关节镜清理术在治疗膝痛风性关节炎中的临床应用——附34例报告

Clinical application of arthroscopic debridement for treating knee gouty arthritis(A report of 34 cases)

目的探讨关节镜清理术治疗膝痛风性关节炎的临床效果。方法回顾性分析2013年1月至2015年12月广州市番禺区中医院采用关节镜清理术治疗的34例单膝痛风性关节炎患者的临床资料，评估手术前后视觉模拟量表（VAS）评分和Lysholm膝关节功能评分。结果所有患者均经关节镜及病理检查明确诊断，术后随访10～24个月（平均16个月），术后1、6个月VAS评分和Lysholm评分分别为（2.8±1.1）分和（83±4）分、（1.4±1.0）分和（92±3）分，明显优于术前的（6.9±1.1）分和（64±8）分，手术前后比较，差异有统计学意义（P＜0.05）。术后5例出现发热，经对症处理后体温恢复正常；所有患者切口均甲级愈合，无关节内感染、血管神经损伤及下肢深静脉血栓形成发生。3例患者术后1个月内症状复发，与饮食控制不良相关，经保守治疗后缓解。结论关节镜清理术对非典型性膝痛风性关节炎具有重要的诊断价值，还可明显缓解患者疼痛症状，改善膝关节功能，短期疗效满意。

Objective To investigate the therapeutic effect of arthroscopic debridement on knee gouty arthritis.Methods Clinical data of34patients with single knee gouty arthritis treated by arthroscopicdebridement from January2013to December2015in Guangzhou Panyu District Hospital of Traditional Chinese medicine,were retrospectively analyzed.Clinical effects were appraised with visual analogue scale(VAS)and Lysholm knee joint function scores.Results All case diagnoses were confirmed by arthroscopic and pathological examination.The patients were followed up for10-24months(average,16months).The VAS and Lysholm scores at one month,six months after operation were(2.8±1.1)and(83±4),(1.4±1.0)and(92±3)respectively,significantly better than the preoperative(6.9±1.1)and(64±8),there were statistically different between preoperative and postoperative results(P<0.05).Five cases had fever after operation,and the body temperature returned to normal after symptomatic treatment.All incisions healed by first class,no joint infection,vascular or nerve injury and deep venous thrombosis occurred.Three patients had recurrence of symptoms within one month after operation,which was associated with poor diet control,and the symptoms were relieved gradually after conservative treatment.Conclusions Arthroscopic debridement plays an important role in the diagnosis of atypical gouty arthritis of the knee.It can achieve short-term satisfactory effects with the relief of the symptoms of pain and the improvement of the function of knee joint.