关节镜有限清理术等综合性措施治疗痛风性关节炎

Role of limited debridement of arthroscope in the comprehensive treatment of gouty arthritis.

目的探讨膝关节痛风性关节炎综合治疗中关节镜的作用和疗效。方法自2000年2月至2009年2月,对45例反复急性发作的膝关节痛风性关节炎患者进行关节镜诊治,利用刮匙除去紧密附着在负重面关节软骨上的尿酸盐结晶,对充血、增生的滑膜及其附着的尿酸盐结晶不予特殊处理;修整剥脱的关节软骨及受侵蚀的半月板;用大量冲洗液冲洗关节腔,最后关节腔内注射复方倍他米松注射液(得宝松)及罗哌卡因等复合药物。术后抗炎镇痛,合理饮食调节及降尿酸治疗。结果 45例患者术后病情均得到不同程度的缓解,28例患者随访期内未发生痛风急性发作。17例患者有2～3次的急性发作,与饮食控制不良和未坚持降尿酸治疗或患有高三酰甘油血症、肥胖等代谢性疾病有关。结论关节镜下手术治疗膝关节痛风性关节炎是一种起效快、微创、效果显著的方法,关节内对软骨、滑膜尽量少的干预及复合镇痛药物的应用,有效地缓解了疼痛。但关节镜微创治疗仅是综合治疗的一部分,尚需要合理饮食调节、降酸等配合治疗。

Objective To investigate the comprehensive methods and results of arthroscopic surgery for the treatment of gouty arthritis.Methods Forty-five patients with gouty arthritis were diagnosed by arthroscopy between Feb.2000 and Feb.2009.The urate crystal stones deposited on the loaded surface of cartilage were removed by curettages.The hyperplastic synovium and the deposited urate crystals were left without special treatment.The microfracture of the affected cartilage repair and meniscectomy were done at the same time.Irrigation was used before the end of the surgery.The compound betamethasone,morphine and rapocaine were injected into the joint.Diet regulation and drug therapy were performed after the operation.Results Joint pain was eliminated after operation in all the 45 patients.Twenty-eight patients had no flare during the follow-up period.Seventeen cases had recurrence of acute gouty arthritis for 2-3 times which was related to bad diet controls or diet syndrome.Conclusion The comprehensive methods including arthroscope is the reliable choice for the treatment of gouty arthritis.Advantages of this technique are minimal invasion,simple procedure,short time for operation and hospitalization with early rehabilitation,and little interference with synovium,but it is part of comprehensive treatment,and appropriate diet regulation and urate-lowering therapy are necessary.