严重痛风的外科治疗(附8例报告)

目的探讨手术治疗严重痛风的临床疗效。方法对8例严重痛风患者采用外科治疗,分别采用关节内类固醇注射、关节镜下病变清理术、痛风病灶清除术、刮除植骨术、Keller手术及关节融合术等。结果术后切口6例一期愈合,2例由于尿酸盐残留延迟愈合。术后随访2个月~2.5 a,平均13个月。随访2个月时血尿酸较术前平均下降45%,4例无高尿酸血症。疼痛解除5例,缓解3例;局部软组织及骨质破坏进程阻断,3例植骨术后12个月愈合。1例手术部位痛风石复发。5例术后无急性发作,3例在2 a内有再次急性发作史,发作部位为非手术部位,应用秋水仙碱可控制症状。结论积极适时的外科治疗可及时阻断痛风的病变进程,减轻机体尿酸负荷,有利于提高患者的生活质量和功能的改善。

Surgical management for severe gout

[Objective] To explore the effectiveness of operation for severe gout and hyperuricemia.[Methods] Eight patients underwent operation for severe gout in our hospital were retrospectively analyzed.Three of them were single joint involved and five patients had multiple lesions.Based upon the degree of the lesions,operations involved aspiration and steroids injection,arthroscopic debridement,tophus resection,bone autograft and allograft,Keller operation and arthrodesis were performed to erase the gout lesions.Recurrent acute attack was occurred in three patients within two years after treatment and can be controlled with colchicines.[Results] The incisions were healed favorably except two.The follow-up period was from two months to 2.5 years.The uric acid level decreased about 45% compared with preoperative level at two months after operation.All the symptoms were alleviated or released and the pathogenic process was blocked during the follow-up period.[Conclusion] Active and timely intervention of the operation can block the pathogenic process of the gout effectively,as well as reduce the systemic uric acid load and improve the function of the extremity.