痛风石的外科治疗进展与临床应用

Research Progress and Clinical Application of Surgical Treatment for Tophaceous Gout

摘要: 目的：系统探讨痛风石的外科治疗现状、术式选择及新兴治疗技术的临床应用价值，为临床痛风石的规范化诊疗提供参考。方法：查阅近年来国内外痛风外科治疗相关文献，梳理传统开放手术、关节镜微创手术、关节重建术的适应证、禁忌证及操作要点，总结真空密闭引流(VSD)、富血小板血浆(PRP)、诱导膜技术等新兴疗法的应用原理与临床效果。结果：外科治疗可有效缓解痛风石患者局部症状、矫正关节畸形、促进破溃创面愈合，降低全身尿酸负荷，其中关节镜微创手术因微创、精准、恢复快等优势成为临床主流术式；VSD、PRP、诱导膜技术等在难治性痛风及痛风相关骨缺损、慢性溃疡治疗中展现出良好应用前景。约30%高尿酸血症患者可进展至痛风石阶段，药物控制不佳、关节严重破坏的病例经外科干预后，生活质量及临床预后显著改善。结论：外科治疗在痛风石管理中具有不可或缺的作用，临床需结合患者病情个体化选择术式，重视多学科协作；新兴疗法的深入研究与临床转化将为痛风外科治疗提供更多优化策略，对改善患者预后具有重要临床意义。

Abstract: Objective: To systematically explore the current status of surgical treatment, surgical selection and clinical application value of emerging therapeutic technologies for tophaceous gout, and to provide reference for standardized diagnosis and treatment of clinical tophaceous gout. Methods: By reviewing the relevant literature on surgical treatment of gout at home and abroad in recent years, the indications, contraindications and operation key points of conventional open surgery, arthroscopic minimally invasive surgery and joint reconstruction were sorted out, and the application principles and clinical effects of emerging therapies such as vacuum sealing drainage (VSD), platelet-rich plasma (PRP) and induced membrane technology were summarized. Results: Surgical treatment can effectively alleviate local symptoms, correct joint deformities, promote the healing of ulcerated wounds and reduce the systemic urate load in patients with tophaceous gout. Among them, arthroscopic minimally invasive surgery has become the mainstream clinical surgical method due to its advantages of minimal invasion, precision and rapid recovery. VSD, PRP, induced membrane technology and other emerging therapies have shown good application prospects in the treatment of refractory gout and gout-related bone defects and chronic ulcers. About 30% of patients with hyperuricemia can progress to the tophaceous stage, and the quality of life and clinical prognosis of cases with poor drug control and severe joint damage have been significantly improved after surgical intervention. Conclusion: Surgical treatment plays an indispensable role in the management of tophaceous gout. Clinically, surgical methods should be selected individually according to the patients condition, and multidisciplinary collaboration should be emphasized. In-depth research and clinical transformation of emerging therapies will provide more optimized strategies for surgical treatment of gout, which is of great clinical significance for improving the prognosis of patients.