晚期手部痛风结石的治疗体会

目的探讨晚期手部痛风结石手术治疗的临床疗效及治疗经验。方法 2007年1月至2018年12月,对27例手部痛风结石患者,痛风石切除同时行肌腱移植15例,痛风石切除同时行关节融合12例,痛风石切除同时行关节融合及肌腱移植7例。术后1周内服用秋水仙碱,每日3次,每次0.5mg。结果术后全部病例均切除了痛风结石,同时纠正了手指的外形畸形,皮肤无坏死,伤口均I期愈合。24例患者获得随访,3例失访,术后随访6个月～3年,手指外形及功能满意,有2例手部痛风石复发。结论手术治疗能有效清除手部痛风结石,同时可纠正手指畸形及外观,改善手功能,是治疗手部晚期痛风结石的有效手段。     

手部痛风石的手术治疗体会

[目的]探讨手部痛风石的手术疗效及临床经验。[方法]对12例手部痛风石患者进行手术治疗,单纯痛风石切除10例,腕管切开正中神经松解、痛风石切除、指浅屈肌腱切除2例,术中采用5%碳酸氢钠溶液冲洗创面。术前及术后应用抗痛风药物。[结果]所有病例术后3周拆除缝合线,切口一期愈合,本组患者随访时间8个月⁶年,手术部位痛风石无复发,畸形得到纠正,手指感觉恢复,功能满意。[结论]手术治疗可及时阻断局部痛风的病理进程,可以改善手的外观和功能。术中应用5%碳酸氢钠溶液冲洗创面可以使手部痛风石的清除更容易、有效。     

痛风致腕管综合征10例疗效

目的探讨痛风致腕管综合征的手术疗效及临床经验。方法 2016年12月-2018年12月,对10例13侧痛风致腕管综合征进行手术治疗,腕管切开减压正中神经松解及痛风石切除,术前及术后应用抗痛风药物。结果所有病例术后2周拆除缝合线,切口均Ⅰ期愈合,全组随访时间1个月,手术部位切口愈合良好,手指感觉恢复,疼痛消失,功能恢复满意。结论痛风致腕管综合征要考虑痛风石压迫神经的可能,切开手术是唯一有效方法,术中要彻底探查腕管,尽量切除病变组织。     

痛风致腕管综合征一例

我们对痛风致腕管综合症 1例患者在抗痛风治疗的基础上 ,积极地采取手术治疗 ,即切开腕管 ,清除痛风石 ,松解正中神经 ,术后常规消炎、抗痛风治疗后感觉明显恢复。体会 :对于痛风所致腕管综合征 ,应在治疗痛风的基础上 ,积极地采取手术治疗 ,彻底地清除痛风结节 ,必要时可行正中神经外膜松解 ,以彻底解除对正中神经的压迫 ,如果屈指深肌腱没有受累 ,建议可将屈指浅腱切除 ,如果屈指深、浅肌腱同时受累 ,则可考虑纵向楔形切除痛风结节痛风致腕管综合征一例$吉林大学中日联谊医院手外科@魏壮 @张巨$吉林大学中日联谊医院手外科 @刘飙$吉…     

保留皮肤的手部巨大痛风结石切除术

目的 探讨手术切除手部巨大痛风结石的可行方法.方法 14例患者的手部痛风结石均侵及肌腱、滑膜等组织,其中12例x线片湿示关节软骨有虫蚀样改变;采用手术切除痛风结石及指伸肌腱吻合术,用大量生理盐水反复冲洗伤口,放置橡皮片引流,尽量保留表面皮肤以覆盖创面.结果 全部患者均切除痛风结石,切口I期愈合.随访6-24个月,手外形得到明显改善;5例患者进行了指伸肌腱吻合,未出现皮肤坏死和切口延迟愈合.结论 对于手部巨大的痛风结石应当采用手术切除治疗,同时尽可能保留表面的皮肤.     

