晚期痛风患者第一跖趾关节巨大痛风石一例  

Giant tophus in the first metatarsophalangeal joint of a patient with late gout: a case report

作　　者：王树龙 雷震 吴俊德 王正义 陈兆军 Wang Shulong;Lei Zhen;Wu Junde;Wang Zhengyi;Chen Zhaojun(Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学第三附属医院,北京100029

出　　处：《新医学》2020年第5期400-404,共5页Journal of New Medicine

基　　金：北京市科技项目“首都特色”课题(Z171100001017205)。

摘　　要：痛风性关节炎好发于第一跖趾关节,早期如果不能及时地进行饮食、生活干预及降尿酸治疗,会延误病情,不仅影响足的负重及行走,急性发作时也给患者的日常生活及身心健康造成巨大痛苦。该文报道1例晚期痛风患者右足第一跖趾关节出现罕见巨大痛风石,该第一跖趾关节与骨质破坏极其严重,患处皮肤破溃、末端血运较差,且患者合并糖尿病、肾功能不全,予右前足清创、痛风石切除、髂骨取骨植骨术、右前足第一跖趾关节融合术治疗,术后右足患处皮肤达到一期愈合,髂骨植骨融合良好,内固定位置良好,右足功能及外观恢复良好。该例的诊治提示,对于保守治疗效果欠佳,痛风石严重影响关节功能、美观,患处局部皮肤已破溃,血管受损严重者建议行手术治疗,并在术后予积极生活干预及药物控制,以改善患者预后,提高患者生存质量。Gouty arthritis occurs most frequently in the first metatarsophalangeal joint. Patient conditions will be delayed if timely intervention of diet and lifestyle and treatment of lowering uric acid are not applied. Gouty arthritis not only affects foot weight bearing and walking, but also its acute attacks bring about great sufferings to patients’ daily life and physical and mental health. Here we reported one patient with advanced gout and a rare giant tophus was found in the first metatarsophalangeal joint on the right foot. The first metatarsophalangeal joint and bone were seriously damaged. The affected region had skin ulcers and poor distal blood supply. The patient also had diabetes and renal insufficiency. The treatment included right front foot debridement, tophus resection, iliac bone grafting, the first metatarsophalangeal arthrodesis on the right front foot. After the surgery, primary healing was achieved on the affected right foot skin. The iliac bone grafting, internal fixation position, and right foot function and appearance were all satisfactory. The diagnosis and treatment of this case indicated that surgical treatment is recommended when the effect of conservative treatment is not ideal, tophi severely impact joint function and aesthetics, affected local skin have ulcerated, and blood vessels are severely impaired. Active life intervention and drug control should also be utilized after operation to improve the prognoses and life quality of patients.

关 键 词：第一跖趾关节 痛风性关节炎 巨大痛风石 

分 类 号：R589.7[医药卫生—内分泌]