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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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

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