Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215.
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Semin Arthritis Rheum. 2016 Jun;45(6):669-74. doi: 10.1016/j.semarthrit.2016.01.005. Epub 2016 Jan 29.
To review the literature concerning surgical intervention of tophaeceous gout and propose clinical circumstances for when it may be considered.
Tophi develop in approximately 12-35% of patients with gout. Tophaceous disease is usually preventable given the availability of effective urate lowering therapies (ULT) including allopurinol, febuxostat, probenecid, lesinurad, and pegloticase. Despite medical therapy, there remains a subset of patients who develop significant complications of tophi including infection, ulceration, and entrapment neuropathy. Tophi in close proximity to joints can cause joint instability, severely limited range of motion, and significant functional impairment. For the rare circumstance when a tophus is causing an urgent complication or if a patient has a contraindication to all available ULTs, surgery may be an appropriate option. This review summarizes the published experience with surgical interventions for tophaceous gout and offers recommendations for its consideration.
Using Medline and Google Scholar, all available series of surgery for tophaceous gout were reviewed.
Overall, 7 published surgical series were identified. In all, 6 of these 7 series were published between 2002 and 2014. The reported outcomes of surgical interventions for tophaceous gout were generally positive without major post-surgical complications.
Although medical therapy with ULTs should be the first-line approach to tophaceous gout, surgery should be considered for the rare patient with impending or severe, debilitating complications including infections, entrapment neuropathy or those at risk for permanent joint destruction. In these selected clinical circumstances, surgical intervention for tophaceous gout may be appropriate.
回顾有关痛风石治疗的文献，并提出可能需要手术干预的临床情况。
痛风石在大约 12-35%的痛风患者中形成。鉴于目前有有效的尿酸降低治疗方法（ULT），包括别嘌醇、非布司他、丙磺舒、lesinurad 和培戈洛酶，痛风石病通常是可以预防的。尽管进行了药物治疗，但仍有一部分患者出现痛风石的严重并发症，包括感染、溃疡和神经嵌压。靠近关节的痛风石会导致关节不稳定、严重的活动范围受限和显著的功能障碍。对于痛风石引起紧急并发症的罕见情况，或者如果患者对所有可用的 ULT 都有禁忌症，则手术可能是一种合适的选择。本综述总结了痛风石手术干预的已有经验，并提出了考虑手术干预的建议。
使用 Medline 和 Google Scholar 检索了所有关于痛风石手术治疗的系列研究。
共确定了 7 篇发表的痛风石手术系列研究。其中 6 篇发表于 2002 年至 2014 年之间。这些系列研究报告的痛风石手术干预结果总体上是积极的，没有出现重大术后并发症。
虽然 ULT 药物治疗应是痛风石的一线治疗方法，但对于即将发生或严重、导致身体虚弱的并发症（包括感染、神经嵌压或有永久性关节破坏风险的患者）的罕见患者，应考虑手术治疗。在这些选定的临床情况下，手术干预痛风石可能是合适的。
