微创针刀镜治疗急性痛风性膝关节炎临床研究

Clinical Study on Minimally Invasive Acupotomy for Acute Gouty Knee Arthritis

目的:观察微创针刀镜治疗急性痛风性膝关节炎的近期疗效和远期疗效。方法:选取42例急性痛风性膝关节炎患者为研究对象,根据其是否同意接受微创针刀镜治疗分为治疗组和对照组,每组21例。对照组给予常规药物治疗,治疗组在此基础上施行微创针刀镜。分别于治疗前、治疗后7天和14天记录患者肿胀关节数、疼痛关节数、压痛关节数、灼热关节数、关节疼痛视觉模拟评分法(VAS)评分及血尿酸(UA)、血沉(ESR)、C-反应蛋白(CRP)值,计算2组随访半年内复发人次。结果:治疗后,2组肿胀关节数、疼痛关节数、压痛关节数、灼热关节数及关节疼痛VAS评分均较治疗前改善(P <0.05)。治疗后7天,治疗组肿胀关节数、灼热关节数及关节疼痛VAS评分改善情况均优于对照组(P <0.05)。治疗后14天,治疗组关节疼痛VAS评分优于对照组(P<0.05)。治疗后7天及14天,2组ESR、CRP及UA水平均较治疗前降低(P <0.05)。与对照组比较,治疗组CRP水平治疗后7天下降更明显(P <0.05)。治疗后14天,治疗组ESR及CRP水平均比对照组下降更明显(P <0.05)。2组UA水平治疗后同期比较,差异均无统计学意义(P> 0.05)。随访半年,治疗组有1例患者复发1次,对照组共有4例患者7次复发,2组复发人次比较,差异有统计学意义(RR=0.143,χ2=4.500,P <0.05)。结论:在常规治疗基础上开展微创针刀镜治疗急性痛风性膝关节炎可提高近期疗效和远期疗效。

Objective：To observe the short-term and long-term curative effect of minimally invasive acupotomy for acute gouty knee arthritis. Methods：Selected 42 cases of patients with acute gouty knee arthritis as study subjects,and divided them into the treatment group and the control group according to whether they agreed to receive minimally invasive acupotomy,21 cases in each group. The control group was treated with routine medicine, while the treatment group was additionally given minimally invasive acupotomy for treatment based on the treatment of the control group. Before treatment and after treatment of seven and fourteen days, recorded the number of swollen joints,the number of painful joints,the number of tender joints,the number of hot joints,visual analogue scores（VAS） of joint pain,and levels of uric acid（UA）,erythrocyte sedimentation rate（ESR） and c-reactive protein（CRP） in the two groups,and calculated the number of recurrence within half a year of follow-up. Results： After treatment, the number of swollen joints, the number of painful joints,the number of tender joints,the number of hot joints and VAS of joint pain were improved when compared with those before treatment（P〈0.05）. After treatment of seven days,the improvement of the number of swollen joints,the number of hot joints and VAS of joint pain in the treatment group was better than that in the control group（P〈0.05）. After treatment of fourteen days,VAS of joint pain in the treatment group was better than that in the control group（P〈0.05）. After treatment of seven and fourteen days,levels of ESR,CRP and UA in the two groups were decreased when compared with those before treatment. Compared with that in the control group,the level of CRP was decreased more obviously after treatment of seven days（P〈0.05）. After treatment of fourteen days, levels of ESR and CRP in the treatment group were decreased more obviously than those in the control group（P〈0.05）. No significant difference was found in the comparison of the level of UA between the two groups after treatment（P〉0.05）. After follow-up for half a year,a patient in the treatment group relapsed once,and four patients in the control group total relapsed seven times,the difference being significant（RR=0.143, χ2=4.500, P〈0.05）. Conclusion： Based on the routine treatment, minimally invasive acupotomy can improve the short-term and long-term effect of acute gouty knee arthritis.