摘要
目的探讨关节镜下关节清理术联合术后置管持续冲洗引流治疗痛风性膝关节炎的方法和疗效。方法 2000年8月-2009年11月,收治41例46膝痛风性膝关节炎男性患者。年龄21～71岁,平均42岁。单侧36例,其中左侧22例,右侧14例;双侧5例。首次发作8例,反复发作33例。病程2个月～20年,中位病程6年2个月。术前膝关节伸直(4.88±6.22)°,屈曲(93.95±35.33)°,膝关节活动度为(87.79±35.19)°;Lysholm评分为(63.2±11.7)分。32例血尿酸增高。术前确诊为痛风性关节炎27例,14例诊断为其他疾病。11例行关节镜下关节清理术,30例行关节镜下关节清理术加术后置管持续冲洗引流。术后均接受正规内科抗痛风治疗及饮食控制。结果结合关节镜检查及病理检查,患者均确诊为痛风性关节炎。术后1例1膝发生关节腔内出血,行关节镜下血肿清除术后愈合;其余患者术后切口均Ⅰ期愈合。患者均获随访,随访时间15～126个月,平均50个月。术后15个月膝关节功能Lysholm评分为(96.8±5.8)分,与术前比较差异有统计学意义(t=—13.844,P=0.000)。膝关节伸直(1.16±3.91)°,屈曲(125.93±18.65)°,膝关节活动度为(126.86±16.33)°,均较术前明显改善(P<0.05)。随访期间13例14膝复发,总复发率为30.4%(14/46);但发作频率、持续时间以及发病时关节肿胀、疼痛症状均较术前改善。结论关节镜下关节清理术可彻底清理尿酸盐结晶体,且创伤小,恢复快,术后配合内科药物治疗和饮食控制,可有效预防痛风性关节炎复发,延缓疾病进展。
Objective To investigate the method and the effectiveness of a combination of the arthroscopic debridement and joint irrigation postoperatively for treating gouty arthritis of the knee. Methods Between August 2000 and November 2009, 41 patients with gouty arthritis of the knee were treated by arthroscopic debridement. All patients were males with an average age of 42 years （range, 21-71 years）, including 8 incipient cases and 33 relapsed cases. The unilaterial knees were involved in 36 cases, including 22 left knees and 14 right knees, and both in 5 cases. The disease duration ranged from 2 months to 20 years （median, 6 years and 2 months）. The extention, flexion, and range of motion （ROM） of the knee joint were （4.88±6.22）, （93.95 ±35.33）, and （87.79±35.19）% respectively, and Lysholm score was 63.2±11.7 preoperatively. The serum uric acid levels were higher than normal value in 32 cases. Twenty-seven cases were definitely diagnosed as gouty arthritis before operation. Arthroscopic debridement was performed in 11 cases, and the arthroscopic debridement with joint irrigation postoperatively in 30 cases. After operation, the anti-gout agents and diet control were given. Results Arthroscope and pathologic examinations confirmed diagnosis of gouty arthritis in 41 patients. Intra-articular hemorrhage occurred in 1 case and was cured after arthroscopic evacuation of hematoma. The other patients achieved healing of incision by first intention. All 41 patients were followed up 15-126 months （mean, 50 months） postoperatively. The Lysholm score was 96.8 ± 5.8 at 15 months after operation, showing significant difference when compared with the preoperative value （t= 13.844, P=0.000）. The postoperative extention （1.16±3.91）°, flexion （125.93±18.65）°, and ROM （126.86±16.33）° of the knee joint were significantly improved when compared with the preoperative ones （P 〈 0.05）. Thirteen cases （14 knees） recurred postoperatively; but occurrence frequency and the duratio
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第8期937-940,共4页
Chinese Journal of Reparative and Reconstructive Surgery
