Zhang Yu, Xu Shan-Qiang, Li Ping, Zhang Wen-Ju, Wang Yong
The Second Department of Orthopaedics, Sichuan Provincial Orthopedic Hospital, Chengdu 610041, Sichuan, China.
Zhongguo Gu Shang. 2020 Mar 25;33(3):274-7. doi: 10.12200/j.issn.1003-0034.2020.03.018.
To explore short-term curative effect of staging operation for large gouty stone on the first metatarsophalangeal joint.
From January 2015 to December 2016, 12 patients with giant gout stone on the first metatarsophalangeal joint were treated with staging operation, including 12 males, aged from 45 to 73 years old, 6 cases on the right side and 6 cases on the left side. After conservative treatment for more than 2 years, the size and location of ventilator stone were detected by dual energy CT. The bone destruction of the first metatarsophalangeal joint was observed on X-ray examination. All patients underwent stageⅠgout radical removal and temporary fixation with Kirschner wire, and metatarsophalangeal joint fusion and internal fixation were performed after local soft tissue conditions were stabilized. The level of blood uric acid before and after hand were compared, and correction and complications of limb deformity were observed, VAS score was applied to evaluate pain relieved degree.
All patients were successfully completed two stages ' operation. Twelve patients were followed up for 9 to 13 months. VAS sco re and uric acid content at different time points were observed and recorded. VAS score before operation ranged from 6 to 9, and decreased to 0 to 1 at 7 weeks after operation; the level of blood uric acid ranged from 443 to 501 μmol/L before operation, and decreased to 307 to 330 μmol/L at 7 weeks after operation. The first metatarsophalangeal joint deformity of foot was corrected and the shape was recovered at 5 to 7 months after operation. One patient occurred incision infection and flap edgenecrosis, and the wound healed by debridement and dressing change.
Staged operation for the treatment of giant gout stone on the first metatarsophalangeal joint of foot could correct joint deformity, restore shape of the first metatarsophalangeal joint, relieve pain of the affected foot, and beneficial for control content of serum uric acid, and has less complications.
探讨分期手术治疗第一跖趾关节巨大痛风石的短期疗效。
2015年1月至2016年12月，对12例第一跖趾关节巨大痛风石患者行分期手术治疗，其中男性12例，年龄45～73岁，右侧6例，左侧6例。经2年以上保守治疗后，采用双能CT检测痛风石大小及位置，X线检查观察第一跖趾关节骨质破坏情况。所有患者均行Ⅰ期痛风石根治清除术并克氏针临时固定，待局部软组织条件稳定后行跖趾关节融合内固定术。比较手术前后血尿酸水平，观察肢体畸形矫正及并发症情况，采用视觉模拟评分法（VAS）评估疼痛缓解程度。
所有患者均顺利完成两期手术。12例患者随访9～13个月，观察并记录不同时间点的VAS评分及尿酸含量。术前VAS评分6～9分，术后7周降至0～1分；术前血尿酸水平443～501μmol/L，术后7周降至307～330μmol/L。术后5～7个月足部第一跖趾关节畸形矫正，外形恢复。1例患者出现切口感染及皮瓣边缘坏死，经清创换药后伤口愈合。
分期手术治疗足部第一跖趾关节巨大痛风石可矫正关节畸形，恢复第一跖趾关节外形，缓解患足疼痛，有利于控制血尿酸水平，且并发症较少。
