2024年第26届亚太风湿病协会联盟(APLAR)大会将于2024年8月21-25日在新加坡举行，会议由亚太风湿病学会联盟(APLAR)组织。
我院王色蓉主任所著论文《Surgical reconstructive surgery in an elderly patient with gouty stones in the joints of the hands and feet: Case report》（译：手足关节痛风石老年患者外科重建手术1例）已被接收到官方会议议程中，将会以壁报展示的方式在会议中呈现。
论文收录详情
Acceptance and Inclusion Details
论文具体内容
Detailed Content
（标题）
Surgical reconstructive surgery in an elderly patient with gouty stones in the joints of the hands and feet: Case report
手足关节痛风石老年患者外科重建手术1例
（正文）
Background:The patient is a 70-year-old male with complaints of multi-joint pain for 5 years and gout with gout stone formation for 3 years. Half a month ago, there was a gouty stone ulcer on the middle finger of the right hand, with white crystallized salt oozing out, and the wound has not healed. 2023.11.27, in order to further confirm the diagnosis, he came to our hospital.
患者男性，70岁，主诉多关节疼痛5年，痛风伴痛风石形成3年。半个月前出现右手中指痛风石破溃，有白色结晶盐渗出，伤口一直未愈合。2023.11.27，为求进一步确诊、遂来我院就诊。
Physical examination: right hand 2, 3, 5 fingers have mass formation (Fig.1), the larger mass 2.5cm, right middle finger distal interphalangeal joint deformation, gout stone ulceration, the right hand is limited to make a fist; left hand 2.3 finger mass 2cm left hand is limited to make a fist; right wrist mass 2cm, the right wrist activity is severely limited, medial pressure pain; right elbow mass 1cm, activity is still possible; left foot 5 toes mass 3cm, the right foot 1.5 toes. The size of the mass was about 3cm with limited movement; the mass at the Achilles tendon of the right foot was 2cm.DR:Gouty arthritis of both feet and hands with gouty stone formation (Fig.2). Laboratory tests: UA: 543.5umol/L; CysC: 1.26mg/L; γ-GT: 93.9U/L; TC: 6.21mmol/L; ESR: 16mm/L, the rest of them were not abnormal.
查体检查：右手2、3、5指均有包块形成（图1），较大包块2.5cm，右手中指远端指间关节变形、痛风石破溃，右手握拳受限；左手2.3指包块2cm左手握拳受限；右腕包块2cm，右腕活动严重受限，内侧压痛；右肘包块1cm、活动尚可；左足5趾包块3cm，右足1.5趾包块大小约3cm，活动受限；右足跟腱处包块2cm。DR:双足、双手痛风性关节炎并痛风石形成（图2）。实验室检查：UA：543.5umol/L；CysC: 1.26mg/L;γ-GT: 93.9U/L; TC: 6.21mmol/L; ESR: 16mm/L，其余未见异常。
Methods：Preoperatively, Chinese herbal soup was given to clear heat and dampness, activate blood circulation. Colchicine tablets 0.5mg.qd.po; sodium bicarbonate tablets 0.3g.tid.po; febuxostat tablets 10mg.qd.po; astragalus zaojiao oral solution 10ml.bid.po; atorvastatin calcium tablets 10mg.hs.po; naproxen sodium chloride injection 100ml; 0.9% sodium chloride injection 100ml+ omphalos sodium for injection; autologous blood therapy, gout pulse therapy; right hand 810 laser therapy. Gouty stone excision of right wrist and both hands was performed on 2023.12.1 and 12.3 (Fig.3).
