[1]郑英慧 谢平金 卢启贵△ 张卫红 黄东红.关节镜下碳酸氢钠灌洗治疗急性痛风性膝关节炎[J].中国中医骨伤科杂志,2020,28(10):43-46.
点击复制

关节镜下碳酸氢钠灌洗治疗急性痛风性膝关节炎()
分享到:

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第28卷
期数:
2020年10期
页码:
43-46
栏目:
临床报道
出版日期:
2020-10-10

文章信息/Info

文章编号:
1005-0205(2020)10-0043-04
作者:
郑英慧1 谢平金1 卢启贵1△ 张卫红1 黄东红1
关键词:
急性痛风性膝关节炎 碳酸氢钠 膝关节镜
分类号:
R684.3
文献标志码:
B
摘要:
目的:观察用5%碳酸氢钠灌洗辅助膝关节镜下清理对急性痛风性膝关节炎患者的临床疗效。方法:64例急性痛风性膝关节炎患者均行膝关节镜探查+关节清理术,采用随机数字表法将其随机分成碳酸氢钠组(32例)和生理盐水组(32例),碳酸氢钠组术中用5%碳酸氢钠+生理盐水灌洗,生理盐水组术中则常规使用生理盐水关节腔冲洗。术后按急性痛风常规治疗,行膝关节功能锻炼指导。评估比较两组患者术后临床疗效有效率,术前、术后第7天及第14天VAS评分,测定C反应蛋白、血尿酸水平,术中、术后第7天膝关节液pH值,统计术后半年内的复发率。结果:疗效总有效率比较差异无统计学意义(P>0.05),但显效率比较中碳酸氢钠组高于生理盐水组,差异有统计学意义(P<0.05); 碳酸氢钠组术后第7天VAS评分、CRP、SUA低于生理盐水组; 膝关节液pH值明显高于生理盐水组,差异有统计学意义(P<0.05); 碳酸氢钠组半年内的总复发率明显低于生理盐水组,差异有统计学意义(P<0.05)。结论:5%碳酸氢钠灌洗辅助膝关节镜下清理能改善急性痛风性膝关节炎患者关节内的酸碱环境,更好地清除关节腔内的尿酸盐,提高临床疗效显效率,降低复发率。

参考文献/References:

[1] DALBETH N,MERRIMAN T R,STAMP L K.Gout[J].Lancet,2016,388(10055):2039-2052.
[2] LEE J S,KWON O C,OH J S,et al.Clinical features and recurrent attack in gout patients according to serum urate levels during an acute attack[J].Korean J Intern Med,2020,35(1):240-248.
[3] SOS B,SZAMOSI S,BENK? S,et al.Recent advances in gout:pathogenesis,diagnosis,comorbidities,treatment[J].Orv Hetil,2018,159(40):1625-1636.
[4] SUN S S,TIAN L,FENG X D,et al.Application of musculoskeletal ultrasound combined with biomechanics in asymptomatic hyperuricemia and acute phase of gout arthritis[J].Chin J Integr Tradit Western Med Imag,2019,17:262-265.
[5] KHAN M,EVANIEW N,JOHAL H,et al.Arthroscopic management of osteoarthritis[J].J Am Acad Orthop Surg,2016,24(7):e79-e80.
[6] PEREZ-RUIZ F,ATXOTEGI J,HERNANDO I,et al.Using serum urate levels to determine the period free of gouty symptoms after withdrawal of long-term urate-lowering therapy:a prospective study[J].Arthritis Rheum,2006,55(5):786-790.
[7] TRIOLO P,ROSSI R,ROSSO F,et al.Arthroscopic synovectomy of the knee in rheumatoid arthritis defined by the 2010 ACR/EULAR criteria[J].Knee,2016,23(5):862-866.
[8] TAYLOR W J,FRANSEN J,JANSEN T L,et al.Study for updated gout classification criteria:identification of features to classify gout[J].Arthritis Care Res(Hoboken),2015,67(9):1304-1315.
[9] SMITH E U R,DLAZ-TORNE C,PEREZ-RUIZ F,et al.Epidemiology of gout,an update[J].Best Practice & Research Clinical Rheumatology,2010,24(6):811-827.
[10] RICHETTE P,DOHERTY M,PASCUAL E,et al.2018 updated european league against rheumatism evidence based recommendations for the diagnosis of gout[J].Ann Rheum Dis,2020,79(1):31-38.
[11] MIN H K,KIM H R.Does normouricemic status in acute gouty arthritis really reflect a normal status consider confounders of serum levels of urate[J].Korean J Intern Med,2020,35(1):62-64.
[12] KHANNA P P,GLADUE H S,SINGH M K,et al.Treatment of acute gout:a systematic review[J].Semin Arthritis Rheum,2014,44(1):31-38.
[13] KHANNA D,KHANNA P P,FITZGERALD J D,et al.2012 American college of rheumatology guidelines for management of gout.Part 2:therapy and antiinflammatory prophylaxis of acute gouty arthritis[J].Arthritis Care Res(Hoboken),2012,64(10):1447-1461.
[14] SHOJI A,YAMANAKA H,KAMATANI N.A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis:evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy[J].Arthritis Rheum,2004,51(3):321-325.
[15] LU C C,WEI J C C,CHANG C A,et al.Limited knee-joint range of motion in patients with tophaceous gout improved with medical treatment:a 18-months follow up[J].Front Med,2020,7:74.
[16] 毛晓东,辛晓春,向韵.膝关节镜对改善痛风性膝关节炎患者关节功能的影响评价[J].中国社区医师,2019,35(18):39-40.
[17] 张伟强,李具宝,李帆冰.关节痛风石取出手术对痛风患者血尿酸水平的影响[J].昆明医科大学学报,2017,38(1):61-64.
[18] BECKER M A,MACDONALD P A,HUNT B J,et al.Determinants of the clinical outcomes of gout during the first year of urate-lowering therapy[J].Nucleosides Nucleotides Nucleic Acids,2008,27(6):585-591.
[19] BAIL?N R,GONZ?LEZ SENAC N M,LPEZ M M,et al.Efficacy and safety of a urate lowering regimen in primary gout[J].Nucleosides Nucleotides Nucleic Acids,2014,33(4-6):174-180.
[20] ROGER A.Physiological chemisty of uric acid:solubility,colloid ion-binding properties[J].Biochem Physiol,1979,67:27-34.
[21] 肖颖,张思容,唐志宏,等.膝关节液 pH 值与痛风结晶的形成[J].中国组织工程研究与临床康复,2011,15(26):4857-4859.

备注/Memo

备注/Memo:
(收稿日期:2020-03-11)基金项目:广东省中医药管理局科研项目(20201312) 深圳市科创委2020年基础研究面上项目 (JCYJ20190812170815559) 1上海中医药大学深圳医院(深圳市罗湖区中医院) (广东 深圳,510405) 通信作者 E-mail:435072998@qq.com
更新日期/Last Update: 2020-10-10