关节镜在诊治急性踝关节痛风性关节炎中的应用

Diagnosis and treatment of acute gout arthritis in ankle under arthroscopy

目的提高对单纯踝关节起病的急性痛风性关节炎的诊断认识并加强其早期治疗。方法回顾总结1999年以来,关节镜检查发现的14例踝关节急性痛风性关节炎的诊治经过,经过半年以上的随访,进行疗效观察。结果14例病人术前均误诊,分别诊断为化脓性关节炎、类风湿性关节炎、急性滑膜炎、骨性关节炎。全部病例在踝关节镜检查后发现确诊。并一期行关节镜下清理术,术后配合以系统药物治疗,经过随访观察,近、远期均取得满意疗效。结论单纯以踝关节起病的急性痛风性关节炎少见,且容易误诊,随着关节镜技术的不断提高和广泛应用,其诊断率将会获得提高,同时亦为早期治疗急性痛风性关节炎增加了一个新的方法。关节镜下手术仅是急性痛风性关节炎的一种局部治疗方法,它可以防止晚期骨性关节炎的早期发生,但不能代替排酸、抑酸及饮食控制的治疗。

[Objective] To introduce the knowledge for the diagnosis of acute gout arthritis that attacked initially in the ankle and improve its early treatment. [Methods] 14 cases with acute gout arthritis in the ankle were diagnosed and treated under arthroscopy since 1999. The experiences were analysed retrospectively and the therapatic results were observed through a follow-up of more than 6 months. [Results] All 14 cases were given a misdiagnosis of suppurative arthritis, rheumatoid arthritis, acute synovitis, osteoarthritis respectively before arthroscopy. All the patients were diagnosed and given a debridment simutaneously under arthoscopy. Then, the patients were given an postoperative systematic drugs therapy. The follow-up showed that all the patients acquired a short-term and longterm satisfactory therapeutic effect. [Conclusions] The acute gout arthritis attacked initially in the ankle is rare and its misdiagnosis rate is very high. The significant improvement and extensive application of arthroscopic technics will improve its diagnosis rate and provide a new way for its early surgical treatment.