关节融合术与改良叉状成形术治疗全肘关节结核的疗效分析  

Efficacy analysis of arthrodesis and modified fork-like arthroplasty for the treatment of total elbow joint tuberculosis

作　　者：姚林明 兰汀隆[2] YAO Lin-ming, LAN Ting-long(Department of Surgery, Shaanxi Provincial Institute for Tuberculosis Control and Prevention, Xi＇an 710105, China)

机构地区：[1]陕西省结核病防治院外科,西安710105 [2]首都医科大学附属北京胸科医院骨科北京市结核病胸部肿瘤研究所北京骨关节结核诊疗中心

出　　处：《中国防痨杂志》2018年第11期1176-1182,共7页Chinese Journal of Antituberculosis

摘　　要：目的 分析肘关节病灶清除术后行关节融合术与改良叉状成形术治疗肘关节结核的疗效,探讨叉状成形术在肘关节结核治疗中的价值。方法 选择2009年2月至2018年2月于陕西省结核病防治院行手术治疗并随访12个月以上的48例成人全肘关节结核患者,其中2009年2月至2015年7月的20例患者采用病灶清除术后行关节融合术治疗（融合术组）,2015年8至2018年2月的28例患者采用病灶清除术后行改良叉状成形术治疗（成形术组）,比较两组患者患肘关节在手术前与术后12个月的屈伸和旋转活动度、疼痛视觉模拟评分（visual analogue scale,VAS）及Mayo肘关节功能评分（Mayo elbow performance score,MEPS）,以评估患肘与前臂功能（运动、稳定性、疼痛、日常生活功能）的手术治疗效果,并观察随访情况。采用SPSS 21.0统计软件进行统计学分析,组间计量资料比较采用t检验,计数资料采用χ2检验,均以P〈0.05为差异有统计学意义。 结果 48例患者均随访12~24个月,平均（13.4±5.5）个月。45例患者均一期治愈,3例患者术后切口未闭合经局部换药,二次手术清创后闭合。 融合术组关节活动度均由术前的屈伸（7.8±6.8）°和旋转（5.5±5.1）°降低到术后12个月时的0°（t=5.111、4.819,P值均〈0.001）;VAS和MEPS评分由术前的（7.3±1.4）分和（7.3±5.0）分改善到术后12个月时的（1.0±1.0）分和（17.5±4.7）分（t=21.642、5.832, P值均〈0.001）。成形术组关节活动度分别由术前的屈伸（8.8±6.9）°和旋转（6.4±5.9）°提高到术后12个月时的（58.8±15.4）°和（37.0±11.8）°（t=16.733、11.569, P值均〈0.001）;VAS和MEPS评分分别由术前的（7.5±1.2）分和（6.3±4.8）分改善到术后12个月时的（1.1±0.9）分和（20.5±3.9）分（t=22.055、13.587,P值均〈0.001）。成形术组术后12个月时的屈伸、旋转活动度和MEPS评分均明显优于融合术组（t=20.222,P〈0.001;tObjective To analyze the efficacy of arthrodesis and modified fork-like arthroplasty after elbow joint debridement for the treatment of elbow joint tuberculosis, and to explore the value of fork-like arthroplasty in the treatment of elbow joint tuberculosis.Methods From February 2009 to February 2018, 48 adult patients with total elbow joint tuberculosis who underwent surgical treatment and followed up for more than 12 months in Shaanxi Provincial Institute for Tuberculosis Control and Prevention were selected. Among them, 20 patients from February 2009 to July 2015 underwent arthrodesis after elbow joint debridement （defined as arthrodesis group）, and 28 patients from August 2015 to February 2018, underwent modified fork-like arthroplasty after elbow joint debridement （defined as arthroplasty group）. The flexion and extension and rotation mobility, visual analogue scale （VAS score） and Mayo elbow performance score （MEPS） before and 12 months after surgery were compared between the two groups, in order to assess the surgical outcome in elbow and forearm function （including exercise, stability, pain, and daily living function）. All patients were observed during follow-up. Statistical analysis was performed using SPSS 21.0 software. t-test was used to compare measurement data between two groups, and χ2 test was used for categorical data. The difference was statistically significant at P〈0.05. Results All 48 patients were followed up for 12 to 24 months, with an average of （13.4±5.5） months. Forty-five patients were cured in one-stage surgery. The incisions in three patients were not closed; but after local dressing and second debridement, all incisions were closed. In the arthrodesis group, the degree of joint mobility was reduced from （7.8±6.8）° in flexion and extension and （5.5±5.1）° in rotation preoperatively to 0° at 12 months postoperatively （t=5.111 and 4.819, Ps〈0.001）, and the VAS and MEPS scores were improved from （7.3±1.4） and （7.3±5.0） preoperative

关 键 词：结核 骨关节 关节融合术 关节成形术 置换 肘 治疗效果 

分 类 号：R684.305[医药卫生—骨科学]