关节镜下行关节腔清理术治疗痛风性膝关节炎的临床研究

目的探讨痛风性膝关节炎在内科治疗后仍反复发作时，采用关节镜辅助下的关节腔清理术对这些患者的治疗效果和手术技巧。方法自2004年1月至2007年1月，对经内科治疗后仍反复发作的31例痛风性膝关节炎患者，行关节镜下的关节腔清理术等。术后坚持正规的降尿酸治疗，对术中难以彻底清除的尿酸盐结晶结合术后短期冲洗，对术前使用糖皮质激素患者比较术后的体温变化情况，比较患者术前和术后12个月的膝关节Lysholm评分。结果痛风性关节炎的关节镜表现为特异性的白色团块状物质沉积在滑膜、软骨和其他关节内结构的表面。术后31例切口甲级愈合，随访12—24个月中全部患者症状均较术前明显缓解，术前曾给予糖皮质激素的患者在术后容易出现体温明显升高，患者术前和术后12月的膝关节Lysholm评分存在显著性统计学差异（t=21．42，P〈0，01）。结论关节镜手术对痛风性膝关节炎具有较高的治疗价值，手术创伤小，术后康复快。术前曾给予糖皮质激素的患者在术后要加强管理。

Application arthroscopy for diagnosis and treatment of gouty arthritis

Objective To investigate the use of arthroscopy for the diagnosis and treatment of gouty arthritis. Methods A total of 31 patients with gouty arthritis were diagnosed by arthroscopy between January 2004 and January 2007. Then biopsy and synovectomy were performed under arthroscope. Others cases were treated with debridement, synovectomy and microfracture because gouty arthritis hadn＇ t been controlled effectively by uricosuric agent. Use the uricosuric agent at post-operation for avoiding symptom recurring. Compare with Lysholm scores of knee between pre-operation and 12 months after operation. Results Arthroscopy showed specific white urate crystal deposited the surface of synovium and cartilage. Joint pain were eliminated rapidly in all cases and all the wounds were healed well after operation. The temperture is easy to go up in the group of patients using glucocorticoids pre-operation. The Lysholm scores of knee in two groups were difference （ t = 21.42, P 〈 0. 01 ）. Conclusions Arthroscopy is the reliable choice for the diagnosis and treatment of gouty arthritis. Advantages of this technique are minimal invasive, simple procedur, less time for operation and hospitalization with early rehabilitation, and all the combined lesion can be treated at the same time. Administrators is serious especially for patients using glucocorticoids pre-operation.