关节镜治疗髋关节布鲁氏杆菌感染  

Arthroscopic debridement and drainage with continuous suction irrigation for hip brucellosis

作　　者：董晨辉 涂鹏 邵宏斌[2] 史超 王龙 赵斌 王耀霆 刘玉杰 李春宝 DONG Chen-hui;TU Peng;SHAO Hong-bin;SHI Chao;WANG Long;ZHAO Bin;WANG Yao-ting;LIU Yu-jie;LI Chun-bao(Department of Orthopaedics,The Fourth Medical Center,General Hospital of CPLA,Beijing 100853,China;Z Department of Sports Medicine,The 940h Hospital,Joint Logistic Support Force of CPLA,Lanzhou 730050,China;Medical School,Northwest Minzu University,Lanzhou 730030,China;Department of Orthopedics,Peopled Hospital of Qitai County,Changji Hui Autonomous Prefecture^Xinjiang Uygur Autonomous Region,Qi-tai 831800,China)

机构地区：[1]中国人民解放军总医院第四医学中心骨科医学部,北京100048 [2]中国人民解放军联勤保障部队第940医院运动医学科,兰州730030 [3]西北民族大学医学部,兰州730030 [4]新疆维吾尔自治区昌吉回族自治州奇台县人民医院骨科,831800

出　　处：《中国矫形外科杂志》2022年第5期452-455,共4页Orthopedic Journal of China

基　　金：国家自然基金面上项目(编号:82072517);联勤保障部队第九四〇医院军队科研项目(编号:2021yxky020);科技冬奥专项项目(编号:2018YFF0301100);2019年度解放军总医院军事医学科研计划项目(编号:CX19004);国家重点研发计划项目(编号:2019YFE0126300);解放军总医院临床科研扶持基金项目(编号:2018FC-WJFWZX-1-06)。

摘　　要：[目的]回顾性分析关节镜微创治疗髋关节布氏杆菌感染患者的临床效果.[方法]2009年2月—2018年12月,解放军总医院骨科采用关节镜术治疗髋关节布氏杆菌感染性关节炎患者8例.行髋关节镜探查清理、滑膜切除、病灶清除术,术中置管,术后持续生理盐水灌洗,多西环素联合利福平,或者链霉素治疗,疗程1.5~3个月.[结果]所有患者均顺利手术,无严重并发症.平均(9.52±2.21)d拔除吸引冲洗管.细菌培养均培养出布鲁氏杆菌,阳性率为100%(8/8),病理学检查均发现杆菌,阳性率为100%(8/8).所有患者随访24个月以上,至末次随访,均无感染复发,无需行翻修手术者.随时间推移,8例患者VAS评分显著下降(P<0.05),而mHHS评分显著增加(P<0.05).与术前相比,末次随访时影像测量髋关节间隙无显著变化(P>0.05).与术前相比,术后ESR和CPR均显著降低(P<0.05),术后12个月和24个月,ESR和CPR均在正常范围.[结论]关节镜清创灌洗,滴注引流术可有效治疗髋关节布氏杆菌感染.[Objective]To explore the clinical outcomes of arthroscopic debridement and drainage with continuous suction irrigation for hip brucellosis.[Methods]From February 2009 to December 2018,8 patients with brucella arthritis of the hip were arthroscopically treated in Department of Orthopedics,General Hospital of CPLA.Synovial resection,debridement and catheterization were conducted during arthroscopy.After that,continuous suction irrigation was maintained to the inflammatory reaction subsided.In addition,doxycycline combined with rifampicin,or streptomycin was given for 1.5-3 months.[Results]All the 8 patients were successfully operated without seri-ous complications.The irrigation-drainage tubes were removed at(9.5±2.21)days on average.The positive rate of brucella proved of 8/8(100%)in bacterial culture,and 8/8(100%)in pathological observation.All patients were followed up for more than 24 months.No infection recurrence and revision surgery occurred in anyone of them to the latest follow-up.The VAS scores decreased significantly(P<0.05),while the mHHS score increased significantly over time in the 8 patients(P<0.05).There were no significant changes in radiographically measured hip space at the latest follow-up compared with those preoperatively(P>0.05).The ESR and CPR were significantly decreased postoperatively compared with those before operation(P<0.05),and remained within the normal range at 12 and 24 months postoperatively.[Conclusion]Arthroscopic debridement and drainage with continuous suction irrigation does effectively treat hip brucellosis.

关 键 词：髋 布鲁氏杆菌病 关节镜术 清创 吸引冲洗 

分 类 号：R681.8[医药卫生—骨科学]