CAJ | 학술논문

目的探讨关节镜下手术治疗慢性痛风性关节炎的方法和疗效。方法自2003年3月~2014年3月对154例反复急性发作的多关节慢性痛风性关节炎患者进行关节镜检查，利用射频汽化仪及刮匙除去紧密附着在关节软骨上的尿酸盐结晶，利用刨刀刨削充血、增生的滑膜及其附着的尿酸盐结晶；同时进行关节腔清理术，修整剥脱的关节软骨及受侵蚀的半月板；最后用大量关节腔冲洗液冲洗关节腔。术后抗炎镇痛，继续饮食控制及降尿酸治疗。结果154例患者术后病情均得到不同程度的缓解，135例术前关节功能障碍在术后得到明显改善。有3例双膝、踝、第一跖趾关节同时手术的患者，术后出现急性痛风发作，经关节腔穿刺放液，对症治疗，很快病情得到控制。经1~10年的随访观察，140例患者随访期间未再发生关节炎急性发作，14例患者有2~3次的急性发作，均与饮食控制不良有关。结论关节镜下手术治疗慢性痛风性关节炎是一种见效快，创伤小，效果稳定的方法，值得临床推广应用。但它仅是一种局部治疗方法,可以防止晚期骨性关节炎的早期发生,但不能代替排酸、抑酸及饮食控制的治疗。
목적탐토관절경하수술치료만성통풍성관절염적방법화료효。방법자2003년3월~2014년3월대154례반복급성발작적다관절만성통풍성관절염환자진행관절경검사，이용사빈기화의급괄시제거긴밀부착재관절연골상적뇨산염결정，이용포도포삭충혈、증생적활막급기부착적뇨산염결정；동시진행관절강청리술，수정박탈적관절연골급수침식적반월판；최후용대량관절강충세액충세관절강。술후항염진통，계속음식공제급강뇨산치료。결과154례환자술후병정균득도불동정도적완해，135례술전관절공능장애재술후득도명현개선。유3례쌍슬、과、제일척지관절동시수술적환자，술후출현급성통풍발작，경관절강천자방액，대증치료，흔쾌병정득도공제。경1~10년적수방관찰，140례환자수방기간미재발생관절염급성발작，14례환자유2~3차적급성발작，균여음식공제불량유관。결론관절경하수술치료만성통풍성관절염시일충견효쾌，창상소，효과은정적방법，치득림상추엄응용。단타부시일충국부치료방법,가이방지만기골성관절염적조기발생,단불능대체배산、억산급음식공제적치료。
Objective To investigate the use of arthroscopy for the diagnosis and treatment of gouty. Methods A total of 154 patients with gouty arthritis were diagnosed by arthroscopy between January 2001 and January 2013.Then biopsy and synovectomy were performed under arthroscope in al the patients.110 cases were treated debridement,synovectomy and radiofrequency ablation, because gouty arthritis had not been control ed ef ectively agent.Use the uricosuric agent at post-operation for avoiding symptom recur ing. Results Arthroscopy specific white urate crystal deposited the surface of synovium and cartilage.Joint pain was eliminated and al the wounds were healed wel after operation.Symptom had transient recur ence in 14 patients to 15 months fol ow- up. Conclusion Arthroscopy is the reliable choice for the diagnosis and treatment chronic gouty arthritis.Advantages of this technique are minimal invasive,simple procedure,less time for operation and hospitalization with early rehabilitation,and al the combined lesions can be treated at the same time.