关节镜下清理术在痛风性关节炎诊治中的应用

Arthroscopic Debridement for the Diagnosis and Treatment of Gouty Arthritis

我科于１９９３年５月～１９９５年１０月用清理术＂诊治痛风性关节炎１１例。跖关节为主９例，踝、膝关节单发各１例。用１．９ｍｍ小关节镜系列，在局麻牵引下进跖关节，用４．０ｍｍ关节镜系列，在连续硬膜外麻醉下进踝、膝关节，检查清除关节内晶体、肥厚绒毛的损害软骨，即刻效果为１００％。清理术＂不仅对诊断、鉴别诊断本病有至关重要的意义，而且在痛风急性关节炎期可以起到与秋水仙碱相似作用，并能预防治疗晚期骨性关节炎。手术中要牵开踝、跖关节，冲洗净关节内及附近红肿区内晶体。尽管不能代替饮食控制，药物（丙磺舒、别嘌呤醇）及晚期切开取痛风石、截骨矫形术，但为痛风性关节炎诊断治疗增加了一个新的方法。

Eleven patients with gouty arthritis were diagnosed and treated with arthroscopic debridement between 1993 and 1995. Nine cases had involvement of the first metatarsophalangeal joint and one each of the ankle and knee, 1.9mm arthroscope was used for the metatarsophalangeal joint and 4.0mm arthroscope for the ankle and the knee. Epidural anesthesia was used for the procedure.Shortterm satisfactory results were seen in all. During the acute stage,the debridement was not only valuable for the diagnosis, but also was effective for symptomatic relief similar to that of Colchicine. Although arthroscopic debridement can not replace diet and drug therapy,open eradication of gouty stone and resection arthroplasty, it could be used as a new method for the diagnosis and treatment of gouty arthritis.