Boedijono Dimas Radithya, Nugroho Ahmad, Handidwiono Raden, Prasetyo Joseph
Department of Orthopaedics and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia.
Department of Orthopaedic and Traumatology, Dr.Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
Int J Surg Case Rep. 2024 Sep;122:110066. doi: 10.1016/j.ijscr.2024.110066. Epub 2024 Jul 25.
Gout is an inflammatory arthritis that causes acute pain due to the accumulation of uric acid crystals. Hyperuricemia primarily causes it, resulting in the deposition of monosodium urate crystals in and around joints. Gout can affect joints such as the metatarsophalangeal joint and the foot's talus bone. Treatment involves addressing hyperuricemia and managing symptoms with medications like febuxostat. Surgical treatment is crucial, especially in cases of chronic tophaceous gout or severe joint damage, including arthroscopic debridement, ankle arthrodesis, or total ankle arthroplasty.
A 32-year-old male with a history of hyperuricemia experienced pain in his left ankle for a year. The ankle was swollen and prone to pain when he walked. Magnetic resonance imaging (MRI) tests revealed the thickening and irregular shape of the anterior talofibular ligament (ATFL), suggesting a rupture. The arthroscopic operation revealed a crystal deposit, leading to the diagnosis of gout arthritis and subsequent debridement for the patient. Following the surgery, the patient experienced minimal pain, an improved range of motion, and a significant improvement in swelling within a week. The patient was able to walk with minimal assistance and without aid.
Gout arthritis and ATFL injuries share common clinical features, including joint swelling, limited motion, and joint deformity. The presence of monosodium urate (MSU) crystals and inflammation in both conditions complicates diagnosis. Performing arthroscopic debridement surgery in gout arthritis presents challenges due to tophi and inflammation, as well as the risk of articular cartilage damage. Expertise is crucial for successful arthroscopic debridement, with patient selection, preoperative planning, and thorough removal of MSU crystals being key factors.
Thorough evaluation, patient selection, preoperative planning, joint identification, removal of MSU crystals, and comprehensive postoperative care are crucial for successful arthroscopic debridement for gout arthritis of the ankle.
痛风是一种炎症性关节炎，由于尿酸结晶的积累而导致急性疼痛。高尿酸血症是其主要病因，会导致尿酸钠结晶在关节及其周围沉积。痛风可影响诸如跖趾关节和足部距骨等关节。治疗包括解决高尿酸血症问题，并使用非布司他等药物来控制症状。手术治疗至关重要，尤其是在慢性痛风石性痛风或严重关节损伤的情况下，包括关节镜清创术、踝关节融合术或全踝关节置换术。
一名有高尿酸血症病史的32岁男性，左脚踝疼痛一年。行走时脚踝肿胀且容易疼痛。磁共振成像（MRI）检查显示距腓前韧带（ATFL）增厚且形状不规则，提示断裂。关节镜手术发现有晶体沉积，从而诊断为痛风性关节炎，并随后为患者进行了清创术。手术后，患者在一周内疼痛减轻、活动范围改善，肿胀也有显著好转。患者能够在极少协助或无需协助的情况下行走。
痛风性关节炎和ATFL损伤具有共同的临床特征，包括关节肿胀、活动受限和关节畸形。两种病症中尿酸钠（MSU）晶体的存在和炎症使诊断变得复杂。由于痛风石和炎症，以及存在关节软骨损伤的风险，在痛风性关节炎中进行关节镜清创手术具有挑战性。专业知识对于成功的关节镜清创至关重要，患者选择、术前规划以及彻底清除MSU晶体是关键因素。
全面评估、患者选择、术前规划、关节识别、清除MSU晶体以及全面的术后护理对于成功进行踝关节痛风性关节炎的关节镜清创至关重要。