术前予以中药汤剂清热利湿、活血通络。秋水仙碱片0.5mg.qd.po；碳酸氢钠片0.3g.tid.po；非布司他片10mg.qd.po；芪枣口服液10ml.bid.po；阿托伐他汀钙片10mg.hs.po ；萘普生钠氯化钠注射液100ml；0.9%氯化钠注射液100ml+注射用奥美拉性钠；自体血治疗、痛风脉冲治疗；右手810激光治疗。于2023.12.1和12.3行右腕、双手痛风石切除手术（图3）。
Results：After surgery, the wound recovered well (Fig.4). 2023.12.9, she was discharged from the hospital with the following indicators: ALB: 38g/L; γ-GT: 65.3U/L; ALP: 194.9U/L; CREA: 55.9umol/L; UA: 198.4umol/L; CRP: 17.5mg/L; ESR: 97mm/L. She was discharged from the hospital and continued to take oral medication (ibid.). On 2024.1.15, UA: 33.1umol/L, right middle finger internal fixation removal surgery was performed, and there was no obvious pain in the joint. on 2024.2.28, uric acid was 270umol/L, and both hands and the right carpal joint had recovered well after the surgery (Fig. 5), and all the indexes had returned to normal.
术后伤口恢复良好（图4），2023.12.9出院复查：ALB: 38g/L；γ-GT：65.3U/L；ALP：194.9U/L；CREA: 55.9umol/L; UA: 198.4umol/L; CRP: 17.5mg/L; ESR: 97mm/L。出院继续口服药物（同上）。2024.1.15复查，UA : 33.1umol/L，行右手中指内固定取出术，关节无明显疼痛。2024.2.28复查，尿酸270umol/L，术后双手、右腕关节伤口恢复佳（图5），各项指标恢复正常。
Conclusion：Elderly people should be more comprehensively assessed and analyzed for risk factors before surgery and be actively treated. Because in the process of surgical removal of gout stones, some urate crystals are dissolved and absorbed into the blood, which is very likely to cause acute attacks of gout in the early postoperative period, so it is advocated to operate on the basis of medication to control uric acid.
老年人术前更应全面评估分析危险因素并作积极处理。因为在手术切除痛风石的过程中，部分尿酸盐结晶溶解并吸收入血，极易造成术后早期痛风急性发作，所以提倡在药物控制尿酸的基础上手术。
（痛风石外科重建手术成果）
图1. 查体显示手脚有痛风石块
图2. DR：双脚和双手痛风性关节炎伴痛风石形成
图3. 痛风石摘除术中的双手
图4. 术后伤口恢复良好
图5. 双手和右腕关节伤口术后恢复良好
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APLAR是隶属于ILAR（国际风湿病协会联合会）的组织，其举办的亚太风湿病学大会（即APLAR年会），是风湿病学领域内前沿科研成果与临床实践信息交流的盛事。
故而，本次大会收录了我院的论文成果，不仅彰显了我院在痛风及痛风石的临床诊疗与科研探索方面所达到的专业高度与领先地位，更是我院在该领域内卓越贡献的有力证明，也激励我们持续努力，保持对专业知识的追求与精进。
我院被中华医学会收录的论文
1、我院「门诊主任朱红梅」、「手术室主任钟太原」共同撰写的学术论文：《A case of multiple systemic gouty stones undergoing surgical treatment》（*译：多发系统痛风石的外科治疗1例）入选中华医学会第21次内分泌学会议
2、我院朱红梅主任、王色蓉主任、崔丽主任以及李里素、何娅联合撰写的学术论文《痛风性肾病的治疗方法研究》和《几例痛风石并存肾结石患者的临床分析与探讨》双双被中华医学会学术年会收录
3、我院由魏琳琳，鲁业东，朱红梅，王色蓉共同撰写《运动康复对类风湿关节炎患者功能恢复的促进作用》学术论文被中华医学会第26次全国风湿病学会议收录
4、我院朱红梅院长发表的《PRP治疗巨大痛风石破溃患者的病案分析1例》学术论文被中华医学会学术会议录用
5、我院3篇学术论文，分别是朱红梅主任（第一作者），钟太原主任，王色蓉主任联合撰写的《PRP治疗痛风石破溃伴感染患者的案例分析》、官献军主任撰写的《痛风病灶切除术联合针刀镜治疗高尿酸血症伴痛风性关节炎的案例分析》及邓焱明主任撰写的《痛风合并肾功能不全个案报道》被第二十七次风湿病学学术会议收录。
