微创针刀镜联合达标治疗痛风性关节炎患者的临床疗效

Clinical effect of minimally invasive acupotomy combined with tight control strategies for patients with gouty arthritis

目的探讨微创针刀镜联合达标治疗痛风性关节炎患者的疗效。方法选取2020年3月1日至2022年3月1日在广州市荔湾中心医院应用微创针刀镜手术治疗后,持续接受降尿酸达标治疗1个月以上的男性痛风患者,并根据患者的手术部位,将患者分为膝关节组(41例)和踝关节组(14例)。其中膝关节痛风患者年龄为(55.58±14.4)岁,踝关节痛风患者年龄为(45.71±10.9)岁。通过比较患者治疗前后膝关节功能(Lyshom)评分、踝关节功能(AOFAS)评分、关节疼痛视觉模拟评分法(VAS)评分、血尿酸(SUA)、红细胞沉降率(ESR)、C反应蛋白(CRP)变化情况,分别评估两组治疗后的临床效果和术后并发症。统计学方法采用Z检验、t检验和χ^(2)检验。结果膝关节组治疗后Lysholm评分高于治疗前,VAS评分低于治疗前[(88.30±7.69)分比(55.85±14.07)分、(1.95±1.18)分比(7.92±1.37)分],差异均有统计学意义(Z=-7.60、t=21.17,均P<0.05)。踝关节组治疗后AOFAS评分高于治疗前,VAS评分低于治疗前[(88.43±8.36)分比(60.92±10.88)分、(1.71±1.14)分比(7.14±1.83)分],差异均有统计学意义(t=-7.50、Z=-4.54,均P<0.05)。膝关节组与踝关节组治疗后SUA、ESR和CRP均较治疗前下降,差异均有统计学意义(Z=-5.58、-5.37、-4.08、-3.30、-3.30、-2.67,均P<0.05)。两组患者术后1月均无痛风急性发作。结论微创针刀镜联合药物达标治疗方案可明显降低痛风性关节炎患者的关节炎症反应,改善关节功能,减轻关节疼痛程度,但需要注意加强微创针刀镜术后的感染预防和患者教育。

Objective To observe the clinical effect of minimally invasive acupotomy combined with tight control strategies for patients with gouty arthritis.Methods Fifty-five male patients with gouty arthritis who took tight control strategies for decreasing uric acid after minimally invasive acupotomy for at least one month at Guangzhou Liwan Central Hospital from March 1,2020 to March 1,2022 were selected.According to the surgical sites,the patients were divided into a knee joint group(41 cases),(55.58±14.4)years old,and an ankle joint group(14 cases),(45.71±10.9)years old.The scores of Lyshom Knee Rsting System(Lyshom),American Orthopedic Foot and Ankle Society(AOFAS),and Visual Analogue Scale(VAS),levels of uric acid(UA)complications of the two groups were evaluated.Z,t,and χ^(2) tests were applied.Results In the knee joint group,the score of Lysholm was higher and the score of VAS was lower after than before the treatment[(88.30±7.69)vs.(55.85±14.07)and(1.95±1.18)vs.(7.92±1.37)],with statistical differences(Z=-7.60 and t=21.17;both P<0.05).In the ankle joint group,the score of AOFAS was higher and the score of VAS was lower after than before the treatment[(88.43±8.36)vs.(60.92±10.88)and(1.71±1.14)vs.(7.14±1.83)],with statistical differences(t=-7.50 and Z=-4.54;both P<0.05).The UA levels,ESR's,and CRP levels in the knee joint group and the ankle joint group were lower after than before the treatment,with statistical differences(Z=-5.58,-5.37,-4.08,-3.30,-3.30,and-2.67;all P<0.05).One month after the surgery,no acute gouty attack occurred in both groups.Conclusions Minimally invasive acupotomy combined with tight control strategies for patients with gouty arthritis can reduce their inflammation,improve their joint function,and relieve their pain.However,it is necessary to enhance infection prevention and patient education after minimally invasive acupotomy.