Ⅰ期全髋关节置换术治疗晚期髋关节结核的疗效分析  

Curative effect of one-stage total hip arthroplasty for advanced tuberculosis of hip

作　　者：邓辉[1] 梁大伟[1] 杨毅[1] 龚跃昆[1] 马珂[1] 李彪[1] 

机构地区：[1]昆明医科大学第一附属医院骨科,昆明650000

出　　处：《中国骨与关节外科》2015年第5期408-411,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景：髋关节结核在我国仍属于常见病,国内外学者对于髋关节结核是否进行Ⅰ期全髋关节置换术仍存在较大分歧。目的：观察Ⅰ期全髋关节置换术治疗晚期髋关节结核的疗效及安全性。方法：2007年3月至2014年2月我院共收治晚期髋关节结核患者33例,均行Ⅰ期全髋关节置换术。33例均为单侧髋关节结核,其中男20例,女13例;平均年龄44.2岁（19-65岁）;髋关节结核感染分期Ⅲ期4例,Ⅳ期29例;其中2合并肺结核（陈旧性）,1例合并脊柱（L1）结核,髋关节窦道形成4例（已闭合）,髋关节强直14例。术前给予正规抗痨治疗平均42.0 d（21-90 d）,红细胞沉降率（ESR）、C反应蛋白（CRP）下降至接近正常范围,给予Ⅰ期病灶清除全髋关节置换术、所有病例均使用生物型假体,术后病理检查均诊断为结核感染,术后继续正规抗痨治疗平均9.2个月（6-12个月）,髋关节功能采用Harris评分系统进行评价,术后及随访复查X线片、CT、ESR、CRP。结果：33例全髋关节置换术切口均甲级愈合,术后假体无松动、下沉、脱位。全部获得随访,平均随访时间61.0个月（5-96个月）,均无髋关节疼痛、功能障碍及结核复发。术前患者平均Harris评分30.5分（20-60分）,末次随访平均Harris评分90.4分（85-97分）。结论：排除混合感染,术前抗结核治疗有效,术中彻底清除病灶,Ⅰ期行全髋关节置换治疗晚期髋关节结核可获得满意的疗效。Background： Although hip tuberculosis is still a common disease in China, there has been much dispute over one-stage total hip arthroplasty（TKA） for the treatment.Objective： To evaluate the efficacy and safety of one-stage TKA for advanced tuberculosis of hip.Methods： From March 2007 to February 2014, 33 patients（33 hips） with advanced tuberculosis of the hip underwent onestage debridement and TKA in our hospital. There were 20 males and 13 females with a mean age of 44.2 years（range, 19-65 years）. According to the classification of the hip tuberculosis, there were 4 cases of grade Ⅲ and 29 cases of grade Ⅳ.Meanwhile, there were 2 cases of old pulmonary tuberculosis, 1 case of spinal tuberculosis（L1）, 4 cases of the closed sinus tract formation of the hip, and 14 cases of the hip ankylosis. After preoperative anti-tuberculous therapy（42.0 d on average,ranging 21-90 d）, the erythrocyte sedimentation rate（ESR） and C reactive protein（CRP） had decreased by the normal level.Bio-based（non-cemented） prosthesis was used in all the patients. Tuberculous infection was proven by postoperative pathological test. Anti- tuberculous therapy continued for 9.2 months on average（range, 6- 12 months） after surgery. Harris hip score was used to evaluate hip function. Some tests, such as X- ray, CT scan, ESR and CRP were performed after surgery and during follow-up.Results： The incision was healed in all the 33 patients. No prosthesis loosening, subsidence or dislocation was found. The mean duration of follow-up was 61.0 months（range, 5-96 months） in all patients, and no hip pain, functional disorders or tuberculosis relapse occurred. Harris score was 30.5 on average（range, 20-60） before surgery and 90.4 on average（range, 85-97） at the final follow-up.Conclusions： Under effective preoperative anti-tuberculous therapy, one-stage debridement and TKA for advanced tuberculosis of the hip can obtain good results and it is safe and feasible.

关 键 词：关节成形术 置换 髋 结核 骨关节 

分 类 号：R687.4[医药卫生—骨科学]