关节镜下关节清理术治疗痛风性膝关节炎疗效观察

The Curative Effect on Arthroscopic Debridement for Gouty Arthritis of the Knee Joint

目的探讨关节镜下关节清理术在痛风性膝关节炎综合治疗中的疗效。方法 2009年5月～2012年5月对保守治疗效果欠佳的25例痛风性膝关节炎患者（男性22例,女性3例,平均年龄41（28～55）岁）,采用关节镜辅助下关节腔清理术清除痛风结晶及炎性因子,术后配合饮食控制及药物治疗。比较患者术前及术后12个月的膝关节Lysholm评分。结果本组25例患者均通过关节镜检查及滑膜病检进一步明确为痛风性关节炎。所有患者术后24 h内膝关节疼痛迅速缓解,术后7 d内尿酸水平均降至正常范围,关节功能障碍在术后得到明显改善。术后随访12～24个月,切口均无感染,术前膝关节Lysholm评分为（57.7±4.9）分,术后12个月为（92.7±5.5）分;手术前后膝关节评分比较差异有统计学意义（P〈0.05）。随访期间6膝复发,复发率为24%（6/25）,但发作频率为每年1～2次,较术前明显减少。结论关节镜下关节清理术治疗痛风性膝关节炎疗效确切,手术创伤小,术后关节功能恢复快;术后配合内科药物治疗和饮食控制,可迅速缓解痛风性关节炎疼痛症状,改善关节功能,减少痛风发作频率。

Objective To explore the effect of arthroscopic debridement in the treatment of gouty arthritis of the knee. Methods The clinical data of 25 patients（ 22 of male and 3 of female） suffered gouty arthritis of the knee joint,aged from 28 to 55 years（ mean 41）,admitted from May 2009 to May 2012 were analyzed retrospectively. After invalid expectant treatment,the arthroscopic debridement and biopsy were performed in all cases. Results The gouty arthritis was diagnosed definitely by arthroscopy and pathologic exam of synovial membrane in all 25 cases. The joint pain was eliminated rapidly during 24 hours after the surgery,and the level of serium uric acid was restored to normal during 7 days after the surgery. During 12 to 24 months followup,all wounds were achieved healed without infection. The Lysholm scores of knee joint was 92. 7 ± 5. 5 points12 months after the surgery,and was higher than 57. 7 ± 4. 9 points before the surgery,there was statistical difference between pre- and post-operative score（ P 〈0. 05）. The recurrence was found in 6 knees with the recurrence rate of 24%,but the seizure frequency of gout was decreased to once or twice per year. Conclusions The arthroscopic debridement is a reliable and effective treatment for gouty arthritis with advantages of mini-invasive,faster recovery of knee joint function. Combined with urate-lowering therapy and appropriate diet regulation,it can release the joint pain,improve the joint function and decrease the seizure frequency.