关节镜清理术联合痛风颗粒治疗膝痛风性关节炎的临床观察
发布时间：2018-11-25 11:11
【摘要】：目的通过观察比较关节镜清理术后患者的主观满意度,疼痛程度,血沉、C反应蛋白、血尿酸的变化,临床疗效,膝关节功能Lysholm评分,术后并发症等,探讨关节镜清理术联合痛风颗粒治疗膝痛风性关节炎的临床疗效,为膝痛风性关节炎寻求安全、有效的治疗方法。方法本次研究对象选取自2013年3月至2014年9月在湖北省十堰市太和医院骨关节科病房住院治疗的60例反复发作的膝痛风性关节炎病人。所有就诊患者按入院的先后顺序采用随机化对照方法(抛硬币法)分为治疗组和对照组两组,治疗组30例,对照组30例,行膝关节清理术及术后的常规处理相同。60例膝痛风性关节炎患者,男性55例,女性5例;年龄34-65岁,病程7天至15年。中医辨证均为湿热蕴结证。入院后完善术前常规检查及术前手术评估,无手术绝对禁忌症。治疗组30例,行关节镜清理术,术后第一天起开始口服痛风颗粒,一袋10克,每日三次,每次一袋,连续14天;对照组30例,行关节镜清理术,术后口服秋水仙碱片、碳酸氢钠片;1周后改服别嘌醇片、丙磺舒片,连续治疗14天。观察术后各组患者主观满意度;术后1周、2周疼痛程度进行视觉模拟评分(VAS评分);术后1周、2周血沉、C反应蛋白、血尿酸的变化;临床疗效;术后1个月、3个月的膝关节功能Lysholm评分;术后并发症。并进行统计学分析结果(SPSSl9.0统计软件)。结果1.两组主观满意度比较治疗组病例评估时满意26例(86.7%),一般3例(10%),不满意1例(3.3%)。对照组病例评估时满意20例(66.7%),一般6例(20%),不满意4例(13.3%)。主观满意度治疗组明显优于对照组(见表2)。2.两组术前及术后1周、2周疼痛程度进行视觉模拟评分比较对两组患者治疗前、治疗后1周以及治疗后2周进行VAS评分,结果如表3所示。结果显示:治疗组患者在治疗1周、2周后其评分分值明显低于对照组(P0.05),治疗组术后疼痛缓解明显优于对照组(见表3)。3.术后1周、2周两组的血沉、C反应蛋白及血尿酸比较治疗组治疗后血沉、C反应蛋白及血尿酸水平明显降低,且降低程度优于对照组,具有统计学差异(P0.01)(见表4)。痛风颗粒降血尿酸、降低血沉以及C反应蛋白,减轻关节炎症优于西药。4.术后3个月两组临床疗效比较术后随访3个月,治疗组总有效率为96.7%,对照组总有效率为73.3%,经统计学比较,差异有统计学意义(PO.05)(见表5)。两组患者临床疗效比较,治疗组明显优于对照组。5.两组术前、术后1个月及3个月的膝关节功能Lysholm评分比较术后1个月随访膝关节功能评分,治疗组为68.15±10.04,对照组为51.80±16.90,治疗组优于对照组,差异有统计学意义(PO.05)(见表6)。术后3个月随访膝关节功能评分,治疗组为85.85±8.08,对照组为63.28±10.02,治疗组明显优于对照组,差异有统计学意义(PO.05)(见表6)。结论通过对关节镜清理术联合痛风颗粒治疗膝痛风性关节炎的临床疗效观察比较,研究结果表明:关节镜清理术联合痛风颗粒治疗膝痛风性关节炎疗效显著,相比关节镜下清理术配合西药治疗疗效更佳,是治疗膝痛风性关节炎的一种安全、有效、微创、迅速的方法。关节镜下清理术联合痛风颗粒治疗膝痛风性关节炎,术后养成良好的生活方式以及饮食习惯,可最大限度减轻关节内损害,阻止病程进展,保护膝关节功能。
[Abstract]:Objective To compare the subjective degree of satisfaction, the degree of pain, the erythrocyte sedimentation rate, the C-reactive protein, the change of the blood uric acid, the clinical curative effect, the Lysholm score of the knee joint function, the postoperative complications and so on by comparing the subjective satisfaction degree, the pain degree, the erythrocyte sedimentation rate, the C-reactive protein, the blood uric acid, the clinical curative effect, the function of the knee joint, the Lysholm score, the postoperative complications, etc. of the patients after the arthroscopy. To explore the clinical effect of arthroscopy combined with gout in the treatment of gouty arthritis, and to find a safe and effective method for the treatment of gouty arthritis of the knee. Methods 60 cases of knee-gouty arthritis were selected from March, 2013 to September, 2014 in the hospital of Taihe Hospital of Taihe Hospital in Shiyan City, Hubei Province. All the patients in the treatment group were divided into the treatment group and the control group according to the sequence of admission, 30 cases of the treatment group, 30 cases of the control group, the operation of the knee joint cleaning and the routine treatment after the operation. 5 female; aged 34-65, course of course 7-15 years. The syndrome differentiation of TCM is the syndrome of damp-heat. The pre-operative routine examination before and after admission and the pre-operative assessment and no absolute contraindication for the operation were performed. In the treatment group, 30 cases were treated with arthroscopy, and the first day after the operation, the oral gout particles were taken, a bag of 10 g, three times a day, one bag for 14 days, 30 cases in the control group, an arthroscopic debridement procedure, an oral colchicine tablet and a sodium bicarbonate tablet after operation, and the alcohol tablet was changed after 1 week. The probenecid tablets were treated for 14 consecutive days. The subjective satisfaction of the patients after operation was observed, and the visual analogue score (VAS score) was performed at 1 week and 2 weeks after the operation; the changes of the erythrocyte sedimentation rate, the C-reactive protein and the blood uric acid were measured at 1 week, 2 weeks after the operation, and the Lysholm score of the knee joint function of 3 months after the operation was 1 month and 3 months after the operation; and the postoperative complications. Statistical analysis was performed (SPSSl92.0 statistical software). Results 1. The subjective satisfaction of the two groups was satisfactory in 26 cases (86.7%) in the treatment group, 3 (10%) and 1 (3.3%). In the control group, 20 cases (66. 