摘要
目的探讨关节镜下手术治疗慢性痛风性关节炎的方法和疗效。方法自2003年3月至2009年3月,对54例反复急性发作的慢性痛风性关节炎患者进行关节镜检查,利用射频汽化仪及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;同时进行关节腔清理术,修整剥脱的关节软骨及受侵蚀的半月板;最后用大量关节腔冲洗液冲洗关节腔。术后抗炎镇痛,继续饮食控制及降尿酸治疗。结果54例患者术后病情均得到不同程度的缓解,35例术前关节功能障碍者术后得到明显改善。有3例双膝、踝、第1跖趾关节同时手术的患者,术后出现急性痛风发作,经关节腔穿刺放液,对症治疗,很快病情得到控制。经3个月至6年的随访观察,50例患者随访期间未再发生关节炎急性发作,4例患者有2-3次的急性发作,均与饮食控制不良有关。结论关节镜下手术治疗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 results of arthroscopic surgery for the treatment of chronic gouty arthritis.Methods A total of 54 patients with chronic gouty arthritis were diagnosed by arthroscopy between March,2003 and March,2009.The urate crystal stones deposited on the surface of cartilage were removed by radiofrequency evaporating apparatus and curettes.The bloodshot,hyperplastic synovium and the urate crystal deposited on it were cut by the shavers under arthroscopy.The joint debridement,cartilage repair and meniscectomy were done at the same time.Irrigation of Ringer＇s solution was used before the end of the surgery.Diet and drug therapy were continued after the operation.Results Joint pain was eliminated and the wounds were healed well after operation in all the 54 patients.The knee functions were improved in all the 35 patients who had knee joints function limitation before the operation.Only 3 patients who accepted both knee,ankle and metatarsophalangeal joints operation had recurrence of acute gouty arthritis.The inflammations were controlled by joint puncture drainage and oral NSAIDs.Acute gouty arthritis did not occur in 51 patients in 3 months to 6 years follow-up.4 patients had 2-3 recurrences of acute gouty arthritis with slight symptom,which was related to bad diet controls.Conclusion Arthroscopy is the reliable choice for the treatment of chronic gouty arthritis.Advantages of this technique are minimal invasive,simple procedure,less time for operation and hospitalization with early rehabilitation,and all the combined lesion can be treated at the same time.
出处
《青岛医药卫生》
2009年第5期321-324,共4页
Qingdao Medical Journal
关键词
关节镜
痛风
关节炎
治疗
Arthroscopy
Gout, Arthritis
Treatment
