| 分期手术治疗第1跖趾关节巨大痛风石的临床研究 |
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投稿时间：2019-02-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 张宇 |
ZHANG Yu |
四川省骨科医院足踝2科, 四川 成都 610041 |
The Second Department of Orthopaedics, Sichuan Provincial Orthopedic Hospital, Chengdu 610041, Sichuan, China |
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| 徐善强 |
XU Shan-qiang |
四川省骨科医院足踝2科, 四川 成都 610041 |
The Second Department of Orthopaedics, Sichuan Provincial Orthopedic Hospital, Chengdu 610041, Sichuan, China |
xushanqiang2008@163.com |
| 李平 |
LI Ping |
四川省骨科医院足踝2科, 四川 成都 610041 |
The Second Department of Orthopaedics, Sichuan Provincial Orthopedic Hospital, Chengdu 610041, Sichuan, China |
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| 张文举 |
ZHANG Wen-ju |
四川省骨科医院足踝2科, 四川 成都 610041 |
The Second Department of Orthopaedics, Sichuan Provincial Orthopedic Hospital, Chengdu 610041, Sichuan, China |
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| 王勇 |
WANG Yong |
四川省骨科医院足踝2科, 四川 成都 610041 |
The Second Department of Orthopaedics, Sichuan Provincial Orthopedic Hospital, Chengdu 610041, Sichuan, China |
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| 期刊信息：《中国骨伤》2020年，第33卷，第3期，第274-277页 |
| DOI：10.12200/j.issn.1003-0034.2020.03.018 |
| 基金项目: |
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中文摘要:
目的：探讨分期手术治疗第1跖趾关节巨大痛风石的近期临床疗效。
方法：自2015年1月至2016年12月，采用分期手术治疗第1跖趾关节巨大痛风石患者12例，全部为男性；年龄45~73岁；右足6例，左足6例；保守治疗2年以上，双能CT检查明确通风石大小及部位；经X线片检查均可见第1跖趾关节骨质破坏。所有患者Ⅰ期手术行痛风病灶的彻底清除及克氏针临时固定，待局部软组织条件稳定后再行跖趾关节的植骨融合内固定手术。比较手术前后血尿酸含量，患肢畸形矫正及并发症情况，采用VAS评分评价疼痛缓解程度。
结果：所有患者顺利完成手术，且获得随访，时间9~13个月。12例患者VAS评分由术前的6~9分降低至术后7周的0~1分；血尿酸含量由术前的443~501 μmol/L降低至术后7周的307~330 μmol/L；术后5~7个月足部第1跖趾关节畸形矫正、外形恢复。术后1例发生切口感染、皮缘坏死，经清创及换药处理后切口愈合。
结论：分期手术治疗足部第1跖趾关节巨大痛风石，可矫正关节畸形，恢复第1跖趾关节外形，改善患足疼痛，有利于控制血尿酸含量，且并发症少。 |
| 【关键词】痛风 尿酸 跖趾关节 外科手术 |
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| Clinical study of staging operation for large gouty stone on the first metatarsophalangeal joint |
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ABSTRACT
Objective: To explore short-term curative effect of staging operation for large gouty stone on the first metatarsophalangeal joint.
Methods: 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.
Results: All patients were successfully completed two stages' operation. Twelve patients were followed up for 9 to 13 months. VAS score 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.
Conclusion: 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. |
| KEY WORDS Gout Uric acid Metatarsophalangeal joint Surgical procedures,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张宇,徐善强,李平,张文举,王勇.分期手术治疗第1跖趾关节巨大痛风石的临床研究[J].中国骨伤,2020,33(3):274~277 |
| 英文格式: | ZHANG Yu,XU Shan-qiang,LI Ping,ZHANG Wen-ju,WANG Yong.Clinical study of staging operation for large gouty stone on the first metatarsophalangeal joint[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(3):274~277 |
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