Evaluation Of The Effect Of Tophus Surgery

Objective:To evaluate surgical treatment of patients suffered from tophus through analyzing functional score of upper and lower limbs and serum uric acid level.Methods:We performed a 3-year retrospective study of adult patients with tophus admitted to plastic surgery department and endocrinology and metabolism department of Shanghai sixth people’s hospital from 1^st January 2016 to 31^st December 2018.Data collected from each medical record included serum uric acid level,imaging examination,quick-DASH and Maryland foot scores assessing upper and lower limb function.Patients were followed up 6 months after different treatments,and data was collected including post uric acid level,upper and lower limb function score,long-term complications,drug use and gout attack frequency.Results:There were significant differences in preoperative and postoperative functional scores of upper and lower limbs among operative patients,and there were also significant differences in serum uric acid levels between operative and non-operative patients before and after treatment.There were no significant differences in serum uric acid levels between operative and non-operative patients after treatment.Conclusion:Both quick-DASH score and Maryland foot score improved significantly after operative treatment of tophus.Limb function should be preserved as much as possible during surgery.Removal of urate crystals is not the primary goal.Although drug therapy can bring blood uric acid levels down to normal levels in patients with tophus,the process always takes several years.The appearance of the limbs was improved by operative treatment,the function was repaired to a certain extent,and the quality of life was improved as well.The improvement of upper limbs was mainly pain relief,and the improvement of lower limbs was mainly deformity correction by operative treatment.The results suggest that operative treatment should perform earlier to preserve the function of the limb as much as possible,rather than the complete removal of urate crystals as the primary goal.Operative treatment combined with drug treatment can effectively improve the local join function and appearance of patients with tophus,which provides a new therapeutic approach and means for the clinical treatment of tophus.