急性膝关节痛风性关节炎关节镜下诊断与治疗.DOCVIP

临床医学论文-急性膝关节痛风性关节炎关节镜下诊断与治疗 ??????????? 作者：张羽飞，王大正,王福生，王立德，张卫国 【关键词】? 痛风性关节炎 　　摘? 要：［目的］提高对单纯膝关节起病的急性痛风性关节炎的诊断认识和治疗水平。［方法］回顾总结2000年以来关节镜检查发现的17例膝关节急性痛风性关节炎的诊治经过，经半年以上随访，进行疗效观察。［结果］17例病人中仅有5例疑及本病，余均误诊，全部病例在关节镜检查后发现确诊，并一期行镜下关节内清理术，术后配以系统药物等治疗，随访10~24个月，近期和远期均取得满意疗效。［结论］单纯以膝关节起病的急性痛风性关节炎少见，误诊率高，随着关节镜技术不断提高和广泛应用，其诊断率将会获得提高，同时亦为外科早期介入治疗急性痛风性关节炎增加了一个新的方法。 ??? 关键词：痛风性关节炎；? 膝关节；? 关节镜；? 诊断；? 治疗 ????? Abstract：［Objective］To introduce the knowledge for the diagnosis of acute gout arthritis that attacked initially in the knee and improve its early treatment［Method］Seventeen cases with acute gout arthritis in the knee were diagnosed and treated under arthroscopy since 2000The experiences were analysed retrospectively and the therapatic results were observed through a followup of more than 6 months［Result］Before arthroscopy,only 5 cases were considered as acute gout arthritis,the other 12 cases were given a misdiagnosisAll the patients were diagnosed and given a debridment simutaneously under arthoscopyThen,the patients were given an postoperative systematic drugs therapyThe followup（ranged from 10 to 24 months）showed that all the patients acquired a shortterm and longterm satisfactory therapeutic effect［Conclusion］The acute gout arthritis attacked initially in the knee is rare and its misdiagnosis rate is very highThe significant improvement and extensive application of arthroscopic techniques will improve its diagnosis rate and provide a new way for its early surgical treatment ??? Key words：Acute gout arthritis；? Knee joint；? Arthroscopy；? Diagnosis；? Treatment ??? 急性痛风性关节炎是由于尿酸盐结晶沉积于关节内而诱发的急性关节内炎症反应，是成年男性发病率最高的关节炎之一，症状剧烈，晚期可致残〔1〕。作者采用关节镜的方法确诊和治疗急性膝关节痛风性关节炎取得满意效果，总结报告如下。 ??? 1? 临床资料 ??? 11? 一般资料 ??? 2000年3月以来，关节镜检查确诊膝关节急性痛风性关节炎17例，全部为男性，首次发病12例，反复多次发病5例，合并有第1跖趾关节发病4例，踝关节发病1例。年龄31~59岁，平均426岁。左膝6例，右膝11例。诱因：过度劳累5例，外伤1例，过量饮酒5例，无明确原因6例。发病到确诊时间2~7 d，平均43 d。血尿酸最高496 μmol/L，最低319 μmol/L，ESR 8~46 mm/h。术前诊断：化脓性关节炎4例，类风湿性关节炎3例，急性滑膜炎5例，术前诊断疑为痛风性关节炎仅有5例。合并症：胃炎或胃溃疡5例，肾结石1例，糖尿病2例，冠心病1例。术前用药：