Effusion of the knee refers to the swelling in the knee caused by excessive synovial fluid retention in the knee joint. Infection, trauma, immune diseases, and degenerative pathologies can all lead to knee effusion.
epidemiology
Good crowd
There are no idiopathic people
symptom
Typical performance
1. When a small amount of fluid accumulates in the knee joint, it is manifested as knee joint soreness, discomfort, slight pain, joint movement can be normal, but there is no lameness, the severity of knee joint pain is not necessarily directly proportional to the amount of fluid accumulation, some patients have a large amount of fluid, and the knee joint pain is mild.
2. Pain is related to the cause, such as septic arthritis, joint tuberculosis and other pains are more severe. Joint activity is related to the amount of fluid accumulation, and a small amount of fluid accumulation has no effect on joint movement; With a large amount of fluid, joint mobility is significantly limited.
cause
Summary
Knee effusion is a clinical manifestation, and the specific cause varies from person to person. Trauma, infection, inflammation, chronic strain, etc. in daily life may lead to fluid accumulation in the patient’s knee joint.
Symptom causes
1. Trauma
Such as meniscus injury, synovial injury, cruciate ligament injury, etc.
2. Infection
Such as knee tuberculosis, septic arthritis, etc.
3. Inflammation
Such as knee synovitis, gouty arthritis, rheumatoid arthritis, rheumatoid arthritis, reactive arthritis, etc.
4. Strain injury and degeneration
Such as patellar malacia, knee degenerative arthritis, etc.
5. Others
Such as synovial chondromatosis.
Common diseases
Knee tuberculosis, septic arthritis, knee synovitis, gouty arthritis, rheumatoid arthritis, rheumatoid arthritis, reactive arthritis, patellar malacia, knee degenerative arthritis, synovial chondromatosis, etc.
Medical treatment
Outpatient indications
1. Repeated joint pain and swelling, aggravated after activity;
2. Symmetrical joints have symptoms at the same time;
3. Joint symptoms migratory attacks, this joint for a while, and the next time it may be another joint;
4. Accompanied by systemic symptoms such as fever and fatigue;
5. Gradually stiffening of joints and limited movement, affecting walking;
6. History of tuberculosis, joint symptoms with long-term low-grade fever, night sweats, etc., suspected joint tuberculosis;
7. Knee joint trauma;
8. Other severe, persistent or progressive symptoms.
Joint effusion is mostly found by imaging or palpation, and patients often seek medical attention due to the above conditions.
Visit the department
Patients can undergo relevant examinations in orthopedics to find out the specific cause and take corresponding treatment.
Preparation for medical treatment
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. If you have recent medical experience, please bring relevant medical records, examination reports, laboratory test sheets, etc.
3. If you have taken some drugs to relieve symptoms recently, you can carry a medicine box.
4. Family members can be arranged to accompany them for medical treatment.
5. Patients can prepare a list of questions they want to consult in advance.
What questions doctors may ask patients
1. When did you find out that you had knee effusion?
2. Do you have any discomfort at the moment?
3. Have the symptoms worsened or decreased since the onset of the disease? Is there any reason?
4. Have you had similar symptoms before?
5. Have you been treated before? How is it treated? How effective is it?
6. Have you had a trauma to your knee joint?
7. Do you suffer from arthritis, joint tuberculosis and other diseases?
What questions can patients ask their doctor?
1. Why do I have knee effusion?
2. Is my condition serious? Can it be cured?
3. How do I need treatment? Do I need to be hospitalized? How long does it take to get better?
4、我需要手术吗？
5、这些治疗方法有什么风险吗？
6、会留下后遗症吗？
7、还会复发吗？
8、我需要做什么检查？
9、我还有其他疾病，这会影响我的治疗吗？
10、回家后我该怎么护理？
11、我需要复查吗？多久一次？
检查
预计检查
医生首先会对患者进行详细的体格检查，初步判断关节的一般情况。同时辅以血液分析检查，帮助查明引发关节痛的病因。x线属于常规检查，观察骨的情况，如有必要还会进行CT、MRI、关节镜等检查。
