Objective: To explore short-term curative effect of staging operation for large gouty stone on the first metatarsophalangeal joint.
Methods: From January 2015 to December 2016, 12 patients with giant gout stone on the first metatarsophalangeal joint were treated with staging operation, including 12 males, aged from 45 to 73 years old, 6 cases on the right side and 6 cases on the left side. After conservative treatment for more than 2 years, the size and location of ventilator stone were detected by dual energy CT. The bone destruction of the first metatarsophalangeal joint was observed on X-ray examination. All patients underwent stageⅠgout radical removal and temporary fixation with Kirschner wire, and metatarsophalangeal joint fusion and internal fixation were performed after local soft tissue conditions were stabilized. The level of blood uric acid before and after hand were compared, and correction and complications of limb deformity were observed, VAS score was applied to evaluate pain relieved degree.
Results: All patients were successfully completed two stages ' operation. Twelve patients were followed up for 9 to 13 months. VAS sco re and uric acid content at different time points were observed and recorded. VAS score before operation ranged from 6 to 9, and decreased to 0 to 1 at 7 weeks after operation; the level of blood uric acid ranged from 443 to 501 μmol/L before operation, and decreased to 307 to 330 μmol/L at 7 weeks after operation. The first metatarsophalangeal joint deformity of foot was corrected and the shape was recovered at 5 to 7 months after operation. One patient occurred incision infection and flap edgenecrosis, and the wound healed by debridement and dressing change.
Conclusion: Staged operation for the treatment of giant gout stone on the first metatarsophalangeal joint of foot could correct joint deformity, restore shape of the first metatarsophalangeal joint, relieve pain of the affected foot, and beneficial for control content of serum uric acid, and has less complications.
Keywords: Gout; Metatarsophalangeal joint; Surgical procedures, operative; Uric acid.