活动性髋关节结核一期病灶清除全髋关节置换28例报告

目的 探讨活动性髋关节结核一期病灶清除全髋关节置换的可行性及其临床疗效.方法 回顾性分析2007年1月至2010年10月期间接受一期病灶清除全髋关节置换治疗的28例晚期活动性髋关节结核患者的相关资料,男17例,女11例；年龄18～72岁,平均36岁.8例单纯关节内脓肿,20例合并关节周围脓肿；均有髋臼及股骨头骨破坏.术前红细胞沉降率为28～102 mm/1 h,平均52 mm/1 h；C反应蛋白为11～73 mg/L,平均38 mg/L.9例合并肺结核,1例合并脊柱结核,术前抗结核治疗时间平均7周(3～32周).所有患者术中均彻底清除髋关节周围脓肿、髋臼死骨,将切除的股骨头颈清除病灶组织后置于体积分数75％酒精浸泡5 min,用生理盐水冲洗,用于骨缺损区植骨,采用非骨水泥型假体置换.病理检查证实为髋关节结核.术后系统抗结核治疗18个月.结果 28例患者均获得随访,随访时间24～56个月,平均37个月.所有患者切口一期愈合,红细胞沉降率恢复正常时间平均为3.3个月(2～5个月),C反应蛋白恢复正常时间平均为2.1个月(1～3个月).髋关节Harris评分从(30.214±9.350)分改善至(90.535±6.746)分.1例患者术后13个月自行停用抗结核化疗后结核复发,术后56个月随访时患者能行走,股骨柄和髋臼杯无松动,目前保留假体密切随访中.结论 活动性全髋关节结核在有效抗结核化疗的基础上行一期病灶清除全髋关节置换可获得较好的临床疗效.

One-stage focal debridement and total hip replacement for active tuberculosis: a report of 28 cases

Objective To evaluate the feasibility and clinical efficacy of one-stage focal debridement and total hip replacement (THR) in treatment of active tuberculosis of the hip. Methods A retrospective analysis was done for 28 cases of active hip tuberculosis who were treated with one-stage focal debridement and THR in our hospital from January 2007 to October 2010. There were 17 males and 11 females, with an average age of 36 years (range, 18-72 years). Eight patients had abscess only inside the joint, while 20 also had periarticular abscess. All patients had acetabular and femoral head damage. The erythrocyte sedimentation rate (ESR) before operation averaged 52 mm/l h (range, 28-102 mm/l h), and the C-reactive protein (CRP) averaged 38 mg/L (range, 11 to 73 mg/L). The anti-tuberculous treatment before operation lasted 7 weeks in average (range, 3-32 weeks). The abscess and acetabular sequestra around the joint were cleared in all operations. The removed femoral head and neck issue were cleared from focus, soaked in 75% alcohol for 5 min, washed with saline, and used as implant in area of bone defect. Cementless THR was performed. All cases were confirmed as hip tuberculosis by pathological examination. Anti-tuberculous treatment was applied for 18 months after operation. Results All of 28 patients were followed up for an average of 37 months (range, 24-56 months). All patients had first intention healing. ESR returned to normal in an average of 3.3 months (range, 2-5 months), and CRP 2.1 months (range, 1-3 months). The Harris hip score improved from 30.214±9.350 preoperatively to 90.535±6.746 postoperatively. One patient stopped anti-tuberculosis chemotherapy 13 months after operation at his own choice, and relapsed. He was able to walk 56 months after operation, and no loosening was observed in the hip stem or acetabular cup. The patient has the prosthesis retained and is under close follow-up. Conclusion It is reliable to use one-stage focal debridement and THR based on effective anti-tuberculous chemotherapy to treat active tuberculosis of the hip.