一期病灶清除联合叉状成形术治疗肘关节结核57例疗效分析  

Analysis on Efficacy of One-stage Debridement with Forked Osteotomy Arthroplasty in 57 Patients with Elbow Tuberculosis

作　　者：严广璇 秦世炳[1] 董伟杰[1] 兰汀隆[1] 范俊[1] 唐恺[1] 李元[1] 徐双铮[1] 

机构地区：[1]首都医科大学附属北京胸科医院骨科北京骨关节结核诊疗中心,101149

出　　处：《结核病与胸部肿瘤》2016年第3期189-193,共5页Tuberculosis and Thoracic Tumor

摘　　要：目的探讨一期病灶清除叉状成形术治疗肘关节结核的手术方法及疗效。方法回顾性分析2005年1月至2014年1月首都医科大学附属北京胸科医院骨科收治的肘关节结核行一期病灶清除联合叉状成形术并获得随访的患者共57例。其中男23例，中位年龄53岁（34-67岁）；女34例，中位年龄51岁（32-72岁），病程3-15个月，平均（5．35±2．30）个月。以患肘屈伸活动度及Mayo肘关节评分（Mayoelbow performance score，MEPS）对术前、末次随访时肘与前臂功能（疼痛、运动、稳定性、日常生活功能）进行评价。结果随访12-36个月，平均15个月；57例患者肘关节结核均治愈，无复发患者；关节屈伸活动度由术前（10．66±2．50）。增加到术后的（65．62±9．12）°，t=-3．35，P〈0．05；Mayo肘关节评分由术前（25．57±10．20）分改善为术后的（68．31±9．82）分，t=4．54，P〈0．05。结论规范抗结核治疗后行一期病灶清除联合叉状成形术是治疗肘关节结核、重建肘关节功能的有效手术方法，可满足患者绝大多数日常生活及工作需要。Objective To evaluate the surgical methods and clinical outcomes of the one-stage debridement with forked osteotomy arthroplasty for elbow tuberculosis. Methods We analyzed retrospectively 57 patients with elbow tuberculosis admitted and received one-stage dehridement with forked osteotomy arthroplasty in Beijing Chest Hospital, Capital Medical University from Jan 2005 to Jan 2014. There were 23 males with the median age 53 （34 ±67） years old and 34 females with the median age 51 （32± 72） years old. The average of the course of disease was 5.35 ± 2.30 ranged from 3 to 15 months. The affected elbow and forearm function parameters including pain, exercise, stability, and daily life function were evaluated according to the affected elbow flexion and extension activities and Mayo Elbow Performance Score （MEPS） before surgery and at the last foUow-up. Results During the average of follow-up 15 months ranged from 12 to 36 months for all patients, 57 patients were cured and no recurrent cases found. The affected elbow flexion and extension activities increased froml0. 66 ± 2.50 before surgery to 65.62 ± 9. 12 after surgery （t= 3.35, P〈0.05）. The MEPS improved from 25.57 ± 10. 20 before surgery to 68. 31 ± 9. 82 after surgery （t= 4.54, P〈0. 05）. Conclusion One-stage debridement with forked osteotomy arthroplasty after standard anti-tuberculosis chemotherapy is the effective surgical methods to treat elbow tuberculosis and to reconstruct function of elbow joint, tt can meet the needs for most patients with daily life and work.

关 键 词：肘关节结核 叉状成形术 关节功能 

分 类 号：R529.2[医药卫生—内科学]