一期全髋置换与关节融合治疗晚期髋关节结核  

One-stage total hip arthroplasty versus hip arthrodesis for advanced hip tuberculosis

作　　者：许斌[1] 贺自克 王玉辉 XU Bin;HE Zi-ke;WANG Yu-hui(Department of Orthopaedics,Henan Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院骨科,河南郑州450000

出　　处：《中国矫形外科杂志》2023年第24期2248-2253,共6页Orthopedic Journal of China

摘　　要：[目的]比较一期全髋关节置换(total hip arthroplasty,THA)与关节融合治疗晚期髋结核的临床结果。[方法]回顾性分析2017年1月—2019年1月本院收治的88例晚期髋关节结核患者的临床资料,根据医患沟通结果,44例采用一期THA,另外44例采用髋关节融合术。比较两组围手术期、随访及辅助检查资料。[结果]两组患者均顺利手术,无严重并发症。置换组在手术时间[(90.3±9.3) min vs (97.1±8.6) min,P<0.05]、术中失血量[(206.5±60.5) ml vs (231.5±54.3) ml,P<0.05]、住院时间[(14.4±1.9) d vs (15.3±1.3) d,P<0.05]、下地行走时间[(8.4±1.3) d vs (9.1±1.2) d,P<0.05]均显著优于融合组。随访时间平均(18.2±3.2)个月,两组恢复完全负重活动时间的差异无统计学意义(P>0.05)。随访过程中,局部结核复发置换组2例,融合组3例,经再次行病灶清除,并规律抗结核治疗后治愈。与术前相比,末次随访两组Harris评分均显著增加(P<0.05),置换组屈-伸及内收-外展ROM显著增加(P<0.05),而末次随访时融合组屈-伸及内收-外展ROM丧失。末次随访时,置换组在Harris评分[(93.2±8.4) vs (85.6±7.4),P<0.05]、屈-伸ROM [(102.9±9.6)°vs 0°,P<0.05]、内收-外展ROM [(164.1±13.2)°vs 0°,P<0.05]均显著优于融合组。辅助检查方面,与术前相比,两组双侧肢长差均显著减小(P<0.05)。相应时间点,两组间辅助检查指标的差异均无统计学意义(P>0.05)。[结论]一期THA及髋关节融合术对晚期髋关节结核均有较好疗效,相比之下THA手术创伤更小,功能恢复更好。[Objective] To compare the clinical outcomes of total hip arthroplasty(THA) versus hip arthrodesis(HA) in the treatment of advanced hip tuberculosis.[Methods] A retrospective study was performed on 88 patients who received surgical treatment for advanced hip tuberculosis in our hospital from January 2017 to January 2019.According to the doctor-patient communication,44 patients received onestage THA,while the other 44 received HA.The documents regarding perioperative period,follow-up and auxiliary examination were compared between the two groups.[Results] All patients in both group had corresponding surgical procedures performed successfully without serious complications.The THA group proved significantly superior to the HA group in terms of operation time [(90.3±9.3) min vs(97.1±8.6) min,P<0.05],intraoperative blood loss [(206.5±60.5) ml vs(231.5±54.3) ml,P<0.05],hospital stay [(14.4±1.9) days vs(15.3±1.3) days,P<0.05] and postoperative walking time [(8.4±1.3) days vs(9.1±1.2) days,P<0.05].The mean follow-up time lasted for(18.2±3.2) months on an average,and there was no significant difference in the time to return to full weight-bearing activities between the two groups(P>0.05).During the follow-up,local tuberculosis recurrence was noted in 2 cases of the THA group,while 3 cases in the HA group,which were cured after repeated debridement and regular anti-tuberculosis therapy.Compared with those preoperatively,the Harris scores in both groups improved significantly,while the flexion-extension and adduction-abduction range of motions(ROMs) in the THA group significantly increased(P<0.05),whereas the ROMs in the HA group were lost at the last follow-up.At the latest follow-up,the THA group was significantly better than the HA groups in terms of Harris score [(93.2±8.4) vs(85.6±7.4),P<0.05],flexion-extension ROM [(102.9±9.6)° vs 0°,P<0.05] and adduction-abduction ROM [(164.1±13.2)° vs 0°,P<0.05].Regarding auxiliary examination,the leg length discrepancy in both groups significantly decreased at the

关 键 词：晚期髋关节结核 全髋关节置换术 髋关节融合术 复发 

分 类 号：R529.2[医药卫生—内科学]