摘要
目的观察一期病灶清除、二期全髋关节置换术（THA）治疗晚期活动性髋关节结核的临床疗效。方法自2008年1月至2013年12月,兰州军区兰州总医院骨科研究所关节外科采用一期彻底清创、二期THA治疗晚期髋关节结核17例（排除髋关节外其他部位存在活动性感染者）,男12例,女5例;年龄20-63岁,平均34.6岁;Babhulkar分期Ⅲ期3例、Ⅳ期14例。清创前抗结核治疗2-4周,行彻底清创术后继续强化抗结核治疗3-6个月,而后再行生物固定型THA,术后抗结核治疗12-18个月。对手术前后髋关节活动度、髋关节;功能评分（Harris评分）等指标采用配对t检验进行统计分析。结果术后平均随访34个月（8-48个月）。髋关节屈伸活动度术前为（35±9）°,末次随访为（103±11）°（t=12.32,P〈0.05）;Harris评分术前为（36±6）分,末次随访为（86±9）分（t=9.64,P〈0.05）。17例患者中16例术后切口一期愈合,未发现结核复发、感染、脱位、假体周围骨折、松动等并发症;1例发生术后感染,经彻底清创、更换髋臼内衬及抗感染治疗后临床治愈。结论一期病灶清除、二期THA和正规抗结核药物治疗,是治疗晚期活动性髋关节结核的安全、有效手段。
Objective To observe the clinical results of total hip arthroplasty（ THA） after onestage debridement for advanced active hip tuberculosis. Methods From January 2008 to December 2013,17 cases of advanced active hip tuberculosis underwent two-stage THA after one-stage debridement at Lanzhou General Hospital of PLA. There were 12 males and five females,aged from 20 to 63 years with an average of 34. 6 years,including three cases of grade Ⅲ and 14 cases of grade Ⅳ hip by Babhulkar classification. All the patients were treated by antituberculous medications for two to four weeks preoperatively,and for three to six months after one-stage thorough debridement; all the cases received two stage cementless THA. Postoperative antituberculous medications were prescribed for 12 to 18 months. The clinical efficacy was evaluated according to the range of motion of hip and Harris score. Results All 17 patients were followed up for 8 to 48 months（ 34 months on average）. At the final follow-up,the range of motion of the hip was significantly improved from（ 35 ± 9） ° to（ 103 ± 11） °（ t = 12. 32,P〈 0. 05）,and Harris score was obviously increased from（ 36 ± 6） to（ 86 ± 9）（ t = 9. 64,P〈 0. 05）. One stage healing of the incision was achieved in all the patients except one case,with no recurrence of tuberculosis,loosening of prosthesis, periprosthetic fracture, dislocation or other complications. One patient with postoperative infection was successfully treated by a thorough debridement and replacement of the acetabular liner followed by a complete course of antibiotics. Conclusion Two-stage THA after one-stage debridement combining the complete course of antituberculous medications is a safe and effective method for advanced active hip tuberculosis.
出处
《中华关节外科杂志（电子版）》
CAS
2016年第2期1-6,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
甘肃省科技计划项目(1208RJZA108)
全军医药卫生基金课题(CLZ12JAO7)
关键词
髋关节
结核
关节成形术
Hip joint
Tuberculosis
Arthroplasty
