关节镜清理联合关节腔灌注消炎镇痛药治疗痛风性膝关节炎的中期效果研究

殷勇 王胜涛 邓伟 蔡杰勇 彭德全 覃小川 张波 谭钢

摘要：[目的] 评价关节镜清理联合关节腔注射消炎镇痛类药治疗痛风性膝关节炎的效果。 [方法] 选择我院自2017 年1月至2018年12月诊断为痛风性膝关节炎并愿意接受膝关节镜手术治疗的患者50例（60膝），记录患者术前Lysholm评分、VAS评分、膝关节活动度、行走能力和手术并发症发生例数，对所有患者进行定期连续性随访至术后24个月并记录每次随访时同一指标的随访结果。[结果] 所有患者术后切口均为Ⅰ期愈合，无切口感染病例，无关节腔感染病例，2例患者发生上呼吸道感染，1例患者发生深静脉血栓，1例患者发生泌尿道感染。膝关节屈曲活动度由术前的70-100°改善为110 ～ 135° ;3例膝关节伸直受限，其余伸直均达0°。Lysholm评分由术前平均71.92分改善为术后94.78分，VAS評分平均由术前6.74改善为术后2.12，连续行走距离由术前平均2154米即需要休息改善为3301米才需要休息，均与术前比较差异有统计学意义（P<0.05），48例患者感觉手术效果非常满意，仅2例患者感手术效果不甚满意。[结论] 关节镜清理术联合关节腔内注射消炎镇痛类药对于疼痛症状严重的痛风性膝关节炎患者具有较好的中期疗效，能够明显缓解大部分患者的疼痛和改善膝关节功能以及改善患者生活质量，且患者对于关节镜手术接受程度高，对延缓患者接受膝关节置换的时间具有明显预防作用，但是其长期效果有待进一步大样本病例随访研究。

关键词：关节镜，关节腔清理，痛风，痛风性膝关节炎，关节腔注射

Abstract：[Objective] To evaluate the effect of arthroscopic debridement combined with intra-articular injection of anti-inflammatory and analgesic drugs in the treatment of gouty knee arthritis. [Method] Fifty patients （60 knees） diagnosed as gouty arthritis and willing to accept arthroscopic surgery were enrolled in this study from January 2017 to December 2018.Lysholm score， VAS score， knee range of motion and the number of surgical complications were recorded at the time of pre-operation.All patients were followed up regularly for up to 24 months after operation. [Result] There were no cases of incision infection and no case of intraarticular infection. There were 2 cases of upper respiratory tract infection， 1 case of deep vein thrombosis and 1 case of urinary tract infection. The flexion range of motion of knee joint was improved from 70-100 ° preoperatively to 110-135 ° and the extension of knee joint was limited in 3 cases， and the extension of the rest was 0 °. Lysholm score was improved from 71.92 preoperatively to 94.78 postoperatively. VAS score was improved from 5.74 to 2.12. Continuous walking distance was improved from 2154 meters before operation to 3301 meters after operation. The difference was statistically significant （P < 0.05），48 patients felt that the operation effect was very satisfactory， only 2 patients felt that the operation effect was not very satisfactory. [Conclusion] Arthroscopic debridement combined with intra-articular injection of anti-inflammatory and analgesic drugs has a good mid-term effect for patients with severe pain symptoms of gouty arthritis， can significantly relieve the pain of most patients and improve the function of the knee joint and improve the quality of life of patients， and patients have a high acceptance of arthroscopic surgery， which has obvious effect on delaying the time of patients accepting knee replacement However， its long-term effect needs further follow-up study of large sample cases.

Key words： Arthroscopic， debridement of articular cavity，intra-articular injection， Gout; Gouty arthritis

【中图分类号】R593.22 【文献标识码】A 【文章编号】1673-9026（2021）08-025-03

痛风是一种高嘌呤代谢性疾病，随着饮食结构的变化，痛风的发病率正逐年增加[1-3]。四肢关节，特别是第一跖趾关节等小关节受累最为常见，而膝关节受累也并不罕见，但由于患者症状不典型，常与其他疾病如骨关节炎、类风湿关节炎等相互混淆，容易漏诊、误诊[4-5]。痛风性膝关节炎是一种炎症性疾病，表现在关节、软骨、滑膜囊、肌腱或软组织中沉积尿酸钠晶……