痛风性膝关节炎关节镜术后谨防痛风急性发作和术后感染的误诊误治  

Beware of misdiagnosis and incorrect treatment of acute gout flare and postoperative infections after arthroscopic surgery for knee gouty arthritis

作　　者：马文婧 熊燕[1,2] 李箭[1,2] MA Wen-jing;XIONG Yan;LI Jian(Sports Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China;Department of Orthopedics and Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西医院运动医学中心,四川成都610041 [2]四川大学华西医院骨科/骨科研究所,四川成都610041

出　　处：《中国骨伤》2024年第7期664-669,共6页China Journal of Orthopaedics and Traumatology

基　　金：四川省科技厅重点研发项目(编号:2023YFS0215)。

摘　　要：目的:比较痛风性膝关节炎行关节镜术后痛风急性发作与术后感染临床特征差异。方法:自2017年1月至2022年12月共收治235例痛风性膝关节炎患者,并接受关节镜下膝关节痛风病灶清理。35例术后发热≥38°C,手术关节发生红、肿、热、痛急性炎症反应,男29例,女6例,年龄17~81(41.48±13.90)岁。23例确诊为痛风急性发作(急性发作组),男18例,女5例,年龄17~81(41.95±14.99)岁,予秋水仙碱、泼尼松龙治疗;12例确诊为术后关节感染(感染组),男11例,女1例,年龄18~61(40.57±11.10)岁,予抗感染治疗及关节腔清理冲洗。比较两组手术情况、血液学、关节液、临床特征。结果:急性发作组起热时间多发生于48 h内,明显早于术后感染组(P=0.037)。急性发作组VAS峰值疼痛(5.32±1.38)分,高于感染组(2.45±0.68)分(P=0.000),其中14例痛风急性发作患者伴发其他关节剧痛。血液学方面,两组白细胞计数及比例等指标均有所上升。炎症指标方面,两组红细胞沉降率、白细胞介素-6(interleukin-6,IL-6)、降钙素原等炎症指标比较,差异无统计学意义(P>0.05);而术后感染组C反应蛋白(220.97±116.30)mg·L^(-1),高于急性发作组(120.67±82.45)mg·L^(-1)(P=0.006)。急性发作组血尿酸(316.55±112.84)μmol·L^(-1),高于感染组(159.14±126.92)μmol·L^(-1)(P=0.001)。感染组关节液检查糖代谢指标低于急性发作组(P=0.001)。术后感染组5例细菌培养阳性。结论:痛风性膝关节炎关节镜术后发生急性炎症反应需谨慎鉴别痛风急性发作和术后感染。二者诊断与鉴别诊断应结合临床体征、血液学和关节液检查结果综合判断,并给予针对性治疗,从而避免误诊误治导致严重并发症发生。Objective To analyze the differences of clinical features of acute gout flare and postoperative infection under arthroscopy of knee gouty arthritis patients to offer guiding opinions of clinical diagnosis and treatment.Methods Between January 2017 and December 2022,235 patients with gouty knee osteoarthritis were admitted,and underwent arthroscopic debridement combined with synovectomy.Among them,35 cases had fever with a temperature higher than 38°C postoperatively while acute inflammatory appears under redness,swelling,heat and pain of the operated joints.There were 29 males and 6 females,with an average age of(41.48±13.90)years old.Among them 23 patients were diagnosed with acute gout attack,and recovered well after being given colchicine and prednisolone;12 patients were diagnosed with postoperative joint infection,and were cured after being given anti-infective treatments and cleaning and rinsing of the joint cavity.The two groups of patients were compared and analyzed in terms of preoperative general data,surgical conditions,hematology,joint fluid,limb function and other clinical characteristics.Results There were no significant difference in the preoperative general data between two groups.The onset of fever in the postoperative acute gout flare group occurred mostly within 48 hours,significantly earlier than that in the postoperative infection group(P=0.037).The visual analogue scale score was significantly higher in the acute gout flare group(5.32±1.38)score than in the postoperative infection group(2.45±0.68)score(P=0.000),while 14 patients with acute gout flare were accompanied by severe pain in other joints. Hematologically,indicators such as white blood cell counts and ratios were significantly higher in both groups. In terms of inflammatory indicators,IL-6,erythrocyte sedimentation rate,procalcitonin and other inflammatory indicators were significantly elevated in both groups,but there was no statistical difference between two groups. The C-reactive protein level in the postoperative infection g

关 键 词：痛风 痛风性关节炎 急性炎症 感染 关节镜 

分 类 号：R684.3[医药卫生—骨科学]