嚴重痛風合併多發性痛風石導致下肢截肢－病例報告

Severe Chronic Tophaceous Gout with Right Below Knee Amputation-Case Report

董莉貞(Li-Chen Tung) ； 王淳厚(Chun-Hou Wang) ； 林文鮮(Wen-Hsien LinE) ； 畢柳鶯(Lu-Ing Bih)

《中華民國物理治療學會雜誌》 22卷4期 (1997/10) Pp. 291-298

https://doi.org/10.29616/JPTAROC.199710.0007

摘要

四十六歲的男性慢性痛風病人，因下肢痛風石附近組識潰爛，傷口壞死接受右側膝下截肢。入院接受義肢的裝配，採用外骨骼式膝下義肢，使用臏骨腱承重式承筒及沙奇腳掌以提供較好的穩定度。經向義肢穿著訓練復，患者可獨立行走約100公尺。該病人同時合併有多樣痛風之併發症，包括兩側手指及左側足部因痛風石造成關節變形、骨骼鏧孔性病變、高血脂症、腎功能受損、心臟血管病變等。住院期間經由藥物治療，血中尿酸濃度從10.9mg/dl降至8.5mg/dl，並無心絞痛情形發作，外科醫師則建議病人接受痛風石切除手術。由於病人合併有許多嚴重的內科疾病，出院後因產生心肌梗塞造成死亡。可見痛風的早期診斷及治療，相當重要。本病例為一少見之嚴重痛風病人，雖然經由物理治療、職能治療訓練及義肢裝配改善了生活品質，仍因本身已潛藏許多內科問題，很遺憾地因心肌梗塞而死亡。

關鍵字

痛風石 ； 截肢 ； 嘌呤 ； 痛風性關節炎

並列摘要

This forty-six-year-old male patient with chronic tophaceous gout suffers from right below knee amputation due to lower limb wound necrosis. He was admitted to our hospital for prosthesis fabrication. We used exoskeletal below knee prosthesis and solid ankle cushion heel foot for better stability. After prosthetic training, patient could walk about one hundred meters with below knee prosthesis and without any support. Multiple complications of hyperuricemia occurred, such as bilateral multiple fingers and left foot deformities due to tophi, chronic renal functional impairment, coronary arterial disease etc. Blood uricacid level decreased from 10.9mg/dl to 8.5mg/dl and angina disappeared after appropriate medication. Surgeon suggested the patient receiving tophi resection surgery. Early diagnosis and treatment of gout is very important. Bone and joint damage and other medical complications can be prevented if early and regular treatment is applied. This was a rarely seen severe gouty patient. He died of myocardial infarction due to underlying medical problems even though his quality of life had been improved after rehabilitation.

並列關鍵字

Tophi ； Amputation ； Purine ； Gouty arthritis