急性痛风性膝关节炎不同治疗方法的疗效对比研究  

Comparative efficacies of different treatments for acute gouty arthritis of the knee

作　　者：李朝晖[1] 陈林建[1] 邓烨[1] 黄凯[1] 陈嘉华[1] 郭紫石[2] 

机构地区：[1]广东医学院佛山禅城医院关节外科,广东佛山528031 [2]广东医学院佛山禅城医院风湿科,广东佛山528031

出　　处：《中国骨与关节外科》2013年第1期9-12,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:众所周知痛风性关节炎必须采用药物治疗,近年来随着关节镜技术的成熟,将其运用于反复发作的痛风性关节炎患者同样可以获得肯定的疗效,但关节镜治疗急性发作,甚至初次发作的急性痛风性膝关节炎的报道鲜见。目的:探讨不同治疗方法治疗急性痛风性膝关节炎的治疗效果。方法:2008年1月至2012年6月收治单膝痛风性关节炎60例,随机分为3组:药物治疗组20例,采取标准药物治疗;关节冲洗组20例,行关节腔冲洗术+标准药物治疗;关节镜治疗组20例,行关节镜清理术+标准药物治疗。观察比较3组患者治疗前后的膝关节视觉模拟评分法(VAS)疼痛评分、关节活动度情况(ROM)及Lysholm评分。结果:全部获得3个月以上随访,其中药物组复发6例,冲洗组复发3例,关节镜组无复发;关节镜组患者伤口均甲级愈合,无一例出现术后并发症。关节镜治疗组治疗后各时间点的患膝关节静息VAS疼痛评分、患膝关节ROM均明显优于药物治疗组和关节冲洗组(P<0.05);各组间治疗后7 d的患膝Lysholm评分无统计学差异(P>0.05),关节镜治疗组治疗后14、30、90 d的患膝Lysholm评分明显优于药物治疗组和关节冲洗组(P<0.05)。结论:关节镜治疗急性痛风性膝关节炎具有起效快、效果持久、关节功能恢复满意、复发率低等优势,可作为标准药物治疗的有效补充。Background： Gouty arthritis is traditionally treated by drug therapy. With the development of arthroscopic techniques, affir-mative results have been achieved in the arthroscopic treatment for recurrent gouty arthritis. But the therapeutic effect of ar-throscopy on acute attack, even the first attack of acute gouty arthritis has scarcely been reported. Objective： To compare the therapeutic results of different methods for acute gouty arthritis of the knee Methods： Sixty patients with unilateral acute gouty arthritis of the knee treated from January 2008 to June 2012 were ran-domly divided into three groups： group A of 20 cases treated with standard drug therapy; group B of 20 cases managed with articular cavity flushing and the standard drug treatment; and group C of 20 cases treated by arthroscopy and the standard drug administration. The visual analogue scale （VAS） of knee joint pain, range of motion （ROM） and Lysholm score were compared among the three groups. Results： All patients were followed up for more than 3 months. Recurrence was found in 6 cases of group A, 3 cases of group B, and none in group C with all the wounds healed and without complications. After knee arthroscopic treatment, the VAS score and ROM in group C were statistically better than that in the other groups （P〈0.05）. There were no significant differences in Lysholm score 7 days after treatment between the groups （P〉0.05）. But Lysholm score in group C was signifi- cantly higher than that in that in group A and B 14, 30 and 90d after treatment （P〈0.05）. Conclusions： Arthroscopic therapy has its distinct advantages in the treatment of acute gouty arthritis, such as immediate and persistent effect, satisfied recovery of joint function, and low recurrence rate. It can be used as an effective complement to the standard drug therapy.

关 键 词：关节镜 痛风 关节炎 治疗方法 效果 

分 类 号：R684.3[医药卫生—骨科学]