Abstract:

Objective　To observe the early efficacy of arthroscopic debridement combined with traditional Chinese medicine packages in the treatment of patients with knee gouty arthritis. Methods　Ninety patients with knee gouty arthritis who were treated in Liwan District Orthopedic and Traumatology Hospital from May 2020 to June 2022 were selected for the randomized controlled trial, with a total of 90 knees. The patients were divided into a conservative treatment group, a minimally invasive treatment group, and a combined treatment group by the random number table method, with 30 cases in each group. The conservative treatment group were (42.93±3.28) years old, with a disease course of (9.72±3.74) months. The minimally invasive treatment group were (43.03±3.64) years old, with a disease course of (10.01±3.83) months. The combined treatment group were (43.58±5.60) years old, with a disease course of (9.86±3.95) months. The conservative treatment group externally applied self-made Chinese medicine packages, once a day. The minimally invasive treatment group took minimally invasive debridement under arthroscope. The combined treatment group were treated with arthroscopic debridement and postoperative Chinese medicine packages. All the three groups were treated with the same anti-inflammatory and analgesic drugs. The scores of Visual Analogue Scale (VAS) and Lysholm joint function of knee joint (Lysholm) and laboratory indicators (white blood cell, blood uric acid, erythrocyte sedimentation rate, and C-reactive protein) before and 1, 2, and 4 weeks after the treatment, and recurrence rates within six months were observed. The repeated measurement analysis of variance and non-parameter test were applied. Results　There were statistical differences in the scores of VAS and Lysholm and laboratory indicators in the three groups between before and 1 week after the treatment (all P<0.05); there were no statistical differences in the scores of VAS and Lysholm and laboratory indicators 1 week after the treatment between the 3 groups (all P>0.05). Two weeks after the treatment, the scores of VAS and Lysholm in the combined treatment group were 2.00 (1.00) and (81.67±6.35); the scores in the minimally invasive treatment group were 2.00 (1.00) and (80.37±5.58); the scores in the conservative treatment group were 3.00 (1.25) and (77.23±6.10); there were statistical differences between the combined treatment group and the minimally invasive treatment group on one hand and the conservative treatment group on the other hand (all P<0.05), and no between the combined treatment group and the minimally invasive treatment group (both P>0.05). Four weeks after the treatment, the scores of VAS and Lysholm in the combined treatment group were 1.00 (1.25) and (87.03±5.26); the scores in the conservative treatment group were 2.00 (1.00) and (80.70±5.80); the scores in the minimally invasive treatment group were 1.50 (1.00) and (82.33±5.36); there were statistical differences between the combined treatment group on one hand and the minimally invasive treatment group and the conservative treatment group on the other hand (all P<0.05), and no between the conservative treatment group and the minimally invasive treatment group (both P>0.05). All the patients in the 3 groups were followed up half year; no case recurred in the combined treatment group; 1 case recurred in the minimally invasive treatment group; 3 cases recurred in the conservative treatment group. Conclusions　Arthroscopic debridement and traditional Chinese medicine packages for patients with knee gouty arthritis both are effective. The combination of the two has better early effect, and can reduce the recurrence of gout, delay the disease progression, so it is worthy of clinical application.

Key words:

Arthroscope, Traditional Chinese medicine packages, Knee gouty arthritis, Efficacy

摘要：

目的　观察关节镜清理术联合中药封包治疗膝痛风性关节炎的早期效果。方法　选取2020年5月至2022年6月就诊于广州市荔湾区骨伤科医院的膝痛风性关节炎患者90例进行随机对照试验，共90个膝关节。采用随机数字表法将所有患者分为保守治疗组、微创治疗组和联合治疗组，各30例。保守治疗组年龄（42.93±3.28）岁，病程（9.72±3.74）个月，采用广州市荔湾区骨伤科医院自制中药封包外敷膝关节治疗，每天1次；微创治疗组年龄（43.03±3.64）岁，病程（10.01±3.83）个月，行膝关节镜微创清理术治疗；联合治疗组年龄（43.58±5.60）岁，病程（9.86±3.95）个月，采用关节镜清理+术后配合中药封包联合治疗。3组均配合相同的消炎止痛类药物治疗。观察治疗前和治疗后1周、2周、4周视觉模拟量表（Visual Analogue Scale，VAS）、膝关节Lysholm关节功能（Lysholm）评分、实验室指标（白细胞、血尿酸、血沉、C-反应蛋白）水平以及半年内复发情况。采用重复测量方差分析和非参数检验。结果　3组患者治疗后1周膝关节疼痛VAS、Lysholm评分及实验室指标水平组内比较，差异均有统计学意义（均P<0.05），组间比较差异均无统计学意义（均P>0.05）。治疗后2周，联合组VAS、Lysholm评分分别为2.00（1.00）分、（81.67±6.35）分，微创组分别为2.00（1.00）分、（80.37±5.58）分，保守组分别为3.00（1.25）分、（77.23±6.10）分，联合组、微创组与保守组比较，差异均有统计学意义（P<0.05）；联合组与微创组比较，差异均无统计学意义（均P>0.05）。治疗后4周，联合组VAS、Lysholm评分分别为1.00（1.25）分、（87.03±5.26）分，保守组分别为2.00（1.00）分、（80.70±5.80）分，微创组分别为1.50（1.00）分、（82.33±5.36）分；联合组与微创组、保守组比较，差异均有统计学意义（均P<0.05）；保守组与微创治疗组比较，差异均无统计学意义（均P>0.05）。3组患者随访半年，联合组无1例复发，微创组有1例复发，保守组有3例复发。结论　关节镜清理术及中药封包治疗膝痛风性关节炎患者均有良好效果，两者结合早期效果更佳，且可减少痛风复发，延缓病程进展，值得临床使用。

关键词:

关节镜, 中药封包, 膝痛风性关节炎, 疗效