7%), 6 (20%) and 4 (13. 3%) were satisfied. The subjective satisfaction treatment group was significantly superior to the control group (see Table 2). The VAS scores were compared between the two groups before and after 1 and 2 weeks after treatment, 1 week after treatment, and 2 weeks after treatment, as shown in Table 3. The results showed that the score of the treatment group was significantly lower than that in the control group after 1 week and 2 weeks (P0.05). The pain relief after the treatment group was better than that of the control group (see Table 3). The levels of erythrocyte sedimentation, C-reactive protein and serum uric acid in the treatment group were significantly lower after 1 week and 2 weeks after the operation, and the degree of reduction was better than that of the control group (P0.01) (see Table 4). The gout granule has the advantages of reducing blood uric acid, lowering the erythrocyte sedimentation rate and C-reactive protein, and relieving the inflammation of the joint to the western medicine. The total effective rate of the treatment group was 96.7%, the total effective rate of the control group was 73.3%, and the difference was statistically significant (PO. 05) (see Table 5). The curative effect of the two groups was better than that of the control group. The function score of the knee joint was followed for 1 month and 3 months before and after the operation. The treatment group was 68. 15-10.04, the control group was 51. 80-16. 90, the treatment group was better than the control group, and the difference was statistically significant (PO. 05) (see Table 6). The functional scores of the knee joint were followed up 3 months after the operation. The treatment group was 85. 85 to 8.08, and the control group was 63.28 to 10.02, and the treatment group was significantly superior to the control group, and the difference was statistically significant (PO. 05) (see Table 6). Conclusion The clinical effect of arthroscopy combined with gout in the treatment of gouty arthritis of the knee was compared, and the results showed that the combination of arthroscopy combined with the treatment of gout was a significant effect on the treatment of the gouty arthritis of the knee. is a safe, effective, minimally invasive and rapid method for treating the gouty arthritis of the knee. under the arthroscope, the combined gout particles can be used for the treatment of the gouty arthritis of the knee, the good living mode and the eating habits are formed after the operation, the damage in the joint can be reduced to the maximum extent, the course of the disease is prevented, and the function of the knee joint is protected.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
本文编号：2355896
[Abstract]:Objective To compare the subjective degree of satisfaction, the degree of pain, the erythrocyte sedimentation rate, the C-reactive protein, the change of the blood uric acid, the clinical curative effect, the Lysholm score of the knee joint function, the postoperative complications and so on by comparing the subjective satisfaction degree, the pain degree, the erythrocyte sedimentation rate, the C-reactive protein, the blood uric acid, the clinical curative effect, the function of the knee joint, the Lysholm score, the postoperative complications, etc. of the patients after the arthroscopy. To explore the clinical effect of arthroscopy combined with gout in the treatment of gouty arthritis, and to find a safe and effective method for the treatment of gouty arthritis of the knee. Methods 60 cases of knee-gouty arthritis were selected from March, 2013 to September, 2014 in the hospital of Taihe Hospital of Taihe Hospital in Shiyan City, Hubei Province. All the patients in the treatment group were divided into the treatment group and the control group according to the sequence of admission, 30 cases of the treatment group, 30 cases of the control group, the operation of the knee joint cleaning and the routine treatment after the operation. 