Department of Hand Surgery, The Affiliated Hospital of Beihua University, Jilin, Jilin 132011, China.
Department of Endocrine, The Affiliated Hospital of Beihua University, Jilin, Jilin 132011, China.
Comput Math Methods Med. 2022 Sep 26;2022:4877708. doi: 10.1155/2022/4877708. eCollection 2022.
To explore the technique of surgical treatment of hand and foot gout stone by using 3D CT reconstruction images and influence factors on prognosis.
48 cases of hand and foot gout were treated surgically and retrospective analyzed. Before operation, we used 3D CT reconstruction images to check the accurate site and amount of uric acid (white chalk foam) deposition. Different surgical methods were applied depending on the different deposition site of urine acid stone. The frequency of gout attack and blood uric acid was compared before and after surgery. Patients were followed up to observe the recovery and recurrence and then analyzed the reason of unsuccessful healing.
Sutures were removed 2 weeks after operation in all cases. The frequency of gout attack and blood uric acid of patients 3 months after operation was lower than those before operation, and the differences were statistically significant. Follow-up ranged from 1 to 3 years, with an average of 1.8 years. Three cases were not followed up. The remaining 45 cases were healed in the first stage. 40 cases had improved joint function, increased range of motion, and relieved discomfort after movement. 5 cases had no improvement in joint function after operation, and 3 of them had gout stone recurrence (nonoperative area) and were treated by second hospital operation.
Surgical treatment of gout stone in hand and foot under the guidance of three-dimensional CT reconstruction image can effectively alleviate the local symptoms of gout stone and improve the function of hand and foot. Deep tissue can be thoroughly washed by the pressure of pulse gun after resection of the lesion, which can reduce the incidence of gout stone. Malnutrition, hypoproteinemia, and residual urine acid in the wound are the main reasons for unsuccessful healing.
探讨 3D CT 重建图像指导下手足痛风石手术治疗的技术及对预后的影响因素。
对 48 例手足痛风患者进行手术治疗，并进行回顾性分析。术前应用 3D CT 重建图像检查尿酸（白垩状泡沫）沉积的确切部位和数量。根据尿酸结石沉积的不同部位，采用不同的手术方法。比较手术前后痛风发作次数和血尿酸水平。术后随访观察患者的恢复和复发情况，分析愈合不良的原因。
所有患者术后 2 周拆线。术后 3 个月患者痛风发作次数和血尿酸水平均低于术前，差异有统计学意义。随访时间为 1~3 年，平均 1.8 年。3 例失访，其余 45 例均一期愈合。40 例关节功能改善，活动度增加，活动后不适缓解。5 例关节功能无改善，其中 3 例术后痛风石复发（非手术区），再次行二次手术治疗。
在 3D CT 重建图像指导下对痛风石进行手术治疗，能有效缓解局部痛风石症状，改善手足功能。病灶切除后应用脉冲枪压力对深部组织进行彻底冲洗，可降低痛风石复发率。营养不良、低蛋白血症、伤口内残余尿酸是导致愈合不良的主要原因。
