CAJ | 학술논문

目的评估非骨水泥全髋关节置换治疗晚期髋关节结核的临床效果.方法上海交通大学附属第六人民医院关节外科2004年7月至2008年9月,共晚期髋关节结核病例行全髋置换术14例,男8例,女6例.术前有1例存在开放性窦道,3例存在陈旧性已闭合窦道瘢痕.术前C反应蛋白(CRP)和红细胞沉降率(ESR)正常者未行术前抗结核治疗；CRP升高、ESR升高者给予术前抗结核治疗2周后再手术.14例中有12例采用一期彻底清创,非骨水泥假体全髋置换,其中1例髋关节高脱位,行粗隆下截骨.另2例术中发现结核,而术前未行抗结核治疗或病灶范围较广泛对彻底清创没有把握,采用间隔物植入,6～8个月后二期置换非骨水泥假体.所有病例术后均采用抗结核药物治疗6个月.结果术后随访平均49(27 ～77)个月,HSS评分从术前平均36分到术后最后一次随访平均87分.1例患者术后7个月出现结核复发,行清创术并去除假体做关节成形,其余13例没有发现结核复发、感染、脱位、骨折和神经血管损伤等并发症.终末随访没有发现进展性的透亮线或腔隙等假体松动的迹象.结论非骨水泥人工全髋关节置换是治疗晚期髋关节结核的有效方法.
목적 평고비골수니전관관절치환치료만기관관절결핵적림상효과.방법 상해교통대학부속제륙인민의원관절외과2004년7월지2008년9월,공만기관관절결핵병례행전관치환술14례,남8례,녀6례.술전유1례존재개방성두도,3례존재진구성이폐합두도반흔.술전C반응단백(CRP)화홍세포침강솔(ESR)정상자미행술전항결핵치료；CRP승고、ESR승고자급여술전항결핵치료2주후재수술.14례중유12례채용일기철저청창,비골수니가체전관치환,기중1례관관절고탈위,행조륭하절골.령2례술중발현결핵,이술전미행항결핵치료혹병조범위교엄범대철저청창몰유파악,채용간격물식입,6～8개월후이기치환비골수니가체.소유병례술후균채용항결핵약물치료6개월.결과 술후수방평균49(27 ～77)개월,HSS평분종술전평균36분도술후최후일차수방평균87분.1례환자술후7개월출현결핵복발,행청창술병거제가체주관절성형,기여13례몰유발현결핵복발、감염、탈위、골절화신경혈관손상등병발증.종말수방몰유발현진전성적투량선혹강극등가체송동적적상.결론 비골수니인공전관관절치환시치료만기관관절결핵적유효방법.
Objective The question of whether a total joint arthroplasty should be attempted in a patient with a current or previous infection of tuberculosis continues to arouse controversy.The aim of this report was to evaluate the clinical outcomes of cementless total hip arthroplasty for the treatment of advanced tuberculosis of hip.Methods A total of 14 patients with advanced tuberculosis of hip treated by cementless total hip arthroplasty were retrospectively analyzed.For the patients with a definite diagnosis of tuberculosis and elevated levels of CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) before surgery,preoperative antituberculous medications were prescribed for at least 2 weeks.The inflamed soft tissues and destroyed bones were completely curetted out at the time of operation.Twelve of 14 patients received onestage cementless total hip arthroplasty after a thorough debridement.For the remaining 2 patients,two-stage strategy was taken with cement articulating spacer implanted after a thorough debridement and followed by cementless total hip arthroplasty at 6-8 months later.All patients were prescribed antituberculous medications postoperatively for the first 6 months.Results The mean Harris Hip Score ( HHS ) was 36 preoperatively and 87 at the last follow-up.Within an average follow-up period of 49 months ( range:27-77 ),only one patient had reactivation of tuberculosis 7 months after primary THA ( total hip arthroplasty)and received resection arthroplasty.Another 13 patients had no reactivation of tuberculosis and revealed stability by bone ingrowth on both socket and femoral stem.Conclusion Cementless total hip arthroplasty is a safe and effective procedure for advanced tuberculosis of hip.With a thorough debridement followed by a conplete course of antituberculous chemotherapy,active tuberculous infection should not be considered a contraindication for THA.In patients whose diagnosis of tuberculosis is confirmed intraoperatively and with no preoperative antituberculous chemotherapy,or in those a thorough debridement can not be achieved,a two-stage surgery may be considered.