CAJ | 학술논문

目的：观察病灶清除手术联合持续多管闭式引流法与单纯引流法治疗早期全膝关节结核的疗效。方法回顾性分析82例早期全膝关节结核患者病历资料。所有患者术前均常规应用抗结核药物治疗2~4周，红细胞沉降率控制在40mm/1h以下。均采用手术彻底清除病灶。根据处理方式将患者分为持续多管闭式冲洗引流组和单纯引流组。持续多管闭式冲洗引流组50例，闭式引流时间3~6周，平均3.8周；单纯引流组32例，闭式引流时间1~3周，平均1.8周；参考相关抗结核药敏试验结果，全身及局部应用敏感的抗结核药物治疗。均定期复查肝肾功能、血常规、红细胞沉降率及膝关节CT，依据结果合理调整用药方案。术后12~24个月判断膝关节结核的治疗效果，参考指标为膝关节活动度、Lysholm评分、切口愈合情况、干扰素γ、红细胞沉降率、C反应蛋白等。结果82例患者术后病理报告均符合结核诊断。随访24~48个月，平均41个月，术后8~12周干扰素γ、红细胞沉降率、C反应蛋白均正常，所有患者均无复发。持续多管闭式冲洗引流组窦道形成1例，单纯引流组窦道形成4例，经持续换药后愈合。术后12个月持续多管闭式引流组关节Lysholm评分为（89.2±8.4）分，高于单纯引流组的（75.6±7.8）分，差异有统计学意义。结论持续多管闭式引流法治疗早期全膝关节结核具有复发率低、保留关节运动功能、操作性强、费用少、应用简单的优点，临床效果好，值得临床推广应用。
목적：관찰병조청제수술연합지속다관폐식인류법여단순인류법치료조기전슬관절결핵적료효。방법회고성분석82례조기전슬관절결핵환자병력자료。소유환자술전균상규응용항결핵약물치료2~4주，홍세포침강솔공제재40mm/1h이하。균채용수술철저청제병조。근거처리방식장환자분위지속다관폐식충세인류조화단순인류조。지속다관폐식충세인류조50례，폐식인류시간3~6주，평균3.8주；단순인류조32례，폐식인류시간1~3주，평균1.8주；삼고상관항결핵약민시험결과，전신급국부응용민감적항결핵약물치료。균정기복사간신공능、혈상규、홍세포침강솔급슬관절CT，의거결과합리조정용약방안。술후12~24개월판단슬관절결핵적치료효과，삼고지표위슬관절활동도、Lysholm평분、절구유합정황、간우소γ、홍세포침강솔、C반응단백등。결과82례환자술후병리보고균부합결핵진단。수방24~48개월，평균41개월，술후8~12주간우소γ、홍세포침강솔、C반응단백균정상，소유환자균무복발。지속다관폐식충세인류조두도형성1례，단순인류조두도형성4례，경지속환약후유합。술후12개월지속다관폐식인류조관절Lysholm평분위（89.2±8.4）분，고우단순인류조적（75.6±7.8）분，차이유통계학의의。결론지속다관폐식인류법치료조기전슬관절결핵구유복발솔저、보류관절운동공능、조작성강、비용소、응용간단적우점，림상효과호，치득림상추엄응용。
OcjectiVe To compare the therapeutic effiects between multiple tube continuous closed drainage and simple drainage combined with focal debridement in treatment of early knee tuberculosis. Methods Clinical data of the patients were retrospectively analyzed. All cases got 2 -4 weeks of regular anti-tuberculosis drug treatment before surgery. ESR was controlled below 40mm/1h. All cases got surgery of debridement. According to different methods of drainage,the patients were divided into two groups:multiple tube continuous closed drainage and simple drainage,50 cases in the former group with drainage time for 3-6 weeks(average 3. 8 weeks),32 cases in the latter group with drainage time for 1-3 weeks(average 1. 8 weeks). Based on the drug sensibvivity test for anti-tuberculosis drugs, the therapeutic regimen should be modified for systemic and local administration. Liver function,renal function and blood routine,ESR,knee joint CT scan were observed on regular eXamination. Based on results,the therapeutic regimen was adjusted reasonably. The efficacy of knee tuberculosis was evaluated 12-24 months after surgery. Follow-ups included range of motion of knee,Lysholm score,healing of incision,interferon-gamma,ESR,CRP and others. Results Eighty-two cases of pathological report were tuberculosis. The follow-up period ranged from 24 -48 months( mean 41 months ). Interferon-gamma, ESR,CRP showed normal between 8-12 weeks after surgery. There were no recurrence cases. One sinuse was found in multiple tube continuous closed drainage group. Four sinuses were found in simple drainage group. They were all cured by changing dressing. Lysholm score of multiple tube continuous closed drainage group was(89. 2 ± 8. 4)scores at 12 months after surgery. Lysholm score of simple draingage group was( 89. 2 ± 8. 4 )scores,there was significant difference. Conclusion The multiple tube continuous closed drainage method in early knee tuberculosis was recommended as low recurrence rate, preserving the function of joint movement,strong operability,cheap price,easy application. The clinical effect was satisfied and had a good clinical application value.