目的 评价关节镜下关节腔清理术在治疗痛风性膝关节炎中的临床疗效及安全性.方法 选择漯河医学高等专科学校第一附属医院收治的86例痛风性膝关节炎患者,按照随机对照原则分为对照组和观察组,每组43例.对照组患者给予100 mg塞来昔布口服,每日早晚各1次,每个疗程0.5个月,共4个疗程;观察组患者行关节镜辅助下关节腔清理术治疗.治疗后对2组患者的临床治疗总有效率进行比较;随访6 ～12个月,评估并比较2组患者治疗前后视觉模拟评分(VAS)、Lysholm评分及美国西部安大略和McMaster大学骨关节炎指数(WOMAC)评分.同时,观察组患者根据患者术前急性发作时是否应用糖皮质激素分为应用组和非应用组,对2组患者术后出现高热(体温≥39℃)的发生率进行比较.结果 对照组患者治疗后显效12例,有效16例,无效15例,总有效率65.1％(28/43);观察组患者治疗后显效21例,有效17例,无效5例,总有效率88.4％(38/43);观察组患者治疗总有效率显著高于对照组(x2=6.52,P＜0.05).2组患者治疗后VAS评分、WOMAC评分显著低于治疗前(P＜0.05),Lysholm评分显著高于治疗前(P＜0.05),且观察组患者治疗后VAS评分、WOMAC评分显著低于对照组(P＜0.05),Lysholm评分显著高于对照组(P＜0.05).观察组患者术前急性发作时应用糖皮质激素患者27例(应用组),术后发生高热患者24例,高热发生率为88.9％ (24/27);术前急性发作时未应用糖皮质激素患者16例(非应用组),术后发生高热患者3例,高热发生率为18.8％ (3/16);应用组患者术后高热发生率显著高于非应用组(x2=21.15,P＜0.01).结论 关节镜辅助下关节腔清理术治疗痛风性膝关节炎临床疗效显著,能够显著改善患者的膝关节功能,且手术安全性较好.但对术前应用糖皮质激素的患者在术后要加强高热管理.%Objective To evaluate the clinical efficacy and safety of arthroscopic debridement in the treatment of gouty arthritis.Methods Eighty-six patients with gouty arthritis in the First Affiliated Hospital of Luohe Medical College were selected and randomly divided into control group and observation group,with 43 patients in each group.The patients in control group were given 100 mg celecoxib (oral administration) twice daily for 4 course of treatment(0.5 months for one course of treatment);the patients in observation group were given arthroscopic debridement.After treatment,the total effective rate of the patients in the two groups were compared,and all the patients were followed up for 6-12 months.The visual analogue scale (VAS) score,Lysholm score and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score was evaluated and compared before and after treatment between the two groups.At the same time,the patients in the observation group were divided into application group and non application group according to whether the patients were given glucocorticoid in acute episode before operation;the incidence of high fever (temperature ≥ 39 ℃) after operation was compared between the two groups.Results After treatment,in control group,12 patients were excellent,16 patients were effective,15 patients were invalid,and the total effective rate was 65.1％ (28/43);in the observation group,21 patients were excellent,17 patients were effective,5 patients were invalid,and the total effective rate was 88.4％ (38/43).The total effective rate of patients in the observation group was significantly higher than that in the control group (x2 =6.52,P ＜0.05).The VAS score and WOMAC score of patients after treatment were significantly lower than those before treatment (P ＜ 0.05),and the Lysholm score was significantly higher than that before treatment in the two groups (P ＜ 0.05).After treatment,the VAS score and WOMAC score of patients in the observation group were significantly lower than those in the control group (P ＜ 0.05);the Lysholm score was significantly higher than that in the control group (P ＜ 0.05).In the observation group,27 patients were treated with glucocorticoid in acute episode (application group)and 16 patients were not treated with glucocorticoid(non application group).The incidence of high fever in application group and non application group was 88.9％ (24/27)and 18.8％ (3/16)respectively;the incidence of high fever in application group was significantly higher than that in the non application group (x2 =21.15,P ＜0.01).Conclusions Arthroscopic debridement has a good curative effect in the treatment of gouty arthritis and this method is safety.It can significantly improve the patient's knee joint function.However,we should pay more attention to high fever in patients who is treated with glucocorticoid before operation.
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