痛风性关节炎的临床及关节镜诊治特点

目的探讨膝、踝关节痛风性关节炎临床及关节镜诊治特点。方法回顾分析21例(22个关节)痛风性关节炎临床发病特点、关节镜下表现及治疗效果。结果21例中7例(33.33%)有第一跖趾关节肿痛史,13例(61.90%)有血尿酸值升高,关节液检查15例(71.43%)尿酸值增高,13例(61.90%)可见尿酸盐结晶。21例病检均为痛风性关节炎,关节镜下特征性表现为关节内各组织结构表面可见点片状或团块状反光的结晶物沉积,滑膜呈急性炎症表现。镜下通过搔刮、打磨、旋切、冲洗等处理,所有病例肿痛症状均迅速缓解,术后随访6个月～7年,原手术关节因软骨严重剥脱呈骨性关节炎而肿痛复发2例,另关节再发1例。结论大关节痛风尽管有些患者症状不典型,但结合病史、症状及化验仍有一定规律可循,结合关节镜可达到早期诊治的目的。

Characteristic of diagnosis and treatment for gouty arthritis in clinic and arthroscopy

Objective To investigate the characteristic of diagnosis and treatment for knee and ankle joint gouty arthritis in clinic and arthroscopy.Method The retrospective analysis was used among the 21 cases(22 joints)in clinical onsets,appearances under arthroscopy and results of therapy.Results In all cases,only 7 cases(33.33%)had the case history of swelling and pain in first metatarsal bone,and 13 cases were(61.90%)with increase of blood uric acid.The examination under joint fluid:15 cases(71.43%)with increase of uric acid,and 13 cases(61.90%)were found uric acid crystals.All cases were tested as gouty arthritis by pathological exam.The distinctive appearances were the deposition of punctiform and lamellar light-reflecting crystallized substances in all joint structure's surfaces,the appearances of synovium were acute inflammation.After the treatments of scoraping,buffing,potary and douching,all cases' symptoms of swelling and pain were released quickly.After 6 months to 7 years follow-up,2 cases' symptoms of swelling and pain were recurred because of the grave exfoliate in exfoliate as osteoarthritis in original operative joint,and 1 case occured at another joint.Conclusion In spite of the untypical symptoms in some cases,there still are some methods that can be followed by integrating case history,symptoms and chemical examination.The integrating of arthroscopy examination can achieve the project of pristine diagnosis.