超声引导下碳酸氢钠溶液冲洗治疗痛风性膝关节炎的临床研究(1)
【摘 要】目的：观察超声引导下膝关节穿刺抽液后用质量分数为5%的碳酸氢钠溶液冲洗治疗痛风性膝关节炎的临床疗效。方法：将60例急性发作期单侧痛风性膝关节炎并髌上囊积液的患者随机分为治疗组和对照组，每组30例。对照组患者行超声引导下穿刺抽液后用生理盐水冲洗关节腔，术后标准药物治疗;治疗组患者行超声引导下穿刺抽液后用质量分数为5%的碳酸氢钠溶液冲洗关节腔，术后标准药物治疗。观察2组患者治疗前后患膝关节疼痛视觉模拟评分法(VAS)评分、Lysholm评分，以及术后6个月复发率。结果：治疗后，2组患者患膝关节VAS评分、Lysholm评分均明显优于治疗前(P < 0.05)，术后7，14，30，90 d患膝关节VAS评分，术后30，90 d患膝关节Lysholm评分，治疗组优于对照组(P < 0.05)。治疗组复发率低于对照组，但差异无统计学意义(P > 0.05)。结论：超声引导下膝关节穿刺抽液后用质量分数为5%的碳酸氢钠溶液冲洗，能减少关节腔内尿酸结晶残余，相对于生理盐水冲洗，能减轻术后疼痛，改善关节功能。
【关键词】 痛风性膝关节炎;碳酸氢钠溶液;超声引导;冲洗
【ABSTRACT】Objective：To observe the clinical effect of 5% sodium bicarbonate solution in the treatment of gouty knee arthritis after ultrasound-guided knee joint puncture and extraction.Methods：Sixty patients with unilateral gouty knee arthritis and hydrops of suprapatellar bursa were divided into a treatment group and a control group，30 cases in each group.In the control group，the joint cavity was flushed with saline after ultrasound-guided puncture and extraction，and treated with standard medicine after operation.In the treatment group，the joint cavity was flushed with 5% sodium bicarbonate solution after ultrasound-guided puncture and extraction，and treated with standard medicine after operation.The VAS score and Lysholm score before and after treatment and the recurrence rate after 6 months were observed.Results：After the treatment，the VAS pain score and Lysholm score of the two groups were significantly better than those before the treatment(P < 0.05).The VAS pain scores 7，14，30 and 90 days after the operation，and the Lysholm scores 30 and 90 days after the operation in the treatment group were better than those in the control group(P < 0.05).The recurrence rate of the treatment group was lower than that of the control group，but the difference was not statistically significant(P > 0.05).Conclusion：Washing with 5% sodium bicarbonate solution can reduce the residual of uric acid crystal in the articular cavity.Compared with washing with normal saline solution，it can reduce postoperative pain and improve joint function.
【Keywords】 gouty knee arthritis;sodium bicarbonate solution;ultrasound guid-ance;washing
痛風性膝关节炎是由于嘌呤代谢紊乱而引起的尿酸生成增多或尿酸排泄减少，尿酸结晶在膝关节沉积所致的一种关节炎症性疾病[1-2]。随着人们生活水平的提高，痛风性膝关节炎患者的人数也逐年增多。对于有关节积液的患者，临床上已开展膝关节穿刺抽液减压以快速缓解关节部位症状;但单纯抽液，沉积于滑膜表面及关节软骨表面的尿酸结晶尚未清除，复发率高。文献报道体外试验用质量分数为5%的碳酸氢钠溶液能有效溶解尿酸结晶，关节腔镜常用于痛风性膝关节炎的治疗。质量分数为5%的碳酸氢钠溶液也逐渐应用于关节镜术后的关节腔冲洗，文献报道治疗效果较生理盐水关节腔冲洗好，且复发率较低[3-4]。但关节腔镜需要住院治疗，部分患者不愿接受[5]。而超声引导下穿刺操作简便，不需住院，患者接受度较高。本研究对比超声引导下膝关节穿刺抽液后用质量分数为5%的碳酸氢钠溶液冲洗与用生理盐水冲洗对痛风性膝关节炎治疗效果，现总结报告如下。, http://www.100md.com(冯明初 梁键锋 韩小华 瞿国萍)
【关键词】 痛风性膝关节炎;碳酸氢钠溶液;超声引导;冲洗
【ABSTRACT】Objective：To observe the clinical effect of 5% sodium bicarbonate solution in the treatment of gouty knee arthritis after ultrasound-guided knee joint puncture and extraction.Methods：Sixty patients with unilateral gouty knee arthritis and hydrops of suprapatellar bursa were divided into a treatment group and a control group，30 cases in each group.In the control group，the joint cavity was flushed with saline after ultrasound-guided puncture and extraction，and treated with standard medicine after operation.In the treatment group，the joint cavity was flushed with 5% sodium bicarbonate solution after ultrasound-guided puncture and extraction，and treated with standard medicine after operation.The VAS score and Lysholm score before and after treatment and the recurrence rate after 6 months were observed.Results：After the treatment，the VAS pain score and Lysholm score of the two groups were significantly better than those before the treatment(P < 0.05).The VAS pain scores 7，14，30 and 90 days after the operation，and the Lysholm scores 30 and 90 days after the operation in the treatment group were better than those in the control group(P < 0.05).The recurrence rate of the treatment group was lower than that of the control group，but the difference was not statistically significant(P > 0.05).Conclusion：Washing with 5% sodium bicarbonate solution can reduce the residual of uric acid crystal in the articular cavity.Compared with washing with normal saline solution，it can reduce postoperative pain and improve joint function.
【Keywords】 gouty knee arthritis;sodium bicarbonate solution;ultrasound guid-ance;washing
痛風性膝关节炎是由于嘌呤代谢紊乱而引起的尿酸生成增多或尿酸排泄减少，尿酸结晶在膝关节沉积所致的一种关节炎症性疾病[1-2]。随着人们生活水平的提高，痛风性膝关节炎患者的人数也逐年增多。对于有关节积液的患者，临床上已开展膝关节穿刺抽液减压以快速缓解关节部位症状;但单纯抽液，沉积于滑膜表面及关节软骨表面的尿酸结晶尚未清除，复发率高。文献报道体外试验用质量分数为5%的碳酸氢钠溶液能有效溶解尿酸结晶，关节腔镜常用于痛风性膝关节炎的治疗。质量分数为5%的碳酸氢钠溶液也逐渐应用于关节镜术后的关节腔冲洗，文献报道治疗效果较生理盐水关节腔冲洗好，且复发率较低[3-4]。但关节腔镜需要住院治疗，部分患者不愿接受[5]。而超声引导下穿刺操作简便，不需住院，患者接受度较高。本研究对比超声引导下膝关节穿刺抽液后用质量分数为5%的碳酸氢钠溶液冲洗与用生理盐水冲洗对痛风性膝关节炎治疗效果，现总结报告如下。, http://www.100md.com(冯明初 梁键锋 韩小华 瞿国萍)
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