四肢痛风石外科治疗时机和适应证  

Indications and timing of surgical treatment of tophi in limbs

作　　者：朱坤智 卢涛 罗张风 吴展羽 周玉虎[1,2,3] 叶川 Zhu Kunzhi;Lu Tao;Luo Zhangfeng;Wu Zhanyu;Zhou Yuhu;Ye Chuan(Department of Orthopaedics,The Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou Province,China;National-Local Joint Engineering Laboratory of Cell Engineering and Biomedicine,Guiyang 550004,Guizhou Province,China;Center for Tissue Engineering and Stem Cell Research,Guizhou Medical University,Guiyang 550004,Guizhou Province,China)

机构地区：[1]贵州医科大学附属医院骨科,贵州省贵阳市550004 [2]贵州医科大学细胞工程生物医药技术国家地方联合工程实验室,贵州省贵阳市550004 [3]贵州医科大学组织工程与干细胞实验中心,贵州省贵阳市550004

出　　处：《中国组织工程研究》2021年第30期4883-4890,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:四肢痛风石的治疗包括内科和外科干预,目前对外科干预的适应证和时机仍有争论,且对于手术操作的技巧认识不足,导致很大一部分患者没有得到有效和及时的救治。目的:综述目前四肢痛风石外科治疗的研究进展和发展前景,探讨各种外科治疗方式的适应证、时机及手术要点,希望为四肢痛风石的外科治疗起到一定的指导作用。方法:通过计算机检索中国知网、万方和PubMed等数据库,中文检索词为"痛风,手术,外科治疗,关节镜,关节置换,医学工程,生物材料",英文检索词为"tophi,tophaceous,gout,gouty arthritis,tophus,surgery,surgical treatment,arthroplasty,arthroscopy,medical engineering,biomaterials"。通过纳入与排除标准,最终选择74篇相关文献进行归纳总结。结果与结论:(1)目前药物治疗是痛风石治疗的基石,但仍有很大一部分患者需要进行外科干预;(2)对于早期痛风石患者,在平衡手术治疗的潜在优势和相关风险后可开展手术;对于晚期痛风石患者,外科治疗是一种较为有效的办法,但外科治疗避免不了医源性的损伤;(3)未来还需要寻找一种有效且无副损伤的方法来治疗痛风石,医学工程及组织工程技术有望解决这一难题。BACKGROUND:The treatment of tophi can be divided into medical treatment and surgical intervention.The indications and timing of surgical intervention continue to be debated,and it is lack of understanding of the operation and skills of the operation.As a result,a large number of patients have not received effective and timely treatment.OBJECTIVE:To review the current research progress and future development prospects of tophi in limbs,to explore the indications,contraindications,timing and key points of surgical treatment,hoping to play a certain guiding role for surgical treatment of tophi in limbs.METHODS:The databases of Wanfang Medical Network,China National Knowledge Infrastructure and PubMed were searched by computer,using the Chinese key words of"tophus,surgery,surgical treatment,arthroplasty,arthroscopy,medical engineering,biomaterials"and English key words of"tophi,tophaceous,gout,gouty arthritis,tophus,surgery,arthroplasty,arthroscopy,medical engineering,biomaterials".According to the inclusion and exclusion criteria,74 related articles were finally included and summarized.RESULTS AND CONCLUSION:(1)At present,medication is the basis of the treatment of gout,but there are still a large number of patients who require surgical intervention.(2)Patients with early gout can be treated by surgery after balancing the potential advantages and related risks of surgical treatment.For advanced patients,surgery is a more efficient way,but surgical treatment cannot avoid iatrogenic injury.(3)In the future,we also need to find an effective and non-injury method to treat tophi;medical engineering and tissue engineering technology are expected to solve this problem.

关 键 词：痛风石 痛风性关节炎 外科治疗 手术 关节镜 关节置换 综述 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]