HEMARTHROSIS (haemarthrosis; grech, haima blood + arthron a joint + - osis) — hemorrhage in a cavity of a joint. The opened or closed injury of a joint is the most frequent reason of G. (bruises, sprains, dislocations, damage of tissues of joint — intra joint changes, ruptures of the capsule, sheaves and others); at some forms of hemorrhagic diathesis, napr, hemophilias, avitaminosis, napr, a scurvy, even the insignificant injury can call G. Nablyudayetsya as well postoperative G.
Amount of blood in a joint depends on the nature of damage of joint elements and fluctuates over a wide range. The most considerable accumulations of blood are observed in a knee joint owing to features of its structure. The synovial membrane at G. becomes impregnated with blood, is thickened, becomes edematous and sharply reacts hypersecretion synovial fluid (see). Blood if integrity of the capsule is kept and there are no intra joint changes, mixes up with the synovial fluid having fibrinolitic properties and long is not curtailed. The picture of a serous inflammation develops, and liquid in a cavity of a joint has serous and hemorrhagic character. Not turned blood at G. is soaked up on limf, to ways, and uniform elements it thanks to phagocytosis resolve. A part of fibrin of blood settles on cartilaginous surfaces, intra joint educations and a synovial membrane and will be organized. At heavier damages there can occur fibrillation, in a synovial membrane there are cicatricial changes, the difficult mechanism of formation of synovial fluid and its absorption is broken; function of a joint at the same time is partially broken.
At the opened and getting injuries of joints in case of accession of an infection of G. promotes development of purulent arthritis (see. Arthritises ) or osteoarthritis (see). At hemophilia often repeating G. can lead to heavy degenerative changes of all joint elements (see. Arthroses ).
The clinical picture and the diagnosis
In a joint is noted morbidity, edges especially is expressed, than in a cavity of a joint blood collects quicker. Pains at the movements amplify. At considerable G. function of a joint is limited, spastic reductions of muscles are noted. The joint quickly increases in volume, its contours smooth out. In a joint the zybleniye is defined, and at damage of a knee joint — as well balloting of a patella (see. Balloting ). Quite often within several days temperature increase, sometimes to 38 ° is observed above.
At suspicion on G. in perhaps earlier terms the puncture of a joint is shown. Availability of blood in punctate confirms the diagnosis, and floating drops of fat in the settled blood testify to an intra joint change. In all cases of G. to exclude dislocation and a fracture, the roentgenogram shall be made. At damage knee joint (see) it is necessary to exclude injury of meniscuses (see. Meniscuses joint ), and also cross-shaped and side sheaves. For G. at hemophilia the anamnesis, repeated G. at an insignificant injury are characteristic, existence of spastic reductions of muscles, etc.
At G. children is caused by the same reasons, as at adults. The knee joint is more often damaged. The accompanying injuries of ligaments, meniscuses and other joint elements at children are observed rather seldom. Usually it is necessary to differentiate G. at children with traumatic synovitis (see), and also arthritises of not traumatic origin (rheumatic, tubercular, brucellous etc.). Along with a diagnostic puncture the pnevmoartrografiya can give essential help (see Artrografiya), to-ruyu carry out on 10 — the 14th day after subsiding of the acute inflammatory phenomena.
Blood from a joint is sucked away and enter 20 ml of 2% of solution of novocaine; to children enter 5 — 10 ml of 1% of solution of novocaine together with 50 mg of a hydrocortisone into a cavity of a joint. Impose a back plaster splint. Sometimes it is necessary to repeat a puncture of a joint. 10 — 12 days later appoint LFK (the dosed movements in a joint, light massage of muscles proksimalno from a joint), physiotherapeutic treatment (paraffin, sukhovozdushny bathtubs). To occupations to lay down. physical culture at children since / a knee joint start in earlier terms, with 2 — the 3rd day since a static stress the four-head of a muscle of a hip and with 7 — the 10th day passing to the active flexion and extensive movements in a knee joint; UVCh-therapy there begin with second day, paraffin and ozokeritovy applications — with 8 — the 10th days. In cases when G. is caused by damages (a change, a rupture of sheaves, etc.) or is a symptom of a disease, treatment of the main damage or a disease is carried out.
the Forecast at G. depends on the main damage; at hemophilia owing to repeated G. preservation of function of a joint is very problematic.
After G. the posttraumatic synovitis proceeding can develop 2 — 3 months and more), difficult giving in to treatment and quite often recurrent not only in the next, but also in the remote terms is long (.
Bibliography: G. A. O hares damages of a knee joint at children, Works Leningr, pediat, medical in-that, t. 36, page 298, 1965; To and p l and A. V N. The closed injuries of bones and joints, page 366, M., 1967; Lyonyushkina. And. ilikhtenm. Ya. Children's out-patient and polyclinic surgery, M., 1967; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 2, page 281, M., 1964.
A. V. Kaplan; BB., M. Gorodnicheva (it is put. hir.).