四肢痛风石的手术治疗

发布时间：2018-04-04 04:40

本文选题：痛风　切入点：痛风石　出处：《吉林大学》2017年硕士论文

【摘要】：目的痛风的发病率在逐渐上升。但是由于痛风患者和部分医生对疾病基础知识认知不足,痛风的管理及治疗效果不甚理想。当痛风逐渐发展成为痛风石时,会严重影响外观及关节功能障碍,这是必须考虑外科手术治疗。回顾分析我院四肢痛风石患者的手术方法及诊治过程,探讨四肢痛风石的手术切除技巧及临床治疗体会,总结诊治经验。方法选取自2012年2月至2015年12月,于我科接受手术治疗的95例四肢痛风石患者,其中男性患者95例,女性患者2例,年龄从15岁~82岁,平均51岁,所有患者均在发作间期接受手术治疗。术前查血尿酸,其平均血尿酸值为565μmol/L,痛风石平均大小为4cm×3cm。并于术前仔细评估患者承受手术的能力,根据以往手术经验估计手术失血量,如病灶超过15处,则考虑分次手术。术中根据痛风石的性状选择不同的手术方式;若发现关节破坏,首选关节成形术,若关节破坏严重,又发生于下肢,可行关节融合术。共有7例患者切除痛风石后存在皮肤缺损,面积从1cm×1cm到4cm×3cm,其中有3例皮肤缺损伴肌腱外露的患者行皮瓣修复术,另外4例通过换药以期延期愈合。结果本组共4例患者创口延期愈合,6例患者因不可挽救的感染接受截肢(指/趾)手术,其中,中指1例,足趾2例,左小指1例,右小指2例。术前存在痛风石破溃的患者平均住院13.1天明显长于术前未发生破溃患(平均住院时间为7.8天)。术后短期内血尿酸,平均值为484μmol/L较术前明显下降。本组共72例患者获得完整随访,随访率为76%,随访时间1年2个月~5年,所有患者四肢外形满意,上肢受累关节活动度明显提高,下肢关节承重无疼痛,且无原位复发病例。结论手术切除痛风石不仅减轻了机体尿酸盐的总负荷,降低了痛风性关节炎的发作频率,更是改善肢体外形及关节功能的最有效途径。所以,四肢痛风石患者一旦出现关节受累就应尽早接受手术治疗。
[Abstract]:Objective the incidence of gout is increasing gradually.However, the management and treatment of gout are not satisfactory due to the lack of basic knowledge of gout patients and some doctors.As gout develops into gout, it can seriously affect appearance and joint dysfunction, which must be considered for surgical treatment.The surgical methods and diagnosis and treatment of limb gout stone in our hospital were analyzed retrospectively. The surgical excision technique and clinical treatment experience of limb gout stone were discussed and the experience of diagnosis and treatment was summarized.Methods from February 2012 to December 2015, 95 patients with limb gout stone were treated in our department, including 95 male patients and 2 female patients, aged from 15 to 82 years (mean 51 years).All patients received surgical treatment during the interictal period.The mean uric acid value was 565 渭 mol / L and the mean size of gout stone was 4cm 脳 3 cm.The patient's ability to bear surgery was carefully evaluated before operation, and the amount of blood loss was estimated according to previous surgical experience.According to the characteristics of gout stone, different operative methods were selected during the operation. If joint destruction was found, arthroplasty was the first choice, and if joint destruction was serious and occurred in lower extremities, arthrodesis was feasible.A total of 7 patients had skin defects, ranging from 1cm 脳 1cm to 4cm 脳 3 cm after removal of gout stones. Among them, 3 patients with skin defects with tendon exposure underwent skin flap repair, and 4 patients were treated with delayed healing by changing dressing.Results six patients with delayed wound healing underwent amputation (finger / toe) operation due to irreparable infection, including 1 middle finger, 2 toe, 1 left small finger and 2 right little finger.The average hospitalization time of patients with gout failure before operation was 13.1 days longer than that of patients without rupture before operation (mean hospitalization time was 7.8 days).The mean value of serum uric acid was 484 渭 mol/L, which was significantly lower than that before operation.A total of 72 patients were followed up, the follow-up rate was 76. The follow-up time was 1 year, 2 months to 5 years. All the patients were satisfied with the appearance of extremities, the range of motion of the involved joints of the upper extremities was obviously improved, the lower extremities had no pain in bearing joint, and there were no cases of recurrence in situ.Conclusion resection of gout stone can not only reduce the total load of uric acid, reduce the frequency of gouty arthritis, but also improve the limb shape and joint function.Therefore, patients with limb gout should receive surgical treatment as soon as their joints are involved.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589.7;R687

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