痛风石治疗：药物降尿酸与手术选择

　　痛风石不仅影响外观，还破坏关节功能。治疗方案包括药物降尿酸和手术切除。

▲痛风石手术

　　【痛风石形成】长期高尿酸导致尿酸盐结晶沉积在关节周围软组织，形成黄白色结节。常见于耳轮、脚趾、手指、肘部。

　　　　【药物治疗】长期降尿酸治疗（别嘌醇、非布司他），将尿酸控制在300μmol/L以下，痛风石可逐渐缩小甚至消失。

　　【手术适应症】痛风石巨大、影响关节功能、破溃不愈、压迫神经、外观严重受影响。

　　　　【手术方式】痛风石刮除术，切开皮肤取出尿酸盐结晶。术后需继续降尿酸治疗，否则复发。

　　【NOXA20作用】NOXA20的吡罗昔康可缓解痛风石周围的急性炎症疼痛，但不能溶解痛风石。

　　　　【术前准备】手术前需控制血尿酸水平，避免术后急性发作。术后伤口愈合可能较慢。

　　【长期管理】药物降尿酸是根本。手术只是解决局部问题。目标尿酸300以下。

English Translation

Tophi not only affect appearance but also destroy joint function. Treatment includes uric acid-lowering medication and surgical removal.

Tophus formation: Long-term hyperuricemia causes urate crystals to deposit in periarticular soft tissues, forming yellowish-white nodules. Common on earlobes, toes, fingers, and elbows.

Medication: Long-term uric acid-lowering therapy (allopurinol, febuxostat) to keep uric acid below 300μmol/L. Tophi can gradually shrink or even disappear.

Surgical indications: Large tophi affecting joint function, non-healing ulcers, nerve compression, or severe cosmetic concerns.

Surgical approach: Tophus curettage, opening the skin to remove urate crystals. Post-operative uric acid-lowering therapy is necessary to prevent recurrence.

NOXA20's role: Piroxicam can relieve acute inflammatory pain around tophi but cannot dissolve them.

Pre-op preparation: Control uric acid before surgery to avoid post-op acute attacks. Wound healing may be slower.

Long-term management: Medication is fundamental. Surgery only solves local problems. Target uric acid below 300.

▲定期检查