晚期活动性全髋关节结核一期病灶清除全髋关节置换术的中远期疗效

目的 观察晚期活动性全髋关节结核一期病灶清除全髋关节置换术的中远期疗效.方法 2002年1月至2008年12月,行一期病灶清除全髋关节置换术治疗晚期活动性全髋关节结核8例9髋.男5例,女3例；年龄18～59岁,平均39.6岁.根据Babhuulkar和Pande髋关节结核影像学分期:Ⅲ期1例1髋,Ⅳ期7例8髋.患者均有髋部疼痛症状,主动及被动活动时加重.髋关节有30°～70°屈曲畸形,后伸、外展及旋转功能障碍,Thomas征均为(+).红细胞沉降率45～125 mm/1 h,结核菌素试验均为强阳性.X线片上均有骨破坏,髋关节间隙变窄或消失,关节周围脓肿.全髋关节结核的诊断经术后病理学检查证实.术前系统抗结核四联(异烟肼+利福平+乙胺丁醇+链霉素)强化治疗2周以上；术后继续四联强化治疗3个月、三联(异烟肼+利福平+乙胺丁醇)治疗6～9个月、两联(异烟肼+利福平)维持3～6个月,总治疗时间12～18个月.结果 全部病例随访50～150个月,平均88.8个月.手术切口均一期愈合,随访期间X线检查未见假体松动及结核复发征象,红细胞沉降率在术后半年内均恢复至正常范围.Harris髋关节评分由术前(25.78±16.15)分提高至末次随访的(94.78±2.91)分,差异有统计学意义.结论 在规范的抗结核化疗保护下,一期病灶清除全髋关节置换术治疗晚期活动性全髓关节结核安全可行,术后中远期复发率低.

Medium- and long-term results of one-stage debridement and total hip arthroplasty for advanced active tuberculosis of the hip

Objective To observe the medium- and long-term results of one-stage debridement and total hip arthroplasty (THA) for advanced active tuberculosis of the hip. Methods From January 2002 to December 2008, 8 patients (9 hips) with advanced active tuberculosis of the hip underwent one-stage debridement and THA in our hospital. There were 5 males and 3 females, aged from 18 to 59 years (average, 39.6 years). According to Babhuulkar and Pande imaging classification, there were 1 case of grade Ⅲ and 7 cases of grade Ⅳ. All patients had hip pain, which got serious during active and passive motion. All patients had dysfunction in stretch, abduction, rotation and flexion of the hip, and the flexion deformity ranged from 30° to 70° (average, 46°). Thomas sign were positive in all patients. The erythrocyte sedimentation rate ranged from 45 to 125 mm/1 h. The results of tuberculin test were all positive. X-rays showed osteoclasia, narrowing or disappearance of the joint space and surrounding abscess in all patients. The diagnosis of hip joint tuberculosis was confirmed by postoperative pathological examination in all patients. All patients were treated with antituberculous medications for 12 to 18 months, including preoperative IRES (≥2 weeks) and postoperative IRES (3 months), IRE (6 to 9 months) and IR (3 to 6 months). Results All patients were followed up for 50 to 150 months (average, 88.8 months). One-stage healing of incision was obtained in all patients. X-rays showed no signs about loosening of prosthesis and recurrence of tuberculosis. The erythrocyte sedimentation rate returned to normal range within 6 months after operation. The average Harris score improved from preoperative 25.78±16.15 to 94.78±2.91 at final follow-up, and the difference was significant. Conclusion Under the standard antituberculosis chemotherapy, the one-stage debridement and THA are safe and feasible for advanced active tuberculosis of the hip, which can result in satisfactory medium- and long-term results.