腕关节结核术后结核病灶复发的相关危险因素分析  

Risk factors associated with recurrence of wrist tuberculosis after surgery combined with anti-tuberculosis therapy

作　　者：刘凯 王鑫[1] 王苏龙 艾尼孜尔·亚里坤 艾合买提江·玉素甫[1] Liu Kai;Wang Xin;Wang Sulong;AinizierYalikun;Aihemaitijiang·Yusufu(Department of Microsurgery,Orthopedic Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院骨科中心显微修复外科,乌鲁木齐830054

出　　处：《中华手外科杂志》2023年第5期457-462,共6页Chinese Journal of Hand Surgery

基　　金：国家自然科学基金(82060401)。

摘　　要：目的探讨手术联合抗结核药物治疗腕关节结核术后病灶复发的危险因素。方法回顾性分析自2003年1月至2020年12月我院手术联合抗结核药物治疗的96例腕关节结核患者的临床资料和辅助检查结果。手术前后进行规范抗结核药物治疗,运用视觉模拟量表进行患肢休息和活动时桡骨和尺骨偏移疼痛评估。采用SPSS21.0统计学软件进行组间差异和Logistic回归分析,P<0.05认为差异有统计学意义。结果本研究共纳96例患者,平均随访时间为49.7个月(24~105个月)。14例(14.5%)患者在腕关节结核术后结核病灶复发。单因素Logistic回归分析结果表明,年龄>45岁、身体质量指数(bodymass index,BMI)<18.5kg/m^(2)、吸烟、糖尿病、腕关节外伤史、结核症状持续时间>6个月、未规范抗结核药物服用和病灶范围累及腱鞘或滑膜与腕关节结核术后结核病灶复发率显著相关(P<0.05)。多因素Logistic回归分析表明,年龄>45岁、BMI<18.5kg/m^(2)、糖尿病、腕关节外伤史和病灶范围累及腱鞘或滑膜与腕关节结核术后结核病灶复发独立相关(P<0.05)。结论手术联合规范抗结核药物是治疗腕关节结核的安全实用方法。年龄>45岁、BMI<18.5kg/m^(2)、糖尿病、腕关节外伤史和结核病灶范围累及腱鞘或滑膜是腕关节结核术后复发的独立危险因素。术后结核病灶复发的概率随着患者合并危险因素数量的增加而增加。Objective To investigate the risk factors of postoperative recurrence of wrist joint tuberculosis treated with surgery combined with anti-tuberculosis drugs.Methods A retrospective analysis was conducted on the clinical data and auxiliary examination results of 96 patients with wrist tuberculosis treated with surgery combined with anti-tuberculosis drugs in our hospital from January 2003 to December 2020.Standardized anti-tuberculosis drug treatment was performed before and after surgery,and the visual analogue scale(VAS)was used to assess the pain of radial and ulnar deviation during rest and movement of the affected limb.SPSS 21.O statistical software was used for inter group differences and Logistic regression analysis,and P<0.05 was considered statistically significant.Results A total of 96 patients were included in this study,with an average follow-up time of 49.7 months(ranged,24 to 105 months).14 patients(14.5%)suffered from recurrence of tuberculosis after wrist tuberculosis surgery.Single factor Logistic regression analysis showed that age>45 years,body mass index(BMI)<18.5 kg/m^(2),smoking,diabetes,history of wrist trauma,duration of tuberculosis symptoms>6 months,non-standard use of anti-tuberculosis drugs and involvement of tendon sheath or synovium in the focus were significantly related to the recurrence rate of tuberculosis after wrist tuberculosis surgery(P<0.05).Multivariate Logistic regression analysis showed that age>45 years,BMI<18.5 kg/m^(2),diabetes,history of wrist trauma and involvement of tendon sheath or synovium in the focus were independently related to the recurrence of tuberculosis focus after wrist tuberculosis surgery(P<0.05).Conclusion Surgery combined with standardized anti-tuberculosis drugs is a safe and practical method for treating wrist joint tuberculosis.Age>45 years,BMI<18.5 kg/m^(2),diabetes,history of wrist trauma,and involvement of tendon sheath or synovium in the tuberculosis focus are independent risk factors for recurrence of wrist tuberculosis after surgery.The prob

关 键 词：腕关节 结核 外科手术 复发 危险因素 

分 类 号：R687.4[医药卫生—骨科学]