全髋关节置换术治疗髋关节结核  

Total hip arthroplasty for treatment of tuberculosis of the hip joint

作　　者：冉学军 张科 余江 胡兆洋 覃勇志 王芳 RAN Xue-jun;ZHANG Ke;YU Jiang;HU Zhao-yang;QIN Yong-zhi;WANG Fang(Dept of Orthopaedics,West China-Guang′an Hospital of Sichuan University,the People′s Hospital of Guang′an City,Guang′an,Sichuan 638001,China)

机构地区：[1]四川大学华西广安医院·广安市人民医院骨科,四川广安638001 [2]重庆建设医院骨科,重庆400050

出　　处：《临床骨科杂志》2022年第3期352-355,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨采用全髋关节置换术(THA)治疗髋关节结核的可行性及如何提高手术成功率。方法采用THA治疗23例髋关节结核患者。术前和术后均给予规范的抗结核药物方案。采用Harris评分评价髋关节功能。结果患者均获得随访,时间12~60个月。21例切口甲级愈合,1例多次发生髋关节脱位,经治疗后未再发生;1例因未遵医嘱规范抗结核治疗,2年后结核复发伴骨破坏导致假体松动,行假体取出术。术后12个月Harris评分为77~95(91.0±4.0)分,其中优19例,良2例,可2例,明显高于术前的21~57(41.3±3.5)分,差异有统计学意义(P<0.05);患者髋关节疼痛消失或有轻微疼痛、功能良好。结论THA是治疗髋关节结核的有效治疗手段。规范有效地抗结核治疗是手术成功的前提和保障;金属髋臼杯的牢固安装、固定是手术成功的关键环节之一。Objective To investigate the feasibility of total hip arthroplasty(THA)in the treatment of hip tuberculosis and how to improve the success rate of operation.Methods The 23 cases of hip tuberculosis were treated with THA.Standardized anti-tuberculosis drug regimen was given before and after surgery.The Harris score was used to evaluate hip joint function.Results All patients were followed up for 12~60 months.Twenty-one cases of incisions got grade A healing.One case had multiple hip dislocations,which did not recur after treatment.In 1 case,due to failure to follow the doctor’s instructions to standardize anti-tuberculosis treatment,the recurrence of tuberculosis and bone destruction caused prosthesis loosening after 2 years,and the prosthesis was removed.At 12 months after operation,the Harris score was 77~95(91.0±4.0)points,19 cases were excellent,2 cases were good,and 2 cases fair,which was significantly higher than the preoperative score of 21~57(41.3±3.5)points,there was significant difference(P<0.05);Hip joint pain was disappeared or slight pain,with good function.Conclusions THA is an effective treatment for hip tuberculosis.Standardized and effective anti-tuberculosis treatment is the prerequisite and guarantee for the success of the operation;the firm installation and fixation of the metal acetabular cup is one of the key links for the success of the operation.

关 键 词：关节成形术 置换 髋 髋关节结核 

分 类 号：R529.2[医药卫生—内科学] R687.4[医药卫生—临床医学]