33例全关节结核的关节镜治疗经验总结

目的:探讨应用关节镜治疗全关节结核的方法和疗效. 方法:收集1995年2月至2006年5月经关节镜治疗的33例全关节结核病例,其中肩关节结核4例,肘关节结核3例,髋关节结核5例,膝关节结核18例,踝关节结核3例.镜下对关节彻底清理,对干酪样坏死组织或脓液进行结核杆菌培养和药物敏感性试验,术毕置管冲洗.术后关节腔用抗结核药物冲洗1～2周,肩、肘关节绷带固定3周后活动,髋、膝、踝关节石膏固定12周(22例)或外固定架固定3～6个月(2例).根据药敏试验结果进行抗结核治疗,持续1年.结果:本组33例均获3个月以上随访,根据Ikeuchi膝关节评分标准,疗效优25例,良8例.髋、膝、踝关节全部融合,所有关节伤口均一期愈合.结论:对于早、中、晚期,甚至合并窦道形成的全关节结核,均可考虑行关节镜下关节清理术.对全关节结核的镜下清理可以彻底清创,减轻创伤,降低伤口不愈合率,保持非负重关节的功能,提高负重关节的融合率.在药敏试验指导下的有针对性的抗结核治疗非常重要.

Arthroscopic treatment for total joint tuberculosis:33 cases report

Objective:To explore the feasibility of arthroscopic treatment for total joint tuberculosis.Methods:From February 1995 to May 2006,thirty-three cases of total joint tuberculosis undergoing arthroscopic management were retrospectively reviewed.Four cases were tuberculosis of shoulder joint, 3 were olecranarthrocace, 5 were coxotuberculosis, 18 were tuberculosis of knee joint, and 3 cases were ankle joint tuberculosis. The joints were thoroughly debrided followed by irrigating tube insertion. Tissue with caseous necrosis or pus was sent for isolating and culturing tubercle bacillus and drug susceptibility test. Irrigation of joints cavity with antituberculosis drugs lasted 1-2 weeks post-operatively.Non-weight-loading joints, such as shoulder joint or elbow joint, were immobilized with bandage for 3 weeks,followed by motion exercises, but for weight-loading joints, such as hip, knee or ankle joint, 22 cases were immobilized with plaster for at least 12 weeks and 2 cases were fixed with external fixator. All cases received antituberculosis chemotherapy directed by the drug susceptibility test. Results: All patients were followed-up at least for 3 months post-operatively. According to Ikeuchii's criteria,25 were excellent and 8 were good.All wounds obtained primary healing and all cases of hip, knee or ankle joint got joint fusion. Conclusions:Arthroscopic management is suitable for total joint tuberculosis at all stages, even for advanced stage with sinus tract formation. This method permits thorough debridement of the tuberculous focus with limited invasion, so complications related to the open operation such as disunion of the wounds significantly decreased.The function of non-weight-loading joints can be maintained and the weight-loading joints can well fuse. Antituberculosis chemotherapy directed by the drug susceptibility test is very important for preventing tuberculosis recurrence.