关节镜下关节清理治疗膝关节痛风性关节炎的疗效分析

Analysis on clinical efficacy of arthroscopic debridment in treatment of knee gouty arthritis

目的探讨关节镜下关节清理治疗膝关节痛风性关节炎的临床疗效。方法 24例（29膝）膝关节痛风性关节炎患者,用刨削刀行关节腔清理,刨除增生水肿炎性滑膜;用刮勺轻轻刮除关节软骨面、半月板和交叉韧带表面附着的白色尿酸盐结晶体,同时使用5%碳酸氢钠溶液冲洗。术后给予降尿酸药物、低嘌呤饮食等综合干预。结果 24例术口均一期愈合无术口感染,关节肿胀于术后4~7 d消失,术后1周出院,2~3周膝关节功能恢复正常。随访10~60个月,平均28.7个月。其中3例于术后1个月、2个月、4个月痛风复发。术前膝关节功能Lysholm评分（42.8±3.1）分提高到术后6个月的（91.7±2.5）分,差异有统计学意义（P〈0.05）。结论关节镜下滑膜及尿酸盐清理可以有效阻止关节内结构进一步侵蚀性破坏,防止关节畸形和功能障碍。

Objective To investigate the clinical efficacy of arthroscopic debridment in treatment of knee gouty arthritis. Methods Using arthroscopic debridment,24 cases（ 29 knees） of patients with knee gouty arthritis underwent local synovectomy,and the urate crystals on menisci,anterior and posterior cruciate ligaments,and articular cartilage surface were scraped and then douched using 5% sodium bicarbonate solution. Uric acid lowering drugs and low-purine diet were incorporated to the postoperative comprehensive treatment. Results 24 cases were healed without infection. Postoperative knee swelling and pain disappeared4- 7 days after operation,and the knee function was recovered in 2- 3 weeks. The follow-up duration ranged from 10 months to 60 months with an average duration of 28. 7 months. Three cases developed postoperative recurrence at 1 months,2 months and 4 months after operation. According to the assessment by knee function Lysholm scoring,the scores（ 91. 7 ± 2. 5） six month after the operation were greatly increased compared with preoperative scores（ 42. 8 ± 3. 1）,with a statistically significant difference（ P 0. 05）. Conclusion Arthroscopy can provide early diagnosis of knee gouty arthritis. Arthroscopic debridment can effectively prevent various intraarticular structures from further erosive damage,thus restraining the development of joint deformity and dysfunction.