关节镜手术治疗踝关节痛风性关节炎的临床研究

Clinical Study on Treatment of Ankle Gouty Arthritis with Arthroscopy Surgery

目的探讨关节镜手术治疗踝关节痛风性关节炎的临床疗效。方法 2011年11月至2013年4月,选择55例(99踝)在我院就诊的痛风性关节炎患者,分为治疗组(n=28)和对照组(n=27)。于我院在西药治疗的基础上,治疗组给予踝关节镜手术,对照组给予痛风定胶囊治疗。治疗后随访10个月,治疗后疗效评定根据血尿酸、ESR(红细胞沉降率)、CRP(C反应蛋白)、健康相关问题评分、AOFAS(美国足踝协会)与后足功能评分评价所有患者。结果治疗后两组ESR、CRP、血尿酸、健康相关问题评分较前明显降低,AOFAS踝与后足功能评分较前明显提高,差异有统计学意义(P<0.05)。治疗后治疗组的健康相关问题评分明显低于对照组(P<0.05),AOFAS踝与后足功能评分明显高于对照组(P<0.05)。治疗组的显效率(84%)明显高于对照组的显效率(68%,P<0.05)。治疗组不良反应发生率为16%,对照组为8%,差异无统计学意义(P>0.05)。结论踝关节镜手术和药物治疗均可有效的治疗踝关节痛风性关节炎,踝关节镜手术在提高患者生活质量和改善踝关节功能方面优于药物治疗。

Objective To explore the clinical therapeutic effect of arthroscopy surgery on ankle gouty arthritis. Methods Fifty-five cases（99 ankles） with gouty arthritis in our hospital from November 2011 to April 2013 were divided into therapy group（n=28） and control group（n=27）. All cases were treated with western medicine, moreover, patients in therapy group were treated with arthroscopy surgery and patients in control group were treated with Tongfengding Capsules. The cases were followed up for 10 months. The blood uric acid, erythrocyte sedimentation rate（ESR）, C-reactive protein（CRP）, health assessment questionnaire（HAQ） score, anklehindfoot scale from American Orthopaedic Foot Ankle Society（AOFAS） were used to evaluate the clinical effect. Results At the last follow-up, the blood uric acid, ESR, CRP, HAQ score significantly decreased in two groups（P〈0.05）, and ankle-hindfoot scale from AOFAS significantly increased in two groups（P〈0.05）. The HAQ score of therapy group was significantly lower than that of control group（P0.05）, whereas the ankle-hindfoot scale from AOFAS was significantly higher than that of control group（P0.05）. The obvious effective rate in therapy group（84 %） was significantly higher than that of control group（68 %, P〈0.05）. The incidence of adverse effect in therapy group（16 %） was higher than that of control group（8 %）, and the difference was not statistically significant（P0.05）. Conclusion Arthroscopy surgery and drug treatment both can be effective for the treatment of ankle gouty arthritis, and arthroscopy surgery is better than drug treatment in improving the quality of life and ankle joint function of the patients.