摘要
目的:观察髋关节结核行一期人工全髋关节置换术的临床疗效。方法:回顾2019年2月至2023年9月确诊为髋关节结核入院,并行一期人工全髋关节置换术治疗的患者,所有患者入院后均完善相关检查,排除全身多发结核病灶及混合菌感染,共28例28个患髋纳入观察。所有患者入院后常规抗结核治疗至少2周,复查红细胞沉降率(ESR)、C反应蛋白(CRP)及结核感染T细胞斑点试验(TBIGRA),复查结果稳定或呈下降趋势后行一期人工全髋关节置换术治疗;术后继续常规抗结核治疗至少18个月,定期复查结核相关炎性指标,CT及X线评估假体稳定程度及骨融合情况,以疼痛视觉模拟量表(VAS)评分及Harris髋关节评分评估患者恢复情况。结果:所有患者均获得18个月以上的随访,所有病例术后6个月和18个月复发率为0%,植骨融合时间为(7.21±2.75)个月,术前和术后1个月的疼痛VAS评分及Harris髋关节评分分别为(6.48±0.93)分和(37.44±5.27)分、(3.05±1.22)分和(82.41±4.90)分,术后3个月、6个月及18个月的疼痛VAS评分和Harris髋关节评分分别为(2.57±0.95)分和(92.05±3.27)分、(2.69±1.44)分和(94.55±2.07)分、(2.71±1.43)分和(94.58±2.05)分,其中术后1个月和术前评分相比,差异有统计学意义(P<0.001),术后6个月和术后3个月、术后18个月和术后6个月评分相比,差异均无统计学意义(P>0.05),术后3个月和术后1个月相比评分差异不大,但差异仍有统计学意义(P<0.001)。结论:以规范的药物治疗为基础,针对髋关节结核行一期全髋关节置换术可取得满意的临床疗效,能明显改善患者的生活质量。
Objective:To investigate the treatment protocol and clinical efficacy of onc-stage total hip arthroplasty(THA)for hip joint tuberculosis.Methods:A retrospective analysis was conducted on 28 patients(28 hips)diagnosed with hip joint tuberculosis and treated with THA from February 2019 to September 2023.All patients underwent comprehensive preoperative evaluations to exclude systemic tuberculosis or polymicrobial infections.Preoperative antituberculosis therapy was administered for at least 2 weeks.Surgery was performed afer confirming stabilized or declining levels of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP).and tuberculosis interferongamma release assay(TB-IGRA).Post-operative antituberculosis therapy continued for more than 18 months.Regular follow-ups included assessments of inflam"matory markers,CT/X-ray evaluations of prosthesis stability rand bone fusion,pain visual analogue scale(VAS)scores,and Harris hip scores(HHS).Results:All patients achieved a follow-up period of at least 18 months.The recurrence rate at 6 months and 18 months post operation was 0%for all cases.The bone graft fusion time was(7.21±2.75)months.The preoperative pain VAS scores and Harris hip scores were(6.48±0.93)points and(37.44±5.27)points,respectively;at 1 month post operation,they were(3.05±1.22)points and(82.41±4.90)points.respectively.At 3 months.6 months,and 18 months post-operation.the pain VAS scores and Harris hip scores were(2.57±0.95)points and(92.05±3.27)points,(2.69±1.44)points and(94.55±2.07)points,and(2.71±1.43)points and(94.58±2.05)points,respectively.Significant differences were observed between the preoperative scores and those at 1 month post-operation,both of which were statistically significant(P<0.001).Minimal differences were found between the scores at 3 months and 6 months post-operation.and between 6 months and 18 months post operation.neither of which were statistically significant(P>0.05).Although the numerical difference between the scores at I month and 3 months post-operation was small,the difference remained statistically significant(P<o,o01).Conclusion:Standardized antituberculosis therapy combined with one-stage THA demonstrates satisfactory clinical outcomes for hip joint tuberculosis.significantly improving patients quality of life.
作者
周宇
卞恒杰
周飞
张坡
任国飞
李同林
王睿
ZHOU Yu;BIAN Hengjie;ZHOU Fei;ZHANG Po;REN Guofei;LI Tonglin;WANG Rui(Nanjing Integratcd Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing 210014,China)
出处
《中国中医骨伤科杂志》
2025年第9期80-83,88,共5页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
基金
江苏省中医药科技发展计划面上项目(MS2022045)
南京市卫生科技发展专项(YKK22186,ZKX23058)
南京市中医药传承创新发展示范试点项目-南京市市级柔性人才引进项目(李义凯岐黄学者工作室)(宁卫财务[2024]49号)。
关键词
结核
髋
置换
生活质量
tuberculosis
hip
arthroplasty
quality of life
