四肢多发痛风石患者手术治疗临床效果分析(附23例报告)

Analysis of clinical effect of surgical treatment in patients with multiple tophi in extremities:A report of 23 cases

目的:探讨四肢多发痛风石切除术前准备要点、操作要点以及术后处理注意事项。方法:选择四肢多发痛风石患者23例,均为男性,年龄31~65岁,平均年龄48.7岁。病程为4~20年,平均病程为9.13年,均为四肢多发痛风石,术前血尿酸380~665μmol·L-1。本组病例在内科综合治疗的基础上,待血尿酸降至正常或接近正常值并且未处在急性发作期时行痛风石切除,部分患者行功能修复重建术,术后积极配合规范痛风内科治疗。结果:21例患者术后2周切口甲级愈合,2例患者切口有尿酸盐渗出,再次清创缝合后愈合。23例患者中18例获得随访,5例失访。随访时间为4~12个月(平均随访时间8个月),与术前比较,16例患者术后关节功能改善、关节活动度增加、不适感减轻;而2例关节活动未见好转,1例并发腕管综合征患者麻痛症状明显减轻。结论:在掌握适应证的前提下,以手术治疗为主的综合疗法在治疗四肢多发痛风石患者方面有优势,能获得满意临床效果,有利于提高患者的生活质量。

Objective:To explore the key points of preoperative preparation,the experience of operation and attentions of postoperative treatment of surgical treatment in multiple tophi in the extremities.Methods: A total of 23 cases of multiple tophi in extremities were selected,all were male;aged from 31 to 65 years old,average 48.7 years old;the course of the disease ranged from 4 to 20 years,with an average of 9.13 years;the blood uric acid before operation ranged from 380 to 665μmol·L-1,the level of uric acid was controlled by physicians before operation and the patients were not in the attack period.The patients underwent gout stone resection.Some of the patients underwent functional reconstruction and were treated with standardized gout medicine after operation.Results:Twenty-one cases of incision were grade A healing 2 weeks after operation,and 2 cases of incision still had uric acid salt exudation and healed after debridement suture.Among 23 cases,18 patients were followed for 4-12 months,an average of 8 months;5 patients were lost to follow-up.0x09Compared with before operation,the joint function was improved,the degrees of joint activity were increased,and the discomfort was relieved in 16 patients after operation;there was no improvement in postoperative joint function in 2 patients,and the pain symptom in 1 patient with carpal tunnel syndrome was reduced.Conclusion:When properly indicated,the comprehensive therapy is the best treatment for the patients with multiple tophi in extremities.It is reliable and can improve the quality of life of the patients.