Pan Feixu, Li Qi, Tang Xin, Xue Jing, Li Jian
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan 610041, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Aug;25(8):937-40.
To investigate the method and the effectiveness of a combination of the arthroscopic debridement and joint irrigation postoperatively for treating gouty arthritis of the knee.
Between August 2000 and November 2009, 41 patients with gouty arthritis of the knee were treated by arthroscopic debridement. All patients were males with an average age of 42 years (range, 21-71 years), including 8 incipient cases and 33 relapsed cases. The unilateral knees were involved in 36 cases, including 22 left knees and 14 right knees, and both in 5 cases. The disease duration ranged from 2 months to 20 years (median, 6 years and 2 months). The extension, flexion, and range of motion (ROM) of the knee joint were (4.88 +/- 6.22), (93.95 +/- 35.33), and (87.79 +/- 35.19) degrees, respectively, and Lysholm score was 63.2 +/- 11.7 preoperatively. The serum uric acid levels were higher than normal value in 32 cases. Twenty-seven cases were definitely diagnosed as gouty arthritis before operation. Arthroscopic debridement was performed in 11 cases, and the arthroscopic debridement with joint irrigation postoperatively in 30 cases. After operation, the anti-gout agents and diet control were given.
Arthroscope and pathologic examinations confirmed diagnosis of gouty arthritis in 41 patients. Intra-articular hemorrhage occurred in 1 case and was cured after arthroscopic evacuation of hematoma. The other patients achieved healing of incision by first intention. All 41 patients were followed up 15-126 months (mean, 50 months) postoperatively. The Lysholm score was 96.8 +/- 5.8 at 15 months after operation, showing significant difference when compared with the preoperative value (t = 13.844, P = 0.000). The postoperative extension (1.16 +/- 3.91) degrees, flexion (125.93 +/- 18.65) degrees, and ROM (126.86 +/- 16.33) degrees of the knee joint were significantly improved when compared with the preoperative ones (P < 0.05). Thirteen cases (14 knees) recurred postoperatively; but occurrence frequency and the duration were decreased and the symptoms of joint swelling and pain were improved.
The arthroscopic debridement is effective in cleaning up uric acid crystals thoroughly, reducing wounds, and speeding up recovery. If anti-gout agents and diet control can be used postoperatively, the recurrence of gouty arthritis can be prevented effectively, and the progression can be delayed.
探讨关节镜下清理术联合术后关节冲洗治疗膝痛风性关节炎的方法及疗效。
2000年8月至2009年11月，对41例膝痛风性关节炎患者行关节镜下清理术。所有患者均为男性，平均年龄42岁（范围21 - 71岁），其中初发8例，复发33例。单膝关节受累36例，其中左膝22例，右膝14例，双膝受累5例。病程2个月至20年（中位数6年2个月）。膝关节伸直、屈曲及活动度（ROM）术前分别为（4.88±6.22）、（4.88±6.22）、（87.79±35.19）度，Lysholm评分63.2±11.7。32例患者血清尿酸水平高于正常。术前明确诊断为痛风性关节炎27例。行单纯关节镜下清理术11例，关节镜下清理术联合术后关节冲洗30例。术后给予抗痛风药物及饮食控制。
关节镜及病理检查确诊41例痛风性关节炎。1例发生关节内出血，经关节镜下血肿清除后治愈。其余患者切口均一期愈合。41例患者术后随访15 - 126个月（平均50个月）。术后15个月Lysholm评分为96.8±5.8，与术前比较差异有统计学意义（t = 13.844，P = 0.000）。术后膝关节伸直（1.16±3.91）度、屈曲（125.93±18.65）度及ROM（126.86±16.33）度较术前均明显改善（P < 0.05）。术后复发13例（14膝），但复发频率及持续时间均降低，关节肿胀、疼痛症状改善。
关节镜下清理术能有效彻底清除尿酸盐结晶，减少创伤，加速恢复。术后联合应用抗痛风药物及饮食控制，可有效预防痛风性关节炎复发，延缓病情进展。
