关节镜下清理联合术后持续灌洗治疗膝关节痛风性关节炎

Clinical application of arthroscopic debridement combined with continuous lavage in the diagnosis and treatment of gouty arthritis of knee joint

目的探讨关节镜下清理联合术后置管持续灌洗治疗在膝关节痛风性关节炎的临床应用效果。方法回顾性分析2011年6月至2013年9月于我院接受关节镜下关节清理和滑膜切除术治疗膝关节痛风性关节炎的24例病例资料,病人均为单膝关节发病,左膝14例,右膝10例;男22例,女2例。所有病人术后均行置管持续灌洗治疗约1周,常规抗感染、镇痛,并服用降血尿酸药物,于拔除引流管后早期行常规功能锻炼。比较病人术前、术后及不同随访时间疼痛视觉模拟量表(visual analogue scale,VAS)评分和Lysholm膝关节评分。结果所有病人均获得3~18个月的随访。病人术后各时间点VAS评分较术前的(6.8±3.1)分均显著下降(均P<0.05)。病人术后各时间点随访Lysholm膝关节评分与术前的(42.7±26.3)分比较,差异均有统计学意义(均P<0.05)。至末次随访,共有3例病人出现症状复发,均与饮食控制不良相关,给予相应口服药物治疗及饮食控制后,症状明显好转。所有病人均未发生严重并发症,恢复良好。结论关节镜对膝关节痛风性关节炎诊断准确率高。关节镜下关节清理加滑膜切除术治疗膝关节痛风性关节炎有显著效果,配合术后置管持续灌洗治疗对加强治疗效果和降低复发概率有一定帮助。

Objective To investigate the clinical value of arthroscopic debridement combined withsynovectomy and continuous lavage in the treatment of arthritis of knee joint. Methods Twenty-four cases ofunilateral gouty arthritis of knee joint from June 2011 to September 2013 were retrospectively analyzed,including 14 cases of left side and 10 cases of right side. There were 22 men and 2 women. All patientswere processed with arthroscopy cleaning and synovial joints resection followed by postoperative cathetercontinuous infusion therapy, routine anti-inflammatory analgesic and blood uric acid-reducing drugs. Earlyfunctional exercise was performed after extubating. Data before and after operation including visual analoguescale(VAS) pain scores and Lysholm knee scores were compared. Results All cases were followed up for 3 to18 months. Postoperative VAS score was significantly reduced as compared with preoperation(6.8±3.1)(P<0.05). Significant difference was also demonstrated in Lysholm knee score before operation(42.7±26.3) and at3 rd month after operation(83.9±11.2)(P<0.05). By the final follow-up, recurrence was detected in 3 cases,which were associated with a poor control of diet and fully controlled with oral medication and alimentarycontrol. There was no serious complication. Conclusion Arthroscopy shows high diagnostic accuracy in kneegouty arthritis. Arthroscopic debridement combined with synovectomy has a significant effect, while cooperationwith postoperative catheter continuous lavage treatment is helpful to strengthen the treatment effect and reducethe probability of recurrence.