Tabbara M, White R (1991) Holmium: YAG laser ablation of human intravertebral disk: Preliminary evaluation. Lasers Surg Med [Suppl] 3:54Google Scholar
- 14.Lane GJ, Mooar PA (1991) Holmium:YAG laser arthroscopic debridement. Lasers Surg Med [Suppl] 3:53Google Scholar
- 15.Lane GJ, Sherk HH, Mooar PA, Black J (1991) CO2 vs. Holmium: YAG laser arthroscopic debridement. Lasers Surg Med [Suppl] 3:52Google Scholar
- 16.Matallana M, Bende T, Seiler T (1990) Laser coagulation with the Ho:YAG laser. Biomed Tech Berlin 35 [Suppl] 3:16–17Google Scholar
- 17.Meller M, Black J, Sherk H, Uppal G, Rodes A (1991) Wavelength selection in laser arthroscopy. Lasers Surg Med [Suppl] 3:50Google Scholar
- 18.Miller DV, O'Brien SJ, Arnoczky SS, Kelly A, Fealy SV, Warren RF (1989) The use of the contact Nd:YAG laser in arthroscopic surgery: effects on articular cartilage and meniscal tissue. Arthroscopy 59:245–253Google Scholar
- 19.O'Brien SJ, Miller DV (1990) The contact Neodymium-Yttrium Aluminium Garnet laser. A new approach to arthroscopic laser surgery. Clin Orthop 252:95–100Google Scholar
- 20.Paus AC, Refsum S, Förre Ö (1990) Histopathologic changes in arthroscopic synovial biopsies before and after open synovectomy in patients with chronic inflammatory joint diseases. Scand J Rheumatol 19:202–208Google Scholar
- 21.Raunest J, Löhnert J (1989) Arthroskopische Synovektomie unter Anwendung des Neodym:YAG-Laser. Chirurg 60:782–787Google Scholar
- 22.Reichel W, Weber KJ (1986) The stabilizing effect of synovectomy on the synovial membrane in arthritic rabbit knees. Arch Orthop Trauma Surg 105:11–17Google Scholar
- 23.Rohe K, Cotta H (1989) Zur Struktur und Funktion der “Neosynovialis”. Licht- und transmissionselektronenmikroskopischev Untersuchungen vom Synovialisregenerat nach operativer Synovialektomie. Unfallchirurgie 15:1–8Google Scholar
- 24.Smith CF, Johansen WE, Vangsness CT, Sutter LV, Marshall GJ (1989) The carbon dioxide laser. A potential tool for orthopedic surgery. Clin Orthop 242:43–50Google Scholar
- 25.Struve B, Huber G (1991) Properties and medical applications of Near-IR Solid-State lasers. J Physique IV [Suppl] III/1:C7–3Google Scholar
- 26.Trauner K, Nishioka N, Patel D (1990) Pulsed holmium: yttrium-aluminium-garnet (Ho:YAG) laser ablation of fibrocartilage and articular cartilage. Am J Sports Med 18:316–320Google Scholar
- 27.Wilkes LL (1985) Arthroscopic synovectomy in the rheumatoid knee. J Med Assoc Ga 74:582–583Google Scholar