药物联合关节镜下滑膜清理术治疗痛风性关节炎的价值

Combination of medication and arthroscopic synovectomy in treatment of gouty arthritis

目的探讨药物联合关节镜下滑膜清理术治疗痛风性关节炎的价值。方法对28例痛风性关节炎患者在使用药物同时,应用关节镜对受累的28个膝关节进行滑膜清理术,术后即在关节腔内注射复方倍他米松注射液(二丙酸倍他米松及倍他米松磷酸盐),且继续前药物治疗。对28例患者进行6个月随访。测定术前及术后2周、4周、12周血沉(ESR),C反应蛋白(CRP),血尿酸(UA)并进行比较,对患者膝关节功能进行Ishikawa评分。结果所有患者在手术次日关节肿痛明显减轻。术后2周,血ESR和CRP与术前比较,差异均有统计学意义(P<0.01),UA与术前比较差异亦有统计学意义(P<0.05);术后第4周及12周,患者血ESR、CRP、UA与术前比较,差异均有统计学意义(P<0.01)。术后3个月,患者关节功能的优良率为92.9%(26/28);术后6个月,患者关节功能的优良率为89.3%(25/28)。结论对痛风性关节炎患者进行关节镜下滑膜清理术联合药物治疗,近期疗效满意,并且关节镜下滑膜清理术对非典型痛风性关节炎具有重要的诊断及鉴别诊断价值。

Objective To evaluate the efficacy of combination of medication and arthroscopic synovectomy in treatment of gouty arthritis. Methods Twenty-eight knees of 28 patients with gouty arthritis were treated with combination of medication and arthroscopic synovectomy. Compound betamethasone was injected into the knee joints after operation, and medication was given continually. All 28 cases were followed up for 6 months. Erythrocyte sedimentary rate（ESR）, C-reactive protein （CRP）and uric acid （UA）were measured before and after operation; Ishikawa＇s scoring system for knee function was evaluated. Results Tenderness and swelling of the knees were relieved after operation. The levels of ESR, CRP and UA significantly decreased in the different period after operation （P〈 0.05 or P〈 0.01）. The excellent and good rate of Ishikawa＇s scoring system was 92.9% 3 months after operation and 89.3% 6 months after operation. Conclusion Combination of medication and arthroscopic synovectomy demonstrates to be effective in treatment of gouty arthritis.