关节镜下清理术治疗膝关节痛风性关节炎

Arthroscopic debridement for treating gouty arthritis of knee joint

目的 探讨关节镜下关节清理术治疗膝关节痛风性关节炎的疗效.方法 回顾分析2006年以来经关节镜探查清理术治疗的32例膝关节痛风性关节炎患者的临床资料.患者均在连续硬膜外麻醉下行膝关节镜探查清理术,手术标本进行病理检测.术后随访12～ 36个月,对患者进行膝关节Lysholm评分和疼痛视觉模拟评分（VAS）,同时对痛风发作频率、持续时间及发病时关节肿胀、疼痛症状进行综合评价.结果 结合关节镜检查及病理检查,患者均确诊为痛风性关节炎.术后患者切口均Ⅰ期甲级愈合.术后20个月随访时,膝关节Lysholm评分[（92.20±8.70）分]较术前[（60.50±12.50）分]明显升高（P＜0.01）;疼痛视觉模拟评分（VAS）[（3.56±2.81）分]较术前[（8.26±1.13）分]明显降低（P＜0.01）.随访期间5例复发,但发作频率、持续时间及发病时关节肿胀、疼痛症状较术前改善.结论 关节镜下清理术是治疗膝关节痛风性关节炎的有效手段,结合系统正规的痛风内科治疗及饮食控制,可取得令人满意的治疗效果.

Objective To investigate the effects of arthroscopic debridement for treating gouty arthritis of knee joint. Methods The data of 32 patients with gouty arthritis of knee joint treated by debridement under arthroscopy since 2006 were retrospectively reviewed. Knee arthroscopic exploration and debridement under continuous epidural anesthesia was per- formed in all patients, and pathological examination of postoperative samples were conducted. The follow-up duration after operation was 12 to 36 months. The Lysholm scoring scale and pain visual analogue scale （VAS） were used to evaluate knee joints functions and patients＇ pain degrees, and the overall evaluation was made based on the attack frequency and du- ration of gout,the joint swelling and arthralgia symptom in attacks. Results All patients were confirmed as gouty arthritis by arthroscopy with pathologic examinations. All operative incisions were grade 1 healing. Compared with pre-operation, the 20-month follow-up resuhs after operation showed that the Lysholm score of knee joint increased significantly（92.20 ± 8.70 vs 60.50 ±12.50,P 〈0.01 ） ,and the VAS score decreased significantly（3.56 ±2.81 vs 8.26± 1.13 ,P 〈0.01 ）. During follow up, gout recurrence was found in five cases, but the attack frequency and duration of gout, the joint swelling and ar- thralgia symptoms during gout attacks were improved compared with pre-operation. Conclusions The arthroscopic debride- ment is an effective method for treating gouty arthritis of knee joint and can achieve satisfactory efficacy by combing with regular medicine treatment and diet control.