晚期活动期髋关节结核行二期全髋关节置换的治疗体会

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摘要目的观察一期病灶清除二期全髋关节置换(total replacement of hip，THA)治疗晚期活动期髋关节结核的可行性和有效性。方法回顾性分析自2007年1月至2013年12月共15例(15髋)连续就诊的晚期活动期髋关节结核患者，其中13髋为骨与软组织严重破坏一期难以彻底清除，2髋有窦道形成，均采用一期病灶清除二期THA和围术期抗结核药物治疗。清创前抗结核治疗至少2周，清创时尽可能清除脓肿、感染与坏死的组织，而后继续强化抗结核治疗至少3个月(平均4.4个月)。当血沉与C反应蛋白达到正常值、切口完全愈合后行二期THA，术后继续抗结核治疗，使一期清创后抗结核治疗总持续时间至少达12个月。结果所有患者均获得随访，平均随访39个月，随访期间无结核复发、关节感染、脱位、假体周围骨折、松动等并发症，1例发生首次病灶清除后感染未控制，经再次清创及延长抗结核治疗后行二期THA。Harris评分由术前的平均36分提高到最后一次随访时的平均89分。结论一期病灶清除二期THA是治疗伴有髋关节严重破坏与窦道形成的晚期活动期髋关节结核安全、有效的方法。

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关键词 ：全髋关节置换, 活动性髋关节结核, 髋关节, 二期治疗

Abstract：Objective To investigate the feasibility and effectiveness of two-stage total hip arthroplsty (THA) after one-stage debridement for patients with advance active tuberculosis (TB) of the hip.Methods Fifteen consecutive patients (15 hips) with advanced active TB arthritis of the hip were retrospectively reviewed in our hospital.Out of these 15 cases，the hip of 13 were destroyed extensively with difficulties of thorough debridement at one operation，and the hips of the other 2 patients were detected of sinus tracts.All cases received the two-stage THA protocol and the perioperative antituberculous medication.During the first stage，a debridement was carried out after at least 2 weeks of antituberculous chemotherapy to remove abscesses and infect and necrotic tissues as thoroughly as possible.Then a minimum of 3 months (average 4.4 months) antituberculous chemotherapy was followed.And when the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were normal and the wound was well healed，hip prosthesis was implanted during the second stage.All cases were taken antituberculous chemotherapy to constitute a total duration of a minimum of 12 months after the first operation.Results All 15 patients were followed up for 23 to 62 months (average 39 months).No reactivation of tuberculosis，loosing of prothesis，periprothesis fracture，dislocation was observed in our 15 patients except 1 patient received the second debridement because of failed to debridement thorough in first operation.The average Harris hip score was increased from preoperative 36 to 89 at the final follow-up.Conclusion Two-stage THA after one-stage debridement following by the completed course of antituberculous medication is a alternative treatment option for patients with advanced active tuberculous of the hip under some difficult condition，such as patients with sinus tract or destroyed extensively with obstacles of thorough debridement at one operation.

Key words： total hip arthroplasty active tuberculosis of the hip hip two-stage operation

通讯作者: 张祥洪

作者简介: 彭伟秋(1970－ )，男，副主任医师，广西科技大学附属柳州市人民医院骨科，545006。

引用本文:

彭伟秋 1，张祥洪 1*，李富明 1，程珂琳 1，刘傥 2. 晚期活动期髋关节结核行二期全髋关节置换的治疗体会[J]. 实用骨科杂志, 2018, 24(1): 31-38.
Peng Weiqiu，Zhang Xianghong，Li Fuming，et al. Two-stage Total Hip Arthroplasty after One-stage Debridement for Patients with Advance Active Tuberculosis of the Hip. sygkzz, 2018, 24(1): 31-38.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I1/31

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