痛风性膝关节炎的关节镜诊断和治疗

Diagnosis and treatment of knee gouty arthritis by arthroscopy

目的了解关节镜对痛风性膝关节炎的诊断价值和近期疗效。方法从2006年7月至2007年12月收治19例痛风性膝关节炎,作膝关节镜检查,了解其镜下表现,将水肿增厚的滑膜和尿酸盐结晶尽可能刮除,勿损伤关节内结构。术后指导功能锻炼,观察手术疗效,常规服用治疗痛风的药物,多饮水,禁食高嘌呤食物。结果术前5例误诊为其他关节炎的术中确诊为痛风性关节炎。关节镜下见滑膜肿胀增厚,可见痛风的特征性表现:白色结晶物呈点状、片状甚至成堆沉积在滑膜等组织上,在软骨上成片状附着或完全覆盖软骨。术后随访3~18个月,膝关节肿胀、疼痛明显减轻,功能改善明显。3例术后出现高热,改变用药或停药后恢复;2例出现非手术关节的轻微肿痛,继续服用非甾体抗炎药后消失。结论关节镜能对痛风性膝关节炎作出正确诊断,是疗效满意的微创手术。

Objective To study the diagnostic value and therapeutic effect in short time after arthroscopy for gouty arthritis of knee. Methods From 3uly of 2006 to December of 2007, 19 cases of knee gouty arthritis were admitted. First, we observed the knees under the arthroscopy, then removed uratic crystal and resected hyperplastic synovium. After the arthroscopy, rehabilitation and medicine for gout were applied with more water drinked and less rich purine food eaten. Also, we observed swelling, pain and function of the knees. Results The final diagnosis was confirmed during arthroscopy for 5 cases but misdiagnosis was made before artl^roscopy in our early practice. Under arthroscopy, synovial membrane was hyperplasy and thickening. The special appearance was：punctiform and lamellar uratic crystal deposited on tissue,such as the synovium; lamellar uratic crystal deposited on the carti- lage or coved cartilage completely. After the arthroscopy, the pain and the swelling relieved quickly, the function of the knees improved obviously during 3--18 months following up. After the arthroscopy,3 cases had high fever and got normal after changed or stopped medicine; 2 cases had mild swelling of the other joints and recovered by taking NSAIDs. Conclusion Under the arthroscopy,we can confirm the diagnosis of the knee gouty arthritis by its special appearance. The arthroscopy is minimal invasive surgery with favourable results for the gouty arthritis of the knee.