The Surgical Operation Of Tophus

Following the development of economy and the change of our life,in our country , the disease rate of gout are increasing gradually and the rate of making a wrong diagnosis are of a high level. Though the greater part of patients could control the expand of gout with druge effectively , there are small number of patients get into the later period without treatment timely or becsuse of making a wrong diagnosis . The circumstances result in the sedimentation of tophus in the hands , feet , joints and so on . It will influence our function and surface . We need surgical management for there patients . The purpose of the article is to analyze twelve patients with tophus accompanied by joint or tendon adhesion , skeleton deformity and carpal tunnel syndrome were surgically treated by our department from 1995 to 2006 retrospctive1y , to discuss the etiology, mechanism and treatment of gout . To observe and evaluate the result to the surgical management of gout .These patients's average course are 10.5 years ranging from two to 36 years , single joint was involved in two and multiple lesions in five of them,including the knees,wrist phalangeal joint metatarsophalangeal joint, tarsometatar-sal joint and so on . Under nerve block anaesthesia, 5 cases underwent extirpating of the tophus , 5 had tophus excision and tenolysis , 6 had tophus excision plus digital nerve releaseor carpal tunnel release. On the choice of surgical operation method, the pure tophus didn't wrap film package, the uric acid salt presents the sand form kind deposition, cut open the skin can pare off a spoon in addition , and use physiology brine to close wound after flush; The tophus which involves in bone joint and tendon can discover that the tophus infringes upon bone and joint or tendon, the bone substance infringe upon can carry on pare off in addition to, flush inside joint chamber.The tendon film side and tophus inside the tendon can adopt razor blade to pare off in addition to, tendon to glue connect loose solution, to hurt severity rather than the tendon of main function if point shallow bend tendon can go excision, if cut off important tendon, need reconstruction surgical operation of go the function; Involve in the case of wrist tube, should go to bend muscle support to take to cut open decompression at the time of cutting off hand tophus.If there is a great deal of tophus deposition inside wrist tube, take care of all can implicate inside each tendon, can cut offpart to point at the time of cutting off tendon and cleft tophus shallow bend muscle key with decrease wrist tube inside of capacity.The necessity is exact center current film outside the nerve cut open decompression, and the clearance film outside the nerve ascend enclosed gout stone, can make the nerve thoroughly loosen a solution.If involve in to point total nerve to also need excision of go the nerve loose solution and tophus.Clearance of tophus was carried out , flushing the involved tissue with physiology brine again and again to clear the tophus completely , with allopurinol 100mg/per , 3per/d before surgical teatment and with the application of anti-cancer druge regularly after surgical treatment . All the tophus was gone without recurrence . Primary healing of the wound was achieved in all case with no skin necrosis . Deformity of the hand was corrected . Neuropathy symptoms relieved. Postoperative follow-up ranged from 6 months to 24 months , there is no recurrence happened with the application of anti-cancer druge regularly. Both appearance and function of the hand was greatly improved.No recurrence happened during 6 months to 24 months follow-up . The looking and function of joints were improved . Itexpressed our satisfaction at the result of surgical management . It is thus clear that, for the tophus of the later period sufferer, make can wear clothes and wear gloves through a surgical operation, recover function and joint stable; The control leads to flow with infection;Soothe ache; Nerve decompression; The facial appearance repair; Metabolize the uric acid total amount of the decrease body.Above various circumstance needs in time a valid surgical operation treatment.Moreover knot stanza to break Kui, wound in the gout through long not more, and diagnose the tophus basis shortage to need the time that the pathology lives check, all should be valid for good time to go a surgical operation .It is conclude that the effect of surgical treatment for gout is good . Active and timely intervention with surgical operation for the patients with gout could block its pathogenic process effectively and reduce system aticuric acid load . Tophi should be resected and use the uricosuric agent at preoperation and postoperation for improving ache and looking , resuming and protecting for the function of hands and feet and avoiding acute gout attacking and improve their quality of life.Propect: Up to now , we have found many related factores about the gout , but the explict cause and mechanism need further research , and the research about the relation between drug treatment and surgical treatment and the opportune moment of treatment will be the target of us in future.