痛风石致腕管综合征9例的治疗

目的探讨痛风石所致腕管综合征(carpaltunnelsyndrome, CTS)的临床特点及治疗方法。方法回顾性分析2013年1月-2018年12月收治的9例经神经肌电图及病理证实的痛风石所致CTS病例资料,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且未处于急性发作期时行痛风石切除治疗。其中4例因术前超声检查示腕部肌腱痛风石沉积较大、范围较广,采用传统S形切口,术中将痛风石连同侵蚀的肌腱一起切除;2例尽可能刮除肌腱上附着的痛风石,保留腱性结构;3例术前超声检查示腕部肌腱痛风石沉积较少,且集中于一处,故采取腕部纵向小切口,清除沉积于肌腱上及腕管内的痛风石。结果患者术后切口均一期愈合,住院期间无痛风急性发作。术后随访7～24个月,手指麻木症状减轻,手部功能恢复良好。结论对于痛风石所致腕管综合征(CTS),术前除完善肌电图检查以确诊CTS,并应做超声检查查明腕部痛风石沉积情况,根据痛风石沉积情况设计手术切口,以达到彻底清除痛风石、减少复发、治愈CTS的目的。手术前后应辅以药物治疗,控制尿酸水平,避免痛风急性发作。     

掌长肌腱移位一期治疗严重腕管综合征

目的评价采用正中神经松解结合掌长肌腱移位拇对掌功能重建术治疗重症腕管综合征的手术效果。方法2004--2008年，选择拇指对掌功能障碍的严重腕管综合征患者24例，分组治疗。14例采用传统手术，10例采用神经松解一期肌腱移位手术，观察术后疗效。结果神经松解肌腱移位手术组术后疗效明显优于传统手术组。结论重症腕管综合征患者在行正中神经松解的同时应用掌长肌腱移位重建拇指对掌功能，能够早期恢复拇指功能，免除二次手术。     

痛风引起腕管综合征诊疗的临床研究

[目的]探讨痛风引起的腕管综合征[痛风性腕管综合征(carpal tunnel syndrome, CTS)]的发病率、诊治方案及手术疗效。[方法]回顾2016年1月～2019年12月佛山市中医院修复重建外科手术治疗的252名腕管综合征患者的临床资料,其中男72例,女80例,平均年龄(53.50±10.04)岁,均采用手术治疗,统计痛风性CTS的发病率,观察治疗效果。[结果]痛风性CTS共16例,占比6.35%,全部为男性;全部病例均清理了痛风结石,解除腕管内正中神经卡压,手指麻木症状好转,皮肤无坏死,伤口均Ⅰ期愈合。术后随访6个月～3年,平均(15.64±2.76)个月,未见患肢腕管综合征复发,腕部及手部外形及功能满意。[结论]痛风石沉积累及正中神经可引起腕管综合征,及早的手术治疗可明显改善正中神经功能及屈伸指功能。     

两点法内镜下治疗腕管综合征

腕管综合征常规手术是将皮肤与腕管横韧带之间的组织完全切断,直视下切开腕横韧带,然后行神经松解。开放性手术的缺点是手术创伤较大,术后手部功能恢复期较长,手的握力和捏力明显下降;手掌部的皮肤切开易损伤正中神经的掌皮支,形成神经瘤而产生疼痛;切口持续性疼痛,活动时加重;易发生弓弦状屈肌腱、神经与皮肤和肌腱粘连、外形不够美观等并发症。尽管开放手术的手术切口不断改良,但最终难免在手掌部残留有痛性或肥厚性瘢痕。日本Okutsu1986年首先应用内镜治疗腕管综合征,通过前臂1cm     

痛风石致腕管综合征的病例分析

目的 探讨痛风石导致的腕管综合征的临床特点,以期指导其诊断和治疗.方法 回顾性分析2008年1月至2010年10月收治的6例腕管综合征患者,病程1～6个月,平均(3.0±0.6)个月.6例均为单发,除腕部外的身体其他部位均未发现痛风石.在行腕管切开减压时,发现腕管内有痛风石生长,痛风石侵犯指屈肌腱和正中神经.术中刮除痛风石,切开腕横韧带,解除周围组织对正中神经的压迫,行正中神经外膜或束膜松解术.结果 6例患者伤口均Ⅰ期愈合,手指麻木症状减轻.术后发现5例患者血尿酸升高,1例患者血尿酸正常.随访10～ 25个月,平均(17.0±5.3)个月,腕管综合征症状消失4例,缓解2例,未见新的痛风石出现.结论 痛风石导致的腕管综合征好发于男性,多伴有血尿酸升高,腕部B超、CT或MRI检查对其有诊断意义;腕横韧带切开,痛风石清除和正中神经外膜松解术是治疗痛风石导致的腕管综合征的有效方法.     

