手腕部痛风的诊断与治疗  

Diagnosis and treatment of gout in the hand or wrist

作　　者：游永刚[1] 徐永清[1] 郭远发[1] 唐辉[1] 石健[1] 范新宇[1] 梅良斌[1] 陈苏丽[2] 

机构地区：[1]成都军区昆明总医院全军骨科中心,昆明650032 [2]昆明医学院第一附属医院整形外科

出　　处：《中华手外科杂志》2010年第4期212-215,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨手腕部痛风的诊断方法及治疗。方法对5例术前临床诊断为手腕部痛风的患者行病灶清除和神经、肌腱松解术，其中2例行痛风石切除。切除病变组织常规行病理检查。结果术后5例患者伤口均工期愈合，无感染发生，术后平均随访时间为7个月。病理检查均证实为痛风性关节炎。2例伴有痛风石的患者，术后手指麻木症状好转，活动功能得到明显改善，但半年以后又有复发。3例患者腕部疼痛消除，腕关节活动及握力恢复接近正常，未再次复发。结论无明显痛风石形成的非典型手腕部痛风的患者，诊断较为困难，有效的治疗方法为手术探查，可早期明确诊断且术后疗效满意。而有明显痛风石形成的患者诊断容易，但术后疗效欠佳。Objective To explore the diagnosis and treatment of gout in the hand and wrist. Methods Of the 5 eases of gout in the hand and wrist, 2 patients had tophus and underwent extirpating of the tophus, tenolysis and neurolysis. Another 3 patients without tophus underwent earpal tunnel release and localized debridement. All the reseeted tissues were subject to histological examination. Results Primary healing of the wound was achieved in all eases with no infection. The average postoperative follow-up period was 7 months. Histology confirmed the diagnosis of gouty arthritis. For the 2 patients with tophus, symptoms of finger numbness were alleviated and wrist function was signifieandy improved. There was, however, recurrence that demanded further treatment. For the 3 patients without tophus, their wrists were pain-free and the grip strength of their hands retttmed to near normal. Coneluslon It is difficult to diagnose non-classic gout of the hand or wrist without tophus. Surgical exploration not only confirms the diagnosis of gout but more importantly is a definitive treatment. Diagnosis of gout with tophus is relatively easy, however surgical treatment leads to less ideal results.

关 键 词：手 腕关节 痛风 关节炎 

分 类 号：R589.7[医药卫生—内分泌]