| The disease of bone joint synovium is one of the major etiopathogenisis which induces arthrocele, soreness and disability. In the past, the soft tissue injury could not be diagnosed by x-ray. Arthrography and arthroscope are the important methods to diagnose joint injury, but both of them are limited because their traumatic occlusion and the potential complication.In recent years, the non-invasive rapid, and convenient high-frequency ultrasound can provide a large amount of screenage information for the diagnosis and differential diagnosis of arthropathy because of the rapid development of ultrasonographic image technology. In clinics, the method which punctures synovial biopsy with the help of ultrasound to make a pathology diagnosis for pathological changes has been widely accepted. Color Doppler can offer a real-time display about the changes of blood stream and the pathology blood vessel structure, that is, it can ensure the safety of intervention and avoid the injury of blood vessel on the puncture pathway and reduce the complication effectively. The character of the none- virulence real-time imaging and no- radioactivity makes ultrasound an important method for joint examination. Interventional ultrasound has become a reliable interventional therapy for arthropathy.48 patients from the out-and-in patients since June 2005 were chosen by this paper, including 21 males and 27 females. The clinical manifestations were joint swelling and pain, and functional limitation to varied degrees. All of the ultrasound scans showed synovial thickening, and clinical diagnoses were not clear. SIEMENS ACUSON Anatres color Doppler ultrasonic diagnostic apparatus were applied and the probe frequency was 5 ~ 10MHz linear transducer. Automatic biopsy device adopted the U.S. BARD MAGNUM automated biopsy gun, with 16G-21G cutting needle trough organization. 149 interventional procedures were carried out on 47 patients, 1 patient failed due to no cooperation, the success rate is 97.9%. The length of biopsy derived by the puncture needle were 1.0 ~ 2.0cm, which were consistent with pathological diagnostic requirements. 47 patients took ultrasound-guided biopsy of synovium, 36 patients were clearly pathologically diagnosed, 8 cases of RA and 3 patients of OA with a total of 11 cases were confirmed by clinical pathological manifestations, imaging and laboratory tests . 5 synovial lesions, among which 15 cases were of rheumatoid arthritis including 7 cases of knee, 3 cases of ankle joint, 4 cases of wrist joint, and 1 case of hip; 3 cases were of osteoarthritis including 1 case of the knee, 2 cases of the hip; pigmented 16 cases were of villonodular synovitis including 13 cases of knee, 1 ankle, and 2 cases of hip; 6 cases were of tuberculous arthritis including3 cases of knee, 1 case of shoulder, 1 cases of joint, and 1 case of hip joint; 7 cases in total were of infected joints, including 6 cases of knee joint, and one case of shoulder joint.Synovitis is the main feature of joint disease, ultrasound showing synovial thickening, cartilage and subchondral bone changes in cortical echo. It varies according to the severity of different lesion. In milder cases it shows rough cartilage edge, heterogeneous echo texture, while in serious cases keyed vocal cord cartilage disappears, cortical echo increases significantly, or continuity is poor, even partially missing. There is a high incidence of joint effusion, part of which shows the merger of suprapatellar bursa effusion.Arthrositis can be induced by both systemic and local disease. It is very hard to make a clear diagnosis according to imageology because of the similar clinical symptom and sonographic appearance of arthrositis. Among the 47 cases in this gounp, 36 cases made a pathology diagnosis by synovial biopsy with the help of ultrasonic puncture; 11 cases got final diagnoses by the combination of pathology, clinical situation, imaging and laboratory examination; 3 were misdiagnosed cases; 1 case was diagnosed as synovial chondromatosis by ultrasound but finally diagnosed as pigmented villonodular synovitis by pathology; another 2 cases were diagnosed as suppurative synovitis by ultrasound but finally diagnosed as tuberculous synovitis by pathology.Ultrasound diagnosis of arthritis can make preliminary diagnosis and differential diagnosis, according to their predilection site combined with the sonographic features of synovial and clinical symptoms, but it can not make a pathological diagnosis. Therefore, an ultrasound guided synovial biopsy diagnosis has an irreplaceable importance in synovial disease when clinical, radiological and laboratory tests can not make a clear diagnosis.Before conducting interventional operation, it is necessary to control indications, contraindications and complications strictly. Besides, we should pay attention to determine the location of synovial lesions, select the appropriate needle direction, and keep away from large vessels to ensure the safety of puncture when conducting ultrasound guidance.Ultrasound-guided automatic biopsy derived a high success rate, 47 patients of this group were selected successfully except one who did not cooperate. The success rate reached 97.9%, and the biopsy specimens were of high satisfaction. Biopsy specimens were accurate and reliable. As automatic biopsy needle moved in high speed and it took short residence in the lesion, it was not likely to cause serious injury, and it caused low complications. Two patients of the group showed dizziness, palpitations and other symptoms, then got remission after rest, the incidence rate was 4.2%. Interventional ultrasound synovial biopsy is safe, reliable and convenient, it is has been more and more widely used in minimally invasive clinical pathological diagnosis and etiological diagnosis for its prominent advantages now. Furthermore, it also provides a new and more effective screening method for the cause of synovitis .Conclusions: (1) High-frequency ultrasound can be used in observing synovial lesions clearly. In addition, it does well in joint effusion, joint intermittent broadening or narrowing, bone destruction and proliferation of the bone surface. It is a simple, convenient, quick, noninvasive inspection method which is repeatable, while it shows difficulty in identifying types of arthritis. (2). Ultrasound guided synovial biopsy inspection has a high accuracy. Color Doppler and Power Doppler can show clearly the blood flow of synovium, and offer a real-time observation of the location of the needle to avoid damaging important organs to guide the synovial puncture. In addition, it can be used to observe the follow-up effect in a long run. (3). Ultrasound-guided automatic biopsy is featured by its good quality, high success rate, convenience, safty and reliability. Biopsy with local anesthesia brings patient less pain, and is easily accepted. (4). Interventional ultrasound in the synovial biopsy can not only significantly reduce the time of diagnosis, but also be combined with pathology, immune cytology and molecular biology techniques which can provide abundant information for the diagnosis of synovial disease. This new minimally invasive clinical diagnostic tool has become an important method of synovial disease.
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