手腕部痛风的诊断与治疗

目的 探讨手腕部痛风的诊断方法及治疗.方法 对5例术前临床诊断为手腕部痛风的患者行病灶清除和神经、肌腱松解术,其中2例行痛风石切除.切除病变组织常规行病理检查.结果 术后5例患者伤口均Ⅰ期愈合,无感染发生,术后平均随访时间为7个月.病理检查均证实为痛风性关节炎.2例伴有痛风石的患者,术后手指麻木症状好转,活动功能得到明显改善,但半年以后又有复发.3例患者腕部疼痛消除,腕关节活动及握力恢复接近正常,未再次复发.结论 无明显痛风石形成的非典型手腕部痛风的患者,诊断较为困难,有效的治疗方法为手术探查,可早期明确诊断且术后疗效满意.而有明显痛风石形成的患者诊断容易,但术后疗效欠佳.     

Digital flexion contracture and severe carpal tunnel syndrome due to tophaceus infiltration of wrist flexor tendon: first manifestation of gout

The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. The sublimis and the profundus tendons were involved. Partial ruptures and multiple whitish lesions suggestive of tophacceous infiltration of the flexor tendons were seen. Macroscopically, the removed synovial tissue was involved by multiple whitish nodules that were milimetric in size and was suggestive of monosodium urate crystals deposits. By light microscopy examination, numerous nonnecrotizing granulomas of different sizes were observed that were compounded by large aggregations of acellular nonpolarized material, surrounded by epithelioid histiocytes, mononuclear cells, and foreign body multinucleated giant cells. Postoperatively, the patient recovered with resolution of the median nerve symptoms and a near-to-full range of motion of the affected digits.To the authors' knowledge, this patient is the first case report with flexor tendons tophacceous infiltration as the first clinical sign of gout. Gouty flexor tenosynovitis can occur in the absence of a long history of gout. A high index of suspicion is paramount to the initiation of proper management. Operative treatment of gouty flexor tenosynovitis is mandatory to debulk tophaceous deposits, improve tendon gliding, and decompress nerves. Routine uric acid determination could be helpful in the preoperative evaluation of patients with flexor tenosynovitis.     

痛风石致腕管综合征的手术治疗

目的 探讨痛风石导致腕管综合征的临床特点及手术治疗效果.方法 回顾性分析2017年10月至2019年12月于复旦大学附属华山医院手外科接受手术治疗的16例(17侧)痛风石致腕管综合征病人的临床资料,痛风病程(7.68±5.48)年,腕管综合征病程(5.22±2.24)个月.术中7侧可见正中神经局部压痕,9侧痛风石广泛包...     

Carpal tunnel syndrome due to tophaceous gout

Tophaceous gout is a recognized cause of carpal tunnel syndrome. Of 2649 carpal tunnel releases, 15 hands in 13 patients were identified with tophaceous gout in the carpal tunnel. The incidence of tophaceous gout in the carpal tunnel was 0.6%. Twelve of 13 patients were male, and 8 of 10 patients with a history of gout developed carpal tunnel syndrome despite adequate medical treatment. Thus, consideration should be given for tophi as a cause of carpal tunnel syndrome, especially in older men despite medical treatment for gout.     

Gouty tenosynovitis and compression neuropathy of the median nerve

Two cases of gouty tenosynovitis were associated with carpal tunnel syndrome. Both patients had carpal tunnel release with good relief of symptoms. In one patient, gout was not suspected before operation; this patient developed wound dehiscence with tophaceous urate crystal drainage that eventually disappeared. Proper preoperative antigout therapy may have prevented this complication. Carpal tunnel syndrome associated with gout is rare. Preoperative investigations for gout may be indicated in patients with carpal tunnel syndrome.     

