病灶清除植骨融合联合外支架治疗晚期腕关节结核疗效观察  

Short-term clinical efficacy observation of lesion removal,bone graft fusion,and external brace treatment for late-stage wrist tuberculosis

作　　者：胡艺彬 费骏 胡德新 陈根君 胡金平 HU Yi-bin;FEI Jun;HU De-xin;CHEN Gen-jun;HU Jin-ping(The Second Clinical Medical College of Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang,China;Department of Orthopaedics,Hangzhou Chest Hospital Affiliated to Zhejiang University Medical College,Hangzhou 310003,Zhejiang,China)

机构地区：[1]浙江中医药大学第二临床医学院,浙江杭州310053 [2]浙江大学医学院附属杭州市胸科医院骨科,浙江杭州310003

出　　处：《中国骨伤》2024年第1期51-56,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:观察病灶清除植骨融合联合外固定架治疗腕关节结核的临床疗效。方法:2015年10月至2019年5月,采用病灶清除植骨融合联合外固定术治疗25例晚期腕关节结核患者,男14例,女11例;年龄40~74 (60.72±8.45)岁;病程5~24 (11.52±7.61)个月;左腕结核11例,右腕结核14例,合并窦道形成者5例。术后继续规律抗结核,观察患者治疗前后视觉模拟疼痛评分(vasual analogue scale,VAS)、炎症指标、Gartland-Werley腕关节功能评分、上肢功能评分(disabilities of the arm,shoulder and hand,DASH)。结果:25例患者获得随访,时间12~36(19.7±6.3)个月,末次随访患者切口愈合可,均无结核、感染复发。术前1周与术后3个月VAS分别为(5.16±1.14)、(1.68±0.80)分,红细胞沉降率(enythrocyte sedimentation rate,ESR)分别为(44.20±20.56)、(14.44±1.14) mm·h^(-1),C反应蛋白(C-reactive protein,CRP)为(12.37±7.95)、(4.30±3.37) mg·L^(-1),各时间点比较差异均有统计学意义(P<0.01)。术前1周与术后1年Gartland-Werley腕关节功能评分分别为(21.32±3.44)、(14.96±1.37)分,两者比较差异有统计学意义(P<0.01);DASH由术前1周的(70.52±7.95)分,提高至术后1年的(28.84±2.30)分(P<0.01)。末次随访所有患者结核病无复发。结论:采用病灶清除植骨融合联合外固定术治疗腕关节结核近期临床疗效满意。Objective To observe the clinical efficacy of lesion removal,bone grafting,fusion,and external fixation in the treatment of late-stage wrist tuberculosis.Methods From October 2015 to May 2019,25 patients with late-stage wrist tuberculosis were treated using lesion removal,bone grafting,fusion,and external fixation.Among these patients,there were 14 males and 11 females,aged from 40 to 74 years old,with an average age of(60.72±8.45)years old.The duration of the disease ranged from 5 to 24 months,with an average of(11.52±7.61)months.There were 11 cases of left wrist tuberculosis and 14 cases of right wrist tuberculosis,with 5 cases accompanied by sinus formation.Postoperative regular anti-tuberculosis treatment was continued.Visual analogue score(VAS),inflammatory indicators,Gartland-Werley wrist function score,and upper limb function score were observed before and after treatment.Results All 25 patients were followed up for ranging from 12 to 36 months with an average of(19.7±6.3)months.At the latest follow-up,all wounds were healed satisfactorily,and there was no recurrence of tuberculosis or infection.VAS at one week before operation and three months after operation were(5.16±1.14)score and(1.68±0.80)score respectively.One week before operation and three months after operation,erythrocyte sedimentation rate(ESR)was(44.20±20.56)mm·h-1 and(14.44±1.14)mm·h^(-1),and C-reactive protein(CRP)was(12.37±7.95)mg·L^(-1) and(4.3±3.37)mg·L-1.The differences in all three data sets were statistically significant(P<0.01).According to Gartland-Werley wrist function scoring,the scores at one week before operation and one year after operation were(21.32±3.44)and(14.96±1.37)respectively,showed a statistically significant difference(P<0.01).According to the upper limb function score(disabilities of the arm,shoulder,and hand,DASH),the score was(70.52±7.95)at one week before operation and(28.84±2.30)at one year after operation.The difference was statistically significant(P<0.01).At the latest follow-up,no patient had

关 键 词：腕关节 结核 外固定 植骨融合术 

分 类 号：R681.7[医药卫生—骨科学]