Shiozaki Taro, Kimura Tadashi, Saito Mitsuru, Kubota Makoto
Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, JPN.
Department of Orthopaedic Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, JPN.
Cureus. 2023 Apr 4;15(4):e37144. doi: 10.7759/cureus.37144. eCollection 2023 Apr.
We encountered three cases of gouty tophus in the foot that required resection. All patients were male and aged 44-68 years at the time of surgery. The lesions were located on the great toe, second toe, and lateral malleolus and were causing ulceration and destruction of the joints. One patient had normal uric acid levels, and another patient had hyperuricemia but no history of attacks and no significant inflammatory symptoms around the gouty tophus, which was attributed to the physical containment of uric acid crystals by the gouty tophus. Given that the crystals were adherent to the surrounding fibrous tissue and cartilage surface, we resected them as far as possible to reduce the total amount of crystals and treated the remaining crystals with uric acid-lowering therapy. There were no complications at the time of surgery. The swelling and bone destruction subsided with continued medical treatment, resulting in significant improvement in quality of life. Patients with gouty tophus should be treated aggressively with medication and monitored to prevent severe joint destruction and ulceration. Excision of the nodule should be considered in cases of exacerbation.
我们遇到了3例足部痛风石需要切除的病例。所有患者均为男性，手术时年龄在44 - 68岁之间。病变位于大脚趾、第二脚趾和外踝，导致关节溃疡和破坏。1例患者尿酸水平正常，另1例患者有高尿酸血症，但无发作史，痛风石周围无明显炎症症状，这归因于痛风石对尿酸晶体的物理包裹。鉴于晶体附着于周围纤维组织和软骨表面，我们尽可能切除它们以减少晶体总量，并对剩余晶体采用降尿酸治疗。手术时无并发症发生。随着持续治疗，肿胀和骨质破坏消退，生活质量得到显著改善。痛风石患者应积极进行药物治疗并接受监测，以防止严重的关节破坏和溃疡。病情加重时应考虑切除结节。
