[1]叶博闻 孙鹏飞 沈军 王凌椿 张永琪 郝泽翰 谢平金 卢启贵 肖涟波 戴号.双能计算机断层扫描检查在痛风石切除术中的应用价值[J].中国中医骨伤科杂志,2025,33(02):24-28+33.[doi:10.20085/j.cnki.issn1005-0205.250205]
　YE Bowen,SUN Pengfei,SHEN Jun,et al.The Applied Value of Dual-Energy Computed Tomography in Tophus Resection Surgery[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2025,33(02):24-28+33.[doi:10.20085/j.cnki.issn1005-0205.250205]
点击复制

双能计算机断层扫描检查在痛风石切除术中的应用价值()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第33卷
期数:
2025年02期
页码:
24-28+33
栏目:
临床研究
出版日期:
2025-02-15

文章信息/Info

Title:
The Applied Value of Dual-Energy Computed Tomography in Tophus Resection Surgery
文章编号:
1005-0205(2025)02-0024-05
作者:
叶博闻 孙鹏飞 沈军 王凌椿 张永琪 郝泽翰 谢平金 卢启贵 肖涟波 戴号
1上海中医药大学附属光华医院(上海,200052)
2上海中医药大学光华临床医学院
3上海中医药大学深圳医院
4上海市中医药研究院中西医结合关节炎研究所
Author(s):
YE Bowen1; SUN Pengfei1; 2; SHEN Jun1; WANG Lingchun1; ZHANG Yongqi1; 2; HAO Zehan1; 2; XIE Pingjin3; LU Qigui3; XIAO Lianbo1; 4; DAI Hao1△
1Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China; 2Guanghua Clinical School of Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China; 3Shenzhen Hospital of Shanghai University of Traditional Chinese Medicine,Shenzhen 528002,Guangdong China; 4Institute of Arthritis Research in Integrative Medicine,Shanghai Academy of Traditional Chinese Medicine,Shanghai 200052,China.
关键词:
痛风;  痛风石;  双能计算机断层扫描;  围手术期
Keywords:
gout;  tophi;  dual-energy computed tomography;  perioperative period
分类号:
R589.7
DOI:
10.20085/j.cnki.issn1005-0205.250205
文献标志码:
A
摘要:
目的:探讨痛风石切除术围手术期应用双能计算机断层扫描检查对提升手术疗效及降低并发症的作用。方法:分析61例痛风石患者,涉及81个手术区域。对行痛风石切除术的患者术前、术后分别应用双能计算机断层扫描检查以评估痛风石的体积和分布,统计术后并发症的情况。结果:患者多为男性(59例,96.72%),平均年龄为 59.19 岁。其中19个手术区域(23.46%)有痛风石破溃合并感染,43个手术区域(53.09%)有痛风石溃疡。双能计算机断层扫描显示术后痛风石的平均体积显著减小(术前20.62 cm3 降至术后3.57 cm3),平均清除率为79.08%。14 d后,59个创面(72.84%)一期愈合,22个创面(27.16%)愈合延迟,未达到一期愈合。其中7个创面(8.64%)出现痛风石液化渗出,7个创面(8.64%)出现皮肤缺损,2个创面(2.47%)进行了二次清创。与一期愈合的患者相比,延迟愈合患者术前痛风石的体积更大(33.67 cm3比15.75 cm3),痛风石切除比例更低(68.96%比83.21%),且术前痛风石破溃感染的比例更高(45.45%比13.33%)。患者术后1周后和2周后血清尿酸水平明显低于术前。结论:痛风石切除术围术期应用双能计算机断层扫描检查可以提高痛风石切除率,便于在术前精确定位痛风石,术后采取引流措施及时排除液化痛风石和血肿,避免切口延迟愈合。
Abstract:
Objective:The aim of this study is to investigate the role of applying dual-energy computed tomography in the perioperative period of tophus resection surgery in enhancing surgical efficacy and reducing complications.Methods:A total of 61 patients with gout stones were analysed in this study,involving 81 surgical areas.Dual-energy computed tomography was applied preoperatively and postoperatively to patients who underwent tophus resection surgery in order to assess the volume and distribution of gout stones and to count the postoperative complications.Results:Most of the patients were male(59 patients,96.72%)with a mean age of 59.19 years old.Among them,19 surgical areas(23.46%)had gout stone rupture combined with infection in the operated area and 43 surgical areas(53.09%)had gout stone ulcers.Dual-energy computed tomography scans showed a significant reduction in the mean size of gout stones after surgery(20.62 cm3 preoperatively to 3.57 cm3 postoperatively),with a mean clearance rate of 79.08%.After 14 d,59 wounds(72.84%)achieved one-stage healing,while 22 incisions(27.16%)showed delayed wound healing and did not achieve one-stage healing.7 of the wounds(8.64%)showed gouty stone liquefaction exudation,7 of the wounds(8.64%)had skin defects,and 2 of the wounds(2.47%)underwent secondary debridement.Compared to patients with one-stage healing,patients with delayed healing had a greater volume of preoperative gout stones(33.67 cm3 vs 15.75 cm3),a lower percentage of gout stones excised(68.96% vs 83.21%),and a higher percentage of preoperative gout stone breakouts and infections(45.45% vs 13.33%).Patients had significantly lower serum uric acid levels at 1 and 2 weeks postoperatively than preoperatively.Conclusion:The perioperative application of dual-energy compute tomography examination for tophus resection surgery improves the rate of tophus excision,facilitates precise localisation of the gout stone in the preoperative period,and postoperative drainage measures are taken to exclude liquefied gout stones and haematomas in a timely manner to avoid delayed healing of the incision.

