手与腕部痛风石的外科分类与相应手术治疗

Surgical classification and corresponding surgical treatment of gouty tophi in the hand and wrist

摘要:

[目的] 回顾性分析手腕部痛风石的外科分类和手腕部痛风石的手术治疗效果。[方法] 回顾性总结 2016 年 1 月— 2023 年 1 月手术治疗手腕部痛风石 39 例患者的临床资料，按手腕部痛风石特征进行分类，包括皮下痛风石，侵及肌腱神经痛风石，破坏骨关节痛风石，合并感染痛风石，给予痛风石清理和相应的其他手术处理，评价临床效果。[结果]依据术中所见对痛风石分类，皮下痛风石 11 例，侵及肌腱神经痛风石 6 例，破坏骨关节痛风石 17 例，合并感染痛风石 5 例。39 例患者中，2 例患者术后伤口感染，经清创抗生素治疗后愈合；5 例患者伤口延迟愈合，经换药后伤口愈合。术后 12 个月随访，术后患者生活质量均显明改善。与术前相比，末次随随访时 VAS 评分 [(5.6±1.3), (3.0±0.6), P＜0.001] 和 Quick DASH 评分 [(20.3±5.0), (7.6±2.7), P＜0.001] 均显著下降。[结论]按术中所见，行痛风石清理和相应手术处理能够有效缓解患者疼痛症状，改善手腕部功能。

Abstract:

[Objective] To analyze the surgical classification of gouty tophi in hand and wrist, as well as the clinical outcomes of the corresponding surgical treatment. [Methods] A retrospective study was made on 39 patients who received surgical treatment for gouty stones in the hand and wrist from January 2016 to January 2023. The patients had the tophi classified according to their characteristics, including subcutaneous gouty tophi, tendinous gouty tophi, osteoarthritic gouty tophi, infectious gouty tophi. The gouty stones were removed and other corresponding surgical treatments were given based the classification, and the clinical consequences were evaluated. [Results] Of them, there were 11 cases of subcutaneous gouty tophi, 6 cased of tendinous gouty tophi, 17 cases of osteoarthritic gouty tophi and 5 cases of infectious gouty tophi. Among 39 patients, 2 patients had postoperative wound infection, which healed after debridement and antibiotic treatment. Delayed wound healing was noted in 5 patients , who got healed after dressing change. At 2 months postoperatively, all the patients had significant improvement in quality of life. Compared with those preoperatively, VAS scores [(5.6±1.3), (3.0±0.6), P＜0.001) and the Quick DASH score [(20.3±5.0), (7.6±2.7), P＜0.001] declined significantly at the latest follow-up. [Conclusion] According to the intraoperative findings, removal of gouty stone and the corresponding surgical treatment can effectively relieve pain and improve the function of the hand and wrist.