5 female; aged 34-65, course of course 7-15 years. The syndrome differentiation of TCM is the syndrome of damp-heat. The pre-operative routine examination before and after admission and the pre-operative assessment and no absolute contraindication for the operation were performed. In the treatment group, 30 cases were treated with arthroscopy, and the first day after the operation, the oral gout particles were taken, a bag of 10 g, three times a day, one bag for 14 days, 30 cases in the control group, an arthroscopic debridement procedure, an oral colchicine tablet and a sodium bicarbonate tablet after operation, and the alcohol tablet was changed after 1 week. The probenecid tablets were treated for 14 consecutive days. The subjective satisfaction of the patients after operation was observed, and the visual analogue score (VAS score) was performed at 1 week and 2 weeks after the operation; the changes of the erythrocyte sedimentation rate, the C-reactive protein and the blood uric acid were measured at 1 week, 2 weeks after the operation, and the Lysholm score of the knee joint function of 3 months after the operation was 1 month and 3 months after the operation; and the postoperative complications. Statistical analysis was performed (SPSSl92.0 statistical software). Results 1. The subjective satisfaction of the two groups was satisfactory in 26 cases (86.7%) in the treatment group, 3 (10%) and 1 (3.3%). In the control group, 20 cases (66. 7%), 6 (20%) and 4 (13. 3%) were satisfied. The subjective satisfaction treatment group was significantly superior to the control group (see Table 2). The VAS scores were compared between the two groups before and after 1 and 2 weeks after treatment, 1 week after treatment, and 2 weeks after treatment, as shown in Table 3. The results showed that the score of the treatment group was significantly lower than that in the control group after 1 week and 2 weeks (P0.05). The pain relief after the treatment group was better than that of the control group (see Table 3). The levels of erythrocyte sedimentation, C-reactive protein and serum uric acid in the treatment group were significantly lower after 1 week and 2 weeks after the operation, and the degree of reduction was better than that of the control group (P0.01) (see Table 4). The gout granule has the advantages of reducing blood uric acid, lowering the erythrocyte sedimentation rate and C-reactive protein, and relieving the inflammation of the joint to the western medicine. The total effective rate of the treatment group was 96.7%, the total effective rate of the control group was 73.3%, and the difference was statistically significant (PO. 05) (see Table 5). The curative effect of the two groups was better than that of the control group. The function score of the knee joint was followed for 1 month and 3 months before and after the operation. The treatment group was 68. 15-10.04, the control group was 51. 80-16. 90, the treatment group was better than the control group, and the difference was statistically significant (PO. 05) (see Table 6). The functional scores of the knee joint were followed up 3 months after the operation. The treatment group was 85. 85 to 8.08, and the control group was 63.28 to 10.02, and the treatment group was significantly superior to the control group, and the difference was statistically significant (PO. 05) (see Table 6). Conclusion The clinical effect of arthroscopy combined with gout in the treatment of gouty arthritis of the knee was compared, and the results showed that the combination of arthroscopy combined with the treatment of gout was a significant effect on the treatment of the gouty arthritis of the knee. is a safe, effective, minimally invasive and rapid method for treating the gouty arthritis of the knee. under the arthroscope, the combined gout particles can be used for the treatment of the gouty arthritis of the knee, the good living mode and the eating habits are formed after the operation, the damage in the joint can be reduced to the maximum extent, the course of the disease is prevented, and the function of the knee joint is protected.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
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