关节镜下治疗跖趾关节痛风性关节炎的临床疗效

Clinical efficacy of arthroscopic surgery in the treatment of gouty arthritis of metatarsophalangeal joint

目的探讨关节镜下手术治疗第一跖趾关节急慢性痛风性关节炎的方法和疗效。方法对20例急慢性痛风性关节炎患者进行关节镜检查,利用刮匙除去紧密附着在关节软骨上的尿酸盐结晶,利用刨刀刨削充血、增生的滑膜及其附着的尿酸盐结晶;用碳酸氢钠注射液冲洗关节腔。术后抗炎镇痛,继续饮食控制及降尿酸等治疗。结果 20例患者术后病情均得到不同程度的缓解。经3～24个月的随访观察,其中3例复发,复发时间最短为术后6个月,最长为术后1年,发作部位均在对侧或其他关节。有3例术侧有微痛、红。复发原因是患者未控制饮食,也未服用抗痛风药物。结论关节镜下手术治疗急慢性痛风性关节炎是一种见效快、创伤小、效果稳定的方法,值得临床推广应用。但它仅是一种局部治疗方法,可以防止晚期骨性关节炎的早期发生,但不能代替排酸、抑酸及饮食控制的治疗。

Objective To investigate the methods and efficacy of arthroscopic surgery in the treatment of gouty arthritis of the first metatarsophalangeal joint. Methods＇ A total of 20 patients with acute and chronic gouty arthritis of metatarsopha- langeal joint were diagnosed by arthroscopy. The urate crystal stones deposited on the surface of cartilage were removed by radioft＇equency evaporating apparatus and curettes. The bloodshot, hyperlastic synovium and the urate crystal deposited on it were cut by the shavers under arthroseopy. The joint cavity was rinsed by sodium bicarbonate injection. Anti-inflammatory analgesia, continued diet control and reduced uric acid treatment were continued slier the operation. Results＇ The postopera- tive conditions of 20 patients were all relieved to varying degrees. After 3-24 months follow-up observation, 3 cases had recurrence, the shortest recurrence time was 6 months after operation, and the longest was 1 year after operation. The episodes were all on the eontralateral side or other joints. There were 3 cases with slight pain and red on operation side. The reason for the reeun＇enee was that the patients did not control the diet and take anti-gout medication. Conclusion Arthro- scopic smgery in the treatment of acute and chronic gouty arthritis of metatarsophalangeal joint is quick, minimally invasive and stable method, it is worthy of clinical application. However, it is only a local treatment that can prevent the early occur- rence of advanced osteoarthritis, but it can not replace the treatment of acid removing, acid suppression and diet control.