摘要
目的探讨痛风石所致腕管综合征(carpaltunnelsyndrome,CTS)的临床特点及治疗方法。方法回顾性分析2013年1月-2018年12月收治的9例经神经肌电图及病理证实的痛风石所致CTS病例资料,在内科综合治疗的基础上,待血尿酸降至正常或接近正常值且未处于急性发作期时行痛风石切除治疗。其中4例因术前超声检查示腕部肌腱痛风石沉积较大、范围较广,采用传统S形切口,术中将痛风石连同侵蚀的肌腱一起切除;2例尽可能刮除肌腱上附着的痛风石,保留腱性结构;3例术前超声检查示腕部肌腱痛风石沉积较少,且集中于一处,故采取腕部纵向小切口,清除沉积于肌腱上及腕管内的痛风石。结果患者术后切口均一期愈合,住院期间无痛风急性发作。术后随访7~24个月,手指麻木症状减轻,手部功能恢复良好。结论对于痛风石所致腕管综合征(CTS),术前除完善肌电图检查以确诊CTS,并应做超声检查查明腕部痛风石沉积情况,根据痛风石沉积情况设计手术切口,以达到彻底清除痛风石、减少复发、治愈CTS的目的。手术前后应辅以药物治疗,控制尿酸水平,避免痛风急性发作。
Objective To investigate the clinical characteristics and treatment of carpal tunnel syndrome(CTS)caused by gout stone.Methods Retrospectively analyzed 9 cases of CTS caused by gout stone confirmed by neuromyography and pathology in our department from January 2013 to December 2018.On the basis of comprehensive medical treatment,gout stone resection was performed when the serum uric acid was reduced to normal or near normal level and was not in the acute stage.Four of the patients underwent traditional S-shaped incision to remove the gouty stone along with the eroded tendons.Two of the patients removed the gouty stone attached to the tendons as far as possible and retained the tendinous structure.Preoperative ultrasonography showed that there was less gout stone deposited in wrist tendon and concentrated in one place.Therefore,a small longitudinal incision was adopted to remove gout stone deposited on wrist tendon and in carpal canal.Results All incisions healed in stage I after operation,and no acute gout attack occurred during hospitalization.Follow-up from 7 months to 2 years showed that the symptoms of finger numbness were alleviated and hand function recovered well.Conclusion For the carpal tunnel syndrome(CTS)caused by gout stone,we should improve the electromyogram examination before operation to diagnose CTS.Ultrasound examination should be done to find out the deposition of gout stone in wrist,and surgical incision should be designed according to the deposition of gout stone in order to complete removal of gout stone,reduce recurrence and cure CTS.Drug therapy should be used before and after operation to control uric acid level and avoid acute gout attack.
作者
冯清波
冯春梅
顾加祥
刘宏君
袁超群
张文忠
王天亮
FENG Qingbo;FENG Chunmei;GU Jiaxiang(West China School of Clinical Medicine,Sichuan University,Chengdu,Sichuan,610041,China)
出处
《实用手外科杂志》
2020年第3期275-277,共3页
Journal of Practical Hand Surgery
关键词
腕管综合征
痛风
手术治疗
随访研究
Carpal tunnel syndrome
Gout
Surgical treatment
Follow-up study
