全髋关节型占位器与压力模型占位器治疗中晚期髋关节结核效果的对比研究  

A comparative study on the therapeutic effects of total hip joint type spacer and pressure model spacer in patients with mid to late stage hip tuberculosis

作　　者：宋宏阁 刘维高 陈莉[1] Song Hongge;Liu Weigao;Chen Li(Department of Orthopedics,Henan Infectious Disease Hospital/The Sixth People’s Hospital of Zhengzhou,Zhengzhou 450015,China)

机构地区：[1]河南省传染病医院/郑州市第六人民医院骨科,郑州450015

出　　处：《中国防痨杂志》2024年第5期562-566,共5页Chinese Journal of Antituberculosis

摘　　要：目的:对全髋关节型占位器(骨水泥、股骨柄、陶瓷关节头等组成的复合体假体)和常规压力模型占位器一期旷置治疗中晚期髋关节结核术后5年的患者生活质量进行评价和比较。方法:回顾性分析2016年1月至2018年12月河南省传染病医院收治的52例中晚期髋关节结核患者的临床资料。术后2~5年内因其他原因/因病去世2例,获得完整随访资料者共50例。根据治疗方法将患者分为全髋关节型组22例,采用全髋关节型占位器进行治疗;压力模型组28例,采用常规压力模型占位器进行治疗。比较两组患者术前和术后1、3、6、12、24、36、48、60个月Harris关节评分,负重20 kg步行试验完成率,术后疼痛、占位器脱位和断裂等并发症的发生率。结果:由于压力模型组在6~24个月时间段脱位及断裂发生率较高,不再比较两组36~60个月各时间段Harris关节评分及负重20 kg步行试验完成率。全髋关节型组术后1、3、6、12、24个月Harris关节评分[(76.45±5.23)(86.55±3.78)(89.32±3.15)(92.05±2.72)(94.09±1.90)分]均明显高于压力模型组[(61.00±6.13)(71.93±5.38)(76.82±11.41)(81.75±15.00)(78.93±15.75)分],差异均有统计学意义(t值分别为9.427、10.809、4.978、3.558、5.047,P值均为<0.001);术后1、3、6、12、24个月全髋关节型组负重20 kg步行试验完成率[27.3%(6/22)、81.8%(18/22)、100.0%(22/22)、100.0%(22/22)、100.0%(22/22)]均明显优于压力模型组[0.0%(0/28)、7.1%(2/28)、17.9%(5/28)、21.4%(6/28)、17.9%(5/28)],差异均有统计学意义(χ^(2)值分别为9.416、28.626、33.466、30.867、33.466,P值分别为0.002、<0.001、<0.001、<0.001、<0.001);全髋关节型组占位器脱位率[0.0%(0/22)]及断裂发生率[0.0%(0/22)]均明显低于压力模型组[7.1%(2/28)和21.4%(6/28)],差异均有统计学意义(χ^(2)值分别为14.351、11.928,P值均为<0.001)。结论:全髋关节型占位器的使用能够加快髋关节结核一期旷置术后患者的恢复进程Objective:To evaluate and compare the quality of life in patients with advanced hip joint tuberculosis(TB),who received one-stage open placement treatment with a total hip joint type spacer device(composite prosthesis composed of bone cement,femoral stem,ceramic joint head,etc.)and a conventional pressure model spacer device,within 5 years after surgery.Methods:A retrospective analysis was conducted.The clinical data of 52 patients with advanced hip joint TB admitted at Henan Provincial Infectious Disease Hospital from January 2016 to December 2018 were analyzed.Within 2-5 years after surgery,2 cases died due to other reasons or illness,and the remaining 50 cases received follow-up and their relevant data were completely collected.According to the treatment method,the patients were divided into two group,namely:22 cases were in the total hip joint type group,who were treated with a total hip joint type spacer device;28 cases were in the pressure model group,who were treated with conventional pressure model spacer.Compare the Harris joint scores,completion rate of the 20 kg walking test as well as the incidence of postoperative complications such as pain,dislocation and rupture of the spacer device between two groups of patients before surgery and at 1,3,6,12,24,36,48,60 months after surgery.Results:Due to the high incidence of dislocation and fracture in the pressure model group during the period of 6 to 24 months after surgery,Harris joint scores and completion rates of the 20 kg walking test were no longer compared between the two groups at different time periods of 36 to 60 months after surgery.The Harris joint scores in the total hip joint type group(76.45±5.23,86.55±3.78,89.32±3.15,92.05±2.72,94.09±1.90)at 1,3,6,12 and 24 months after surgery were respectively higher than those in the pressure model group(61.00±6.13,71.93±5.38,76.82±11.41,81.75±15.00 and 78.93±15.75).The differences were statistically significant(t-values were 9.427,10.809,4.978,3.558,and 5.047 respectively,with all P-values<0.001)

关 键 词：髋关节 结核 关节成形术 生活质量 对比研究 

分 类 号：R529.2[医药卫生—内科学] R81[医药卫生—临床医学]