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.

Diagnosis and treatment of gout in the hand or wrist

Objective To explore the diagnosis and treatment of gout in the hand and wrist. Methods Of the 5 cases of gout in the hand and wrist, 2 patients had tophus and underwent extirpating of the tophus, tenolysis and neurolysis. Another 3 patients without tophus underwent carpal tunnel release and localized debridement. All the resected tissues were subject to histological examination. Results Primary healing of the wound was achieved in all cases with no infection. The average postoperative follow-up period was 7 months.Histology confirmed the diagnosis of gouty arthritis. For the 2 patients with tophus, symptoms of finger numbness were alleviated and wrist function was significantly improved. There was, however, recurrence that demanded further treatment. For the 3 patients without tophus, their wrists were pain-free and the grip strength of their hands returned to near normal. Conclusion It is difficult to diagnose non-classic gout of the hand or wrist without tophus. Surgical exploration not only confirms the diagnosis of gout but more importantly is a definitive treatment. Diagnosis of gout with tophus is relatively easy, however surgical treatment leads to less ideal results.