围术期抗结核并一期病灶清除加髋关节置换术治疗髋关节结核的临床结局评价  

Evaluation of the Clinical Outcomes of Hip Joint Tuberculosis Treated by Peroperative Period Antituberculous Therapy Combined with One-stage Debridement and Total Hip Replacement

作　　者：张兴睿 丁慧勇[2] ZHANG Xing-rui DING Hui-yong(Department of Orthopedic Surgery, the First People＇s Hospital of Yi Autonomous Prefecture of Liangshan, Yi Autonomous, Sichuan 615000, China Department of Orthopedics, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, China)

机构地区：[1]凉山彝族自治州第一人民医院骨外科,四川凉山彝族自治州615000 [2]新疆医科大学第二附属医院骨科,乌鲁木齐830001

出　　处：《临床误诊误治》2017年第1期13-16,共4页Clinical Misdiagnosis & Mistherapy

基　　金：四川省卫生厅科研资助项目(120391)

摘　　要：目的探讨围术期抗结核并一期病灶清除加髋关节置换术治疗髋关节结核的临床效果。方法以我院2008年1月—2014年10月收治的100例髋关节结核为研究对象,均接受围术期抗结核治疗。术前红细胞沉降率及C-反应蛋白达标后行一期病灶清除加髋关节置换术治疗,术后继续抗结核治疗12~18个月。术后平均随访18个月,观察手术情况及结核复发率,比较术前1 d及术后3个月髋关节疼痛视觉模拟评分(visual analogue scale,VAS)和术前1 d及末次随访时髋关节Harris评分。结果本组手术切口均一期愈合;术后3个月及末次随访时VAS评分均较术前1 d明显下降(F=26.025,P=0.000)。末次随访时患者髋关节Harris各维度评分及总评分较术前1 d均明显升高,差异均有统计学意义(P<0.01)。随访终点,髋关节功能恢复优良率90.00%,结核复发率12.00%。结论围术期抗结核并一期病灶清除加髋关节置换术治疗髋关节结核能明显减轻患者髋关节疼痛,改善髋关节功能。Objective To investigate clinical effect of peroperative period antituberculous therapy combined with one- stage debridement and total hip replacement in treatment of hip joint tuberculosis. Methods A total of 100 patients with hip joint tuberculosis admitted between January 2008 and October 2014 were recruited in this study, and were treated with perop- erative period antituberculous therapy. One-stage debridement and total hip replacement were given after preoperative levels of erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） were up to the standard. All patients received antituber- culous therapy continuously for 12-18 months, and were followed up for average 18 months after the operation. Operative con- ditions and recurrence rate of tuberculosis were observed, visual analogue scale （VAS） scores of hip joint pain on preoperative 1 d and postoperative 3 months, and Harris scores of hip joint on preoperative 1 d and at the last follow-up were compared. Results All operative incisions were primary healing. VAS scores in postoperative 3 months and at the last follow-up were significantly lower than those on preoperative 1 d （ F = 26. 025, P = 0. 000）. At last follow-up, the Harris score of hip joint and the total score were significantly higher than those on preoperative ld （P 〈 0. 01 ）. At the end of follow-up, the excellent and good rate of hip functional recovery was 90.00% , and the recurrence rate of tuberculosis was 12.00%. Conclusion Peroperative period antituberculous therapy combined with one-stage debridement and total hip replacement in treatment of hip joint tuberculosis can significantly decrease hip pain and improve the hip function.

关 键 词：结核 骨关节 抗结核药 外科手术 关节成形术 置换 髋 

分 类 号：R687.4[医药卫生—骨科学]