多发性巨大痛风石的临床综合治疗及效果

目的 探讨和评价全身多发巨大痛风石以手术治疗为主的综合治疗方法及效果。方法 回顾分析我院2003年以来收治的全身多发巨大痛风石患者6例，均在间歇期或慢性期采用以手术治疗为主的综合治疗方法，同时行一期关节功能重建。结果 6例患者均获得满意随访，随访期为12～24个月。手术部位共22处，术后切口I期愈合18处，延期愈合4处；1例行局部转移皮瓣覆盖创面；1例行掌指关节融合术，一年后骨性融合；1例两指行异体肌腱移植，2例行自体肌腱移植；6例均行关节囊修复术；4例关节疼痛消失，缓解2例；6例关节功能均获得满意改善，1例单部位术后8个月复发；无严重并发症出现。术前年均发作次数平均为（4．8±1．1）次，术后平均为（0．8±0．6）次，较术前明显减少。结论 采用以手术治疗为主的综合疗法是全身多发巨大痛风石的最佳治疗方法，术中保护关节功能及功能重建尤为重要，能改善临床症状，减少发作次数，有利于提高患者的生活质量。

Cornbined therapy and clinical effects of multiple enormous tophi

Objective To explore and evaluate the effect and the combined therapy of multiple enormous tophi. Methods Since 2003, six cases with multiple enormous tophaceous gout all over the body have been analyzed retrospectively. During the intermission and chronicity, the comprehensive therapy was centred on surgery. The joint function was rebuilt at the same time. Resuls Six cases gained satisfactory fellow-up visit. All cases were followedup for 12 to 24 months. Twenty-two lesions involved were treated. Primary wound healing was achieved in 18 cases while 4 cases had delayed healing. 1 case with raw surface was sheathed with local flap grafting. Metacarpophalangeal joint fusion was used in lcase. Bone union was observed in one year postoperatively. Variant tendon transplantation was used in 1 case with two fingers. Autoallergic tendon transplantations were used in 2 cases. Articular capsularrhaphy were used in all of the cases. Pain was completely gone in 4 cases and alleviated in 2 cases. Joint function improved in all the 6 cases.The number of recurrent tophi at the surgical site was one in 1 case after 8 months,with no serious complication. The incidence of acute recurrent attack was two to eight with an average of 4.8±1.1 annually before the operation and decreased obviously after the operation with an average of 0.8 ±0.6 within one year. Conclusion The comprehensive therapy is the best treatment for patients with multiple enormous tophaceous gout all over the body. It is especially important to safeguard joint function during the operation and functional restoration. This can also amend clinical symptom, decrease incidence of attack, and improve the quality of life.