关节镜手术在痛风性关节炎诊治中的应用

Application arthroscopy for diagnosis and treatment of gouty arthritis

目的探讨关节镜手术对痛风性关节炎诊断和治疗的应用价值。方法自2001年1月￣2004年1月,对29例关节镜探查术初步诊断痛风性关节炎的患者常规行关节清理术和滑膜病检术;另外对7例痛风性关节炎经保守治疗,仍不能阻止软骨与骨继续破坏,后行关节镜下的病灶清除术、滑膜切除术和软骨缺损微骨折术等;术后对确诊患者坚持正规的降尿酸治疗。结果痛风性关节炎的关节镜表现为白色针状、絮状或团块状物质沉积在滑膜、软骨和其他关节内结构的表面。术后36例症状均明显缓解、切口甲级愈合,随访6～15月,仅2例出现短暂复发,部分患者的MRI随访提示骨与软骨破坏未继续扩大。结论关节镜手术对大关节的痛风性关节炎具有较高的诊断价值,还可同时处理关节内病变,减缓病程发展。

[Objective] To investigate the use of arthroscopy for the diagnosis and treatment of gouty arthritis. [Methods] A total of 29 patients with gouty arthritis were diagnosed by arthroscopy between January 2001 and January 2004. Then biopsy and synovectomy were performed under arthroscope. 7 more cases were treated with debridement, synovectomy and microfracture because gouty arthritis had not been controlled effectively by uricosuric agent. Use the uricosuric agent at post-operatlon for avoiding symptom recurring. [Results ] Arthroscopy showed specific white urate crystal deposited the surface of synovium and cartilage. Joint pain were eliminated rapidly in all cases and all the wounds were healed well after operation. Symptom had transient recurrence in two patients （from 6 to 15 months follow-up）. [Conclusion] Arthroscopy is the reliable choice for the diagnosis and treatment of gouty arthritis. Advantages of this technique are minimal invasive, simple procedure, less time for operation and hospitalization with early rehabihtation, and all the combined lesion can be treated at the same time.