Medically managed gout precipitating acute carpal tunnel syndrome

Background

The most common compressive neuropathy affects the median nerve in the carpal tunnel; it is typically chronic and progressive. Acute carpal tunnel syndrome (ACTS), on the other hand, is a less frequently encountered surgical emergency that usually occurs in the setting of trauma, such as a displaced fracture of the distal radius or carpal dislocation. To our knowledge, there are only two cases of acute carpal tunnel secondary to gout reported in the literature, with both being outside of the USA and the last case being over 20 years ago. We reviewed the literature describing acute carpal tunnel syndrome (ACTS) caused by gout and present a recent case of atraumatic ACTS caused, in part, by a tophaceous gouty mass.

Methods

Review of the literature consisted of a PubMed search of all articles in the English language using the following keywords: “Acute Carpal Tunnel Syndrome” and “Tophaceous Gout” and “Gout.”

Results

We present the youngest reported case of atraumatic ACTS caused by tophaceous gout and the only reported case with a documented history of gout being actively medically managed with a uric acid lowering agent. This was successfully treated with an emergent extended carpal tunnel release, a complete flexor synovectomy, and excision of a gouty mass adhered to the carpal tunnel floor.

Conclusions

Atraumatic ACTS secondary to gout is rare and has never been reported in a patient already being managed with uric acid lowering agents. Such a presentation requires rapid surgical exploration with release of the carpal tunnel, debridement of all gouty tissue, and increasingly aggressive adjuvant medical therapy.     

Carpal tunnel syndrome secondary to intratendinous infiltration by tophaceous gout.

Carpal tunnel syndrome caused by gout is rare. We describe a case of entrapment of the median nerve secondary to intratendinous infiltration by gouty tophi in a 54-year-old man. The tophus was excised from the profundus tendon but the superficialis was too infiltrated and destroyed to be saved. The patient made an uneventful recovery with relief of his symptoms. This case illustrates the potential consequences this could have for hand function.     

Case report. Initial manifestation of gout after carpal tunnel release.

A carpal tunnel release was performed on a patient with recurrent carpal tunnel syndrome and asymptomatic hyperuricaemia with no prior history of gouty arthritis. Intraoperatively, the patient was found to have tenosynovitis without crystals or tophaceous deposits in the carpal tunnel. Postoperatively, the patient developed an acutely inflamed hand, which responded dramatically to anti-gout medications. We report this patient as an initial attack of gout after a carpal tunnel release.     

Intraosseous tophus deposits in the os trigonum

High levels of uric acid cause accumulation of monosodium urate crystals. This formation of masses is called tophus. Intraosseous tophus deposits are rare, even for patients with gout. We report an unusual case of intraosseous tophus deposits in the os trigonum. The patient presented with ankle pain with no previous history of gout. On examination, tenderness on the posterior aspect of his ankle and limitation of plantarflexion was noted. Laboratory values were normal, except for an elevated serum uric acid value. Radiographs of the right ankle showed the presence of a large os trigonum with osteosclerotic changes, whereas magnetic resonance imaging showed intraosseous tophus deposits in the os trigonum. Conservative therapy failed, and the patient was admitted for an endoscopic resection of the os trigonum.Intraosseous chalky crystals were detected during endoscopic resection of the os trigonum. The histological diagnosis was tophaceous gout. The underlying pathological mechanism of intraosseous tophi is uncertain. Penetration of urate crystals from the joint due to hyperuricemia may be the mechanism of deposition in this patient.When a patient with hyperuricemia presents with posterior ankle impingement symptoms, intraosseous tophus deposits should be included in the differential diagnosis. Posterior endoscopic excision may be an option for treating intraosseous lesions of the os trigonum because of good visualization, satisfactory excision, and rapid recovery time.     

Relationship of carpal canal contents volume to carpal canal pressure in carpal tunnel syndrome patients

Forty patients long-term haemodialysis with a second recurrence of carpal tunnel syndrome and concomitant loss of flexor tendon function due to flexor adhesions were treated by excision of the flexor digitorum superficialis tendons. During the procedure the carpal canal pressure was measured using a continuous infusion technique. The preoperative mean carpal canal pressure was 81 (SD, 53)mmHg. After removal of all the flexor digitorum superficialis tendons, the carpal canal pressure decreased to 10 (SD, 8)mmHg. The clinical symptoms of carpal tunnel syndrome were relieved and hand strength and finger motion were improved in all patients.