| 米尔阿地力·麦麦提依明,赵巍,阿布都艾尼·热吾提,等.一期人工关节置换治疗晚期活动性膝关节结核.骨科,2020,11(3): 192-198. |
| 一期人工关节置换治疗晚期活动性膝关节结核 |
| One-stage joint replacement in advanced active tuberculosis of the knee |
| 投稿时间：2020-01-08 |
| DOI：10.3969/j.issn.1674-8573.2020.03.003 |
| 中文关键词: 结核 膝关节 关节成形术，置换，膝 抗结核治疗 |
| 英文关键词: Tuberculosis Knee Arthroplasty Replacement Antitubercular therapy |
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| 中文摘要: |
| 目的 探讨一期病灶清除人工关节置换术治疗晚期活动性膝关节结核的可行性及疗效。方法 回顾性分析2009年3月至2019年3月在我院骨科中心行一期人工膝关节置换术治疗晚期活动性膝关节结核的15例病人的临床资料，其中男5例（6膝），女10例（10膝），平均年龄为53.9岁（26~77岁），入院时均有膝关节疼痛，膝关节不同程度出现畸形、活动受限，4例出现膝关节强直。术中均采用骨水泥型膝关节假体。收集15例病人入院后首次、术前、术后1周、术后1个月、术后6个月、末次随访时的C反应蛋白（C-reactive protein, CRP）、红细胞沉降率（erythrocyte sedimentation rate, ESR），术前和末次随访时的美国特种外科医院（Hospital for Special Surgery, HSS）膝关节评分和膝关节活动度（range of motion, ROM），以及假体稳定性、结核复发情况。结果 所有病人获得12~88个月随访，术后规律抗结核治疗12~18个月。12例术后病理检查见典型的结核性肉芽肿，3例抗酸染色阳性。随访期间1例复发，进行病灶清除术后治愈。ESR和CRP均在术后6个月内基本恢复正常，不同时间的数值整体比较，差异均有统计学意义（P均<0.05）。末次随访时，所有病人未见结核复发，X线检查未见假体松动，膝关节HSS评分由术前的（43.4±9.4）分增加至（82.7±7.5）分，ROM由49.3°±31.3°增加至86.0°±32.5°，手术前后的数值比较，差异均有统计学意义（t=-13.231，P<0.001；t=-5.500，P<0.001）。结论 在手术前后规律抗结核治疗、术中彻底病灶清除的前提下，一期人工关节置换治疗晚期活动性膝关节结核可以控制感染，解除疼痛，重建膝关节功能，复发率较低，远期疗效仍需进一步观察研究。 |
| 英文摘要: |
| Objective To discuss the feasibility and clinical efficacy of one-stage joint replacement in advanced active tuberculosis of the knee. Methods From March 2009 to March 2019, 15 cases of advanced active tuberculosis of knee joint were treated by one-stage knee joint replacement in the orthopedic center of our Hospital, including 5 males (6 knees), 10 females (10 knees), with an average age of 53.9 years (26-77 years). All patients had knee joint pain at the time of admission, and the knee joint was deformed and restricted in different degrees, 4 cases had ankylosis of knee joint. Cemented prosthesis was used during the operation. Following data were collected: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at the first time after admission, before surgery, 1 week, 1 month and 6 months after surgery, and last follow-up; American Hospital for Special Surgery (HSS) score and range of motion (ROM) before surgery and at last follow-up; and the stability of the prosthesis, the recurrence of tuberculosis. Results All patients were followed up for 12 to 88 months, and regular anti-tuberculosis treatment was given for 12 to 18 months. Twelve cases showed typical tuberculous granuloma after pathological examination, and 3 cases were positive for acid-fast staining. During the follow-up period, one patient relapsed and healed after debridement. Both ESR and CRP basically returned to normal within 6 months after surgery. The overall comparison of the values at different time points showed statistically significant differences (both P<0.05). At the last follow-up, all patients had no recurrence of tuberculosis, and X-ray showed no loosening of prosthesis. The knee HSS score increased from 43.4±9.4 points before operation to 82.7±7.5 points, and ROM increased from 49.3°±31.3° to 86.0°±32.5°, and the differences were statistically significant before and after the operation (t=-13.231, P<0.001; t=-5.500, P<0.001). Conclusion Under the premise of regular anti-tuberculosis treatment before and after surgery and thorough focus removal of the lesions during the operation, one-stage joint replacement treatment for advanced active knee tuberculosis can control infection, relieve pain, reconstruct knee joint function, and the recurrence rate is low. Observation and research are still required for the long-term efficacy. |
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