| 全膝关节表面置换术治疗结核性膝关节强直或僵硬(附10例报告) |
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| 引用本文： | 胡胜平,石仕元,费骏,赖震,马鹏飞. 全膝关节表面置换术治疗结核性膝关节强直或僵硬(附10例报告)[J]. 中国防痨杂志, 2018, 40(8): 884-889. DOI: 10.3969/j.issn.1000-6621.2018.08.019 |
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| 作者姓名： | 胡胜平 石仕元 费骏 赖震 马鹏飞 |
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| 作者单位： | 310003.杭州,浙江省中西医结合医院 浙江省结核病诊疗中心 |
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| 基金项目： | 杭州市科技发展计划项目(2015YD22) |
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| 摘 要： | 目的 探讨全膝关节表面置换治疗膝关节结核强直或僵硬膝的临床应用可行性。方法 回顾性分析2011年10月至2015年7月我院收治的膝关节结核强直或僵硬膝患者10例,行全膝表面置换术,术前充分评估膝关节功能及结核控制情况,对膝关节结核控制良好,骨缺损不影响假体稳定,无窦道混合感染存在者,行实验室及膝关节MRI、X线、CT扫描等影像学检查,规范化抗结核药物治疗后,行全膝表面置换术,术后继续行正规抗结核药物治疗,随访评估关节假体稳定性、膝关节功能[美国特种外科医院膝关节评分 (hospital for special surgery knee score, 简称 “HSS 评分”)]及关节活动度,关节结核的复发情况。结果 10例患者中,强直膝3例,僵硬膝7例;其中活动期膝关节结核4例,病程4~9个月;陈旧性膝关节结核6例,病程20~41个月;术后全部获24~41个月随访,平均(35.4±9.6)个月;手术时间90~118min,平均(102.0±8.5)min;患者术前膝关节僵硬角度15.0°~55.0°,至末次随访,膝关节屈膝角度恢复至95.0°~120.0°,平均(105.0±14.8)°;伸直角度恢复至-5.0°~10.0°,平均(0.5±7.0)°;术前膝关节HSS评分为(46.6±16.2)分,术后恢复至(79.6±9.6)分。至末次随访,全部假体未见松动,结核无复发。结论 在个体化正规抗结核治疗的前提下,采用普通表面膝关节置换治疗结核性膝关节强直或僵硬疗效确定、临床可行,但需严格掌握手术适应证。
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| 关 键 词： | 结核 骨关节 膝关节 关节强直 关节成形术 置换 膝 治疗结果 |
| 收稿时间： | 2018-01-29 |
Clinical effects of total knee resurface arthroplasty in treatment of patients with tuberculous knee joint stiffness or rigidity |
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| Sheng-ping HU,Shi-yuan SHI,Jun FEI,Zhen LAI,Peng-fei. MA. Clinical effects of total knee resurface arthroplasty in treatment of patients with tuberculous knee joint stiffness or rigidity[J]. The Journal of The Chinese Antituberculosis Association, 2018, 40(8): 884-889. DOI: 10.3969/j.issn.1000-6621.2018.08.019 |
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| Authors: | Sheng-ping HU Shi-yuan SHI Jun FEI Zhen LAI Peng-fei. MA |
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| Affiliation: | Zhejiang Provincial Integrated Chinese and Western Medicine Hospital, Zhejiang Provincial Clinical Center for Tuberculosis Diagnosis and Treatment,Hangzhou 310003,China |
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| Abstract: | Objective To explore the clinical feasibility of total knee resurface arthroplasty (TKR) in treatment of the patients with tuberculous knee joint stiffness.Methods A retrospective analysis was used. A total of 10 cases with tuberculous knee joint stiffness, who hospitalized at our hospital from October 2011 to July 2015 and were treated with TKR, were enrolled into this study. Before the operation of TKR, a comprehensive assessment was given to each patient, including the function of the knee joint and the situation of tuberculosis (TB) disease. The laboratory examinations, magnetic resonance imaging (MRI) of knee joint, X-ray and CT scan, as well as the correct anti-TB chemotherapy were given to the patients. The total knee resurface arthroplasty was performed to the patients whose knee joint TB had been well controlled, bone defects did not influence the stability of joint prostheses and had no sinus tract and mixed infections. After the operation, the correct anti-TB chemotherapy was continued, and the joint prosthesis stability, the knee joint functions (Hospital for Special Surgery Knee Score (HSS) was used), the range of motion and the relapse of knee joint TB were evaluated.Results Before the operation, among 10 patients, 3 cases had rigidity knee while 7 cases had stiff knee; 4 cases had active knee joint TB with the disease course of 4-9 months, and the remaining 6 patients had old lesions of knee joint TB with the disease course of 20-41 month. All patients were followed up till 24-41 months after surgery, and the average follow-up time was (35.4±9.6) months. The time of operation ranged from 90 minutes to 118 minutes, and the average time was (102.0±8.5) minutes. The preoperative knee joint stiffness angle of the patients ranged from 15.0° to 55.0°; at the end of follow-up, the flexion angle of the patients’ knee ranged from 95.0°to 120.0°(mean (105.0±14.8)°) and the extensor angle ranged from -5.0°to 10.0°(mean (0.5±7.0)°). The score of HSS had improved from 46.6±16.2 before the operation to 79.6±9.6 after the operation. At the end of follow-up, no loosening of joint prostheses and no relapse of TB were found.Conclusion Under the premise of individual and correct anti-TB chemotherapy, the clinical treatment to the patients with tuberculous knee joint stiffness by using total knee resurface arthroplasty is effective and feasible. However, the surgical indications should be strictly assessed and followed. |
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| Keywords: | Tuberculosis osteoarticular Knee joint Ankylosis Arthroplasty replacement knee Treatment outcome |
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