1 case of gout knots that are affected by large bone joint damage in the palm knuckles

Gout is an inflammatory disease caused by uric acid deposition, which is associated with hyperuric acidemia due to metabolic disorders and reduced uric acid excretionIn the absence of the formation of uric acid nodules, no surgical treatment is required, but for patients who have large gout nodules to form or tired of the bone and joint, in addition to the necessary medical treatment, surgery should be kept up in time to prevent further damage to the bone and joints leading to serious damage to limb functionThe hospital treated 1 case located in the left hand oatric joint, and the palm knuckle joint serious damage, palm bone far end and the near end of the knuckles have more defects of patients, the use of lesions scraping, take the tibia section of the bone to retain the length of the finger, the recent effect is satisfactoryclinical datapatients, male, 38 years old, left hand finger joint intermittent red, swollen, pain, swelling gradually born for up to 9 years9 years ago, there was no clear cause of left-handed nephrology joint redness, swelling, pain, and found about sorghum rice grain size nodules, in the local hospital, check blood uric acid 600 mol/LDiagnosed as "gout", to autumn daffodils, ibuprofen and other treatment (specific dose and course of treatment is not known), symptom reliefThe nodules gradually grew, red, swollen, pain and occasional, the treatment of the disease improvedWith the end of the grow, the left otoid knuckle joint activity gradually lost, until the hospital has been completely inactiveThe knot saves chestnut size, and the patient requires hospitalization to remove nodulesAdmission examination: left index finger knuckle joint back side can be seen about 2CM x 2CM size, hard, light pressure pain, inactive swelling, palm knuckles slightly flexo bit malformation, palm knuckles all parties to the activity are disappeared, knuckles flex activity is OK, end skin feeling, blood movement normalX-ray piece shows the left hand second palm joint bone damage, tired of the far end of the palm bone and near the near end of the finger bone, the suffering of the bone is almost completely missingBlood routine: white blood cells 7.97 x 109/L, neutral 52.6%, mononucleosis, alkaline granulocytes, eosinophils, lymphocyte normal, C-reactive protein 18mg/L (normal 10mg/L), hematuraric acid 655.8 smol/LDiagnosis: Left index finger joint gout nodule, left index finger knuckle joint damagetreatment and results
active preoperative preparation after admission to hospitalUsing arm clump anaesthetic on the back side of the left oesophagus knuckles "S"-shaped incision, layer by layer cut, protect the index finger extension tendon, and lead open, see the left index finger knuckles are about 2CM size white swelling replaced, after cutting can be seen its contents For the white "slag" sample substance, first the whole piece cut off most of the knots, and then use the key to scrape away the soft tissue adhesion tight ureate crystallization, treatment of the far end of the palm bone and the near end of the finger bone, completely scrape the surface of the bone tissue uric acid crystallization, so that the bone marrow cavity smoothPull the far end of the index finger, so that it returns to normal length, see the palm joint bone defect about 3.0CM longThen in the same side of the tibia to take the outer plate and tibia length of about 3.0CM, width of about 1.2CM, thickness of about 1.0CM of tibia strip, after dressing planted in the original palm knuckles to fill the bone defect between the palm bone and the knuck bone, and use the inherent arcofy of the tibia, so that its top towards the back side, so that the original palm joint slightly bent, close to the palm joint functionWith the keratosis bone block and palm bone, finger bone fixed, release drain strip, after surgery 48h pull drainage tube, wound 2 weeks tearing line, healing gooddiscussedgout is an inflammatory lesions caused by excessive deposition of monosodium uric acid in joints and tissues of the sliding membrane, and there are many treatmentsWang Qi and others believe that gout patients should take the following measures: (1) patient education: the purpose is to make patients understand the disease, actively cooperate with the treatment; Some scholars also believe that clinically mainly drug treatment, including acute attack period, chronic uric acid reduction period and preventive drug treatmentTraditional Chinese medicine also has a good performance in the treatment of goutZhai Lei and others believe that simple drug treatment can not control the development of gout nodules, can not improve joint shape and function, they use non-busta treatment at the same time surgery to remove gout nodules, and achieved better treatment resultsLi Wei reported that the use of lesions to remove VSD coverage to treat finger joint gout co-infection patients, the effect is satisfactorythis case of patients with serious joint damage, bone damage range, bone tissue defect section length, simple lesions scraping will lead to bone defects, after surgery finger shrinkage obvious (about 3CM), seriously affecting aesthetics, while the loss of function is also very serious (due to illness finger for the index finger, in the hand function plays an important role)In order to restore the length of the finger, as far as possible to save the function of the finger, the use of a complete outer plate and shin bone for bone implantation, that is, the recovery of finger length and a certain strength, but also the use of the natural arc of the tibia, so that the knuckles after surgery close to the functional positionAfter the Kersker needle fixed the bone block and closed the wound, the finger shape is very close to normal, passive activity between the two fingers joint, the activity degree is satisfactorythe postoperative time of this case is short, and the post-bone healing and function recovery need to be further followed upRecently looked at the appearance of satisfaction, the original joint function has no loss, patients and physicians are more satisfied with postoperative results, for the future treatment of similar cases provides a useful reference