体格检查
体检有时可发现正常膝关节外形消失，局部肿胀明显。髌韧带两侧膝眼处隆起、饱满，触诊可有囊性感，关节积液如超过50毫升则浮髌试验呈阳性。
实验室检查
1、血常规
适用于感染性疾病的排查，白细胞计数升高常提示感染性疾病。
2、结核菌素试验
适用于结核杆菌感染的排查，阳性有助于滑膜结核等疾病的诊断。
3、自身抗体检测
是类风湿性关节炎有别于其他炎性关节炎的指标之一。
4、关节滑液检查
关节滑液的外观、细胞数等常可为某些关节炎症提供诊断依据。尿酸盐结晶可见于痛风。
影像学检查
1、X线片
可观察关节间隙情况，如关节囊肿胀，则间隙增宽；如关节面软骨有破坏，则关节间隙变窄。
2、CT、MRI
膝关节CT及MRI等影像学检查可清晰显示病灶部位、有无空洞和死骨形成，也可早期发现关节软骨及软骨下骨质的异常改变。
病理检查
取病变部位活组织做病理检查，有助于确定病变的性质。
其他检查
1、膝关节穿刺
有助于判断病变性质。关节液抽吸及检验对鉴别诊断意义重大。
2、关节镜检查
可直接观察关节腔结构，抽取滑液或活检组织进行检查。
诊断
诊断原则
根据患者主要临床表现，如关节肿胀疼痛、活动功能受限。结合实验室及影像学检查可初步做出诊断。需要注意鉴别是否合并有骨性关节炎、半月板损伤等疾病。
鉴别诊断
1、膝关节结核
膝关节结核患者多为儿童及青壮年，多有结核病史或结核病接触史，少数患者可同时患有其他骨结核或骨外结核病。全身症状可表现为低热、盗汗、贫血、消瘦等；膝关节表现为疼痛、肿胀、积液、肌肉萎缩，多以单侧关节发病，双关节或多关节发病者极少见。
2、半月板损伤
多数有明显外伤史。急性期膝关节有明显疼痛、反复肿胀和积液，关节屈伸活动障碍，可能出现弹响。急性期过后，肿胀和积液可自行消退，但活动时关节仍有疼痛，尤以上下楼、上下坡、下蹲起立、跑、跳等动作时疼痛更明显，严重者可跛行或屈伸功能障碍，或在膝关节屈伸时有弹响。
3、膝关节滑膜炎
在任何年龄阶段都会发生，运动量大时，易因膝关节受到打击、扭转、运动过度而发生肿胀、疼痛、活动困难、走路跛行、局部皮肤温度高、皮肤肿胀紧张或关节穿刺出血性液体等。
4、类风湿性关节炎
早晨起床时出现关节活动不灵活的主观感觉，它是关节炎症的一种非特异表现；可有多关节受累表现；可伴有体重减轻、低热及疲乏感等全身症状。超声检查可发现关节积液。
5、风湿性关节炎
关节疼痛是风湿性关节炎首要的症状，典型的表现为对称性、游走性疼痛，并伴有红、肿、热的炎症表现，关节症状受气候变化影响较大，常在天气转冷或下雨前出现关节痛。可有肌肉酸痛不适、周身疲乏、食欲缺乏、烦躁等症状。伴有不规则的发热现象、皮下结节、环形红斑等。超声检查可发现关节积液。
6、滑膜性软骨瘤病
是一种少见的良性关节病，是由滑膜软骨化生而引起。患者可表现为膝关节内疼痛，活动时加重，有时可使病人跌倒。反复出现膝关节突然锁住，不能伸直和屈曲。稍活动膝关节后，常出现弹响，随后症状消失。发作后，关节可肿胀、积液。每次发作时疼痛部位常不相同，伴膝关节活动受限、股四头肌萎缩。
治疗
预计治疗
明确诊断，找出病因，针对膝关节积液的原发病进行治疗，减轻疼痛、炎症，控制病情发展，阻止发生不可逆的骨改变，尽可能的保护关节和肌肉的功能，改善患者的生活质量。药物、理疗、手术可改善不适症状。
治疗方法
原发病治疗：
1、膝关节结核
（1）支持疗法和抗结核药物治疗
改善全身健康情况。
（2）早期卧床及牵引
可迅速减轻症状，用皮肤牵引使关节伸直。
（3）滑膜型结核
早期关节内注射，如无效，应早期手术。
（4）手术治疗
①骨型结核：应及早去除病灶，以免向关节扩散。
②滑膜型结核：如大部分软骨完整，可做病灶清除术，去除病变滑膜、髌上脂肪，软骨面上肉芽；如半月板受累也需切除，术毕完全止血，置患肢于托马氏夹板上，行皮肤牵引，保持关节伸直。以后逐渐活动关节，但休息时将膝关节保持伸直位，抗结核药物治疗持续6个月以上，儿童多能保留全关节的一定活动度。
(180) Total joint tuberculosis: When the bone is obviously damaged, the knee joint should be fused into the functional position after the lesion is completely removed. Children should be fused in a <>° straight position of the knee joint, and be careful not to injure the epiphysis.
2. Meniscus injury
(1) Acute stage
If there is obvious effusion (or blood accumulation) in the joint, the effusion should be extracted under strict aseptic operation; If there is an “interlock” in the joint, the technique should be used to release the “interlock”, and then the knee joint should be fixed in an upright position for 1 weeks with a tubular cast from the upper 3/4 of the thigh down to the ankle. During immobilization and after immobilization, actively work on the quadriceps to prevent muscle atrophy.
(2) Chronic phase
If nonsurgical treatment is ineffective, the symptoms and signs are obvious, and the diagnosis is clear, the injured meniscus should be surgically removed as soon as possible to prevent traumatic arthritis. After the operation, the knee extension position is compressed and bandaged, and the quadriceps static contraction exercises are started the next day, and the straight leg raising exercises are started after 2~3 days to prevent quadriceps muscle atrophy.
(3) Arthroscopic application
Arthroscopy can be used for the treatment of meniscus injury, where suture repair is feasible for meniscus edge tears, usually with partial meniscus resection to preserve the undamaged part. Emergency arthroscopy can be performed for those suspected of meniscus injury in the early stage, which can shorten the course of treatment, improve the treatment effect, and reduce the occurrence of rejuvenating arthritis. Through arthroscopic surgery, there is little trauma and quick recovery.
3. Knee synovitis
Timely detection and timely treatment.
(1) Western medicine treatment
The treatment of knee synovitis mainly includes oral drugs, injected drugs into the joint cavity, irrigation, surgery, etc.
(2) Traditional Chinese medicine treatment
Including external therapy, massage therapy, etc.
prognosis
General prognosis
Generally speaking, after timely and effective treatment, knee joint effusion can be well recovered and the normal function of the joint can be maintained. However, it may also affect the movement of the joints and affected limbs due to untimely treatment of the primary disease, causing inconvenience to work and life.