参考文献/References:

[1] WEAVER A L.Epidemiologyof gout[J].Cleve Clin J Med,2008,75(5):S9-S12.
[2] RICHETTE P,DOHERTY M,PASCUAL E,et al.2016 updated EULAR evidence-based recommendations for the management of gout[J].Ann Rheum Dis,2017,76(1):29-42.
[3] DALBETH N,NICOLAOU S,BAUMGARTNER S,et al.Presence of monosodium urate crystal deposition by dual-energy CT in patients with gout treated with allopurinol[J].Ann Rheum Dis,2018,77(3):364-370.
[4] BOLZETTA F,VERONESE N,MANZATO E,et al.Chronic gout in the elderly[J].Aging Clin Exp Res,2013,25(2):129-137.
[5] 刘静,陈玥桥,陈秋志,等.痛风患者痛风石形成现状及相关因素分析[J].现代预防医学,2022,49(17):3252-3259.
[6] EMMA S,DAMIAN H,MARITA C,et al.The global burden of gout:estimates from the Global Burden of Disease 2010 study[J].Ann Rheum Dis,2014,73(8):1470-1476.
[7] 王阳阳,潘元飞.双源CT双能量成像在痛风性关节炎诊断中的价值[J].影像研究与医学应用,2024,8(13):149-151.
[8] 宋连英,周静威,张耀圣,等.基于DECT探讨痛风石经络分布规律[J].辽宁中医药大学学报,2023,25(12):127-131.
[9] BERA S,SHARMA S,GUPTA V,et al.Management of ulcerated finger pad tophi[J].Reumatologia,2020,58(3):173-178.
[10] LINTON R R,TALBOTT J H.The surgical treatment of tophaceous gout[J].Annals of Surgery,1943,117(2):161.
[11] LARMON W A.Surgical management of tophaceous gout[J].Clin Orthop Relat Res,1970,71:56-69.
[12] LARMON W A,KURTZ J F.The surgical management of chronic tophaceous gout[J].J Bone Joint Surg Am,1958,40(4):743-772.
[13] KUMAR S,GOW P.A survey of indications,results and complications of surgery for tophaceous gout[J].New Zealand Med J,2002,115(1158):U109.
[14] 陆军帅,高礼层,徐小彬,等.痛风性膝关节炎的外科治疗进展[J].中国实用医药,2023,18(16):171-173.
[15] 林泽玉,曲军杰,孙德麟,等.足踝部痛风石清除术的早期临床观察[J].中国矫形外科杂志,2024,32(11):1046-1049.
[16] 梅伟,谷远洋,曹子丰,等.周福贻教授治疗痛风性关节炎临床经验[J].中国中医骨伤科杂志,2024,32(7):85-87.
[17] TRIPOLI M,FALCONE A R,MOSSUTO C,et al.Different surgical approaches to treat chronic tophaceous gout in the hand:our experience[J].Tech Hand Up Extrem Surg,2010,14(3):187-190.
[18] MARTINON F,PÉTRILLI V,MAYOR A,et al.Gout-associated uric acid crystals activate the NALP3 inflammasome[J].Nature,2006,440(7081):237-241.
[19] POPA-NITA O,NACCACHE P H.Crystal-induced neutrophil activation[J].Immunol Cell Biol,2010,88(1):32-40.
[20] SOWINSKA I,SOWINSKI R,RUTKOWSKA-SAK L.Tophi-surgical treatment[J].Reumatologia,2016,54(5):267-272.
[21] KASPER I R,JURIGA M D,GIURINI J M,et al.Treatment of tophaceous gout:when medication is not enough[J].Semin Arthritis Rheum,2016,45(6):669-674.
[22] MALLINSON P I,COUPAL T M,MCLAUGHLIN P D,et al.Dual-energy CT for the musculoskeletal system[J].Radiology,2016,281(3):690-707.
[23] COUPAL T M,MALLINSON P I,GERSHONY S L,et al.Getting the most from your dual-energy scanner:recognizing,reducing,and eliminating artifacts[J].Am J Roentgenol,2016,206(1):119-128.
[24] 杨海云,颜梅,刘刚,等.能谱CT定量分析在痛风石与增生钙化中的应用[J].中国CT和MRI杂志,2022,20(9):177-178.
[25] NEOGI T,JANSEN T L,DALBETH N,et al.2015 gout classification criteria:an American College of Rheumatology/European League against Rheumatism Collaborative Initiative[J].Ann Rheum Dis,2015,67(10):2557-2568.
[26] TILL U,TRON E,KAROLIUSSEN L F,et al.Two-year reduction of dual-energy CT urate depositions during a treat-to-target strategy in gout in the NOR-Gout longitudinal study[J].Rheumatology(Oxford),2022,61(SI):SI81-SI85.
[27] 张宪男,顾宇,张樑,等.中青年四肢痛风石患者手术治疗50例[J].中国中医骨伤科杂志,2023,31(4):76-79.
[28] 陈龙凤,肖宇,陶娜.双源电子计算机断层扫描痛风石检查在痛风诊断中的应用价值[J].医疗装备,2022,35(18):41-43.
[29] WANG H,YAN C,WU Q,et al.Acute gout attacks during the perioperative period and risk factors of recurrence after orthopedic surgery among untreated gout patients[J].J Orthop Surg Res,2023,18(1):61.
[30] AHN S J,ZHANG D,LEVINE B D,et al.Limitations of dual-energy CT in the detection of monosodium urate deposition in dense liquid tophi and calcified tophi[J].Skeletal Radiol,2021,50(8):1667-1675.

备注/Memo

备注/Memo:
基金项目:上海市卫生健康委员会科研项目(20194Y0432)
△通信作者 E-mail:daihao_guanghua@126.com
更新日期/Last Update: 2025-02-15