樊粤光中西医结合分期治疗痛风性关节炎经验

Experience of FAN Yue-Guang in Treating Gouty Arthritis by Staging Treatment with Integrated Chinese and Western Medicine Therapy

总结樊粤光教授采用中西医结合疗法分期治疗痛风性关节炎的经验。痛风性关节炎是临床常见的需要长期管理的炎症性疾病,樊粤光教授认为脾失健运及湿热外邪侵袭或饮食不节是痛风性关节炎的基本病机;临证以本虚标实为多见,主张标本兼治,以健脾祛湿为基本治法,方以参苓白术散加减,分急性期和缓解期辨证论治。对因痛风石沉积导致关节变形,影响关节功能的患者,则建议尽早手术治疗。对痛风石沉积第一跖趾关节且已致局部骨质破坏缺损,关节畸形,严重影响关节功能和生活质量的患者,建议采取病灶清除、负压封闭引流、创面修复和植骨融合术等手术治疗;对痛风石沉积膝关节且已影响膝关节功能的患者,樊粤光教授主要采取关节镜手术来达到清除病灶,改善症状,恢复关节功能。

The experience of Professor FAN Yue-Guang in treating gouty arthritis with integrated Chinese and western medicine therapy was summarized. As a commonly-seen inflammatory disease which needs long-term management, Professor FAN Yue-Guang believes that gouty arthritis had the basic pathogenesis of failure of spleen in transportation,attack by damp-heat pathogens,or improper diet. The clinical manifestations of gouty arthritis are characterized by deficiency in the origin and excess in the superficiality,and the treatment should aim at treating the symptoms and root cause simultaneously. The syndrome differentiation and treatment for gouty arthritis can be based on the classification of acute stage and remission stage,invigorating spleen and expelling damp are the basic therapies,and the modified Shen Ling Baizhu Powder is commonly used. For the patients with deformed joints and impaired joint function induced by the deposit of gouty tophus,early surgery is proposed. For the patients with bone destruction and defect and deformed joints induced by the deposit of gouty tophus in the first metatarsophalangeal joint,the joint function and quality of life of the patients were usually severely injured,so operative treatment for the clearance of focal lesion,vacuum sealing drainage(VSD),wound repair,and bone graft fusion is proposed. For the patients with impaired knee joint function due to the deposit of gouty tophus,Professor FAN Yue-Guang suggested that arthroscopic surgery should be used for the clearance of focal lesion,relief of symptoms,and the recovery of joint function.