一期病灶清除全髋关节置换术治疗活动期髋关节结核

发布时间：2018-07-15 14:27

【摘要】：目的：探讨一期病灶清除全髋关节置换术治疗活动期髋关节结核治疗效果。方法：回顾性分析我院自2009年12月至2012年7月共收治活动期髋关节结核9例，其中男7例、女2例，平均年龄40岁（16－63岁），合并肺结核3例，术前给予正规抗痨治疗平均14天（7－20天），给予一期病灶清除全髋关节置换术、8例使用生物型假体、1例使用骨水泥型假体，术后继续正规抗痨治疗平均11个月（8－12个月），髋关节功能评价采用Harris髋关节评分系统（HHS）进行评价，髋关节假体情况采用X线检查评价，并定期复查血沉、C－反应蛋白等相关检查调整抗痨治疗方案。结果：所有患者切口均一期愈合，术后无假体松动、下沉、脱位、感染等并发症、无血管、神经并发症，术前患者平均HHS评分33分（24－48分）、末次随访平均HHS评分92分（88－96分），平均随访时间20个月（8-36个月），所有患者均可不扶拐行走，X线检查未见假体松动、脱位等现象，无一例髋关节结核复发。结论：全髋关节置换术可以彻底清除病灶，，重建髋关节功能，解除患者病痛，提高患者生活质量。对于活动期髋关节结核病人通过全面的术前评估，改善患者营养状况，早期、联用、适量、规则、全程抗痨治疗，术中彻底病灶清除行全髋关节置换术是较为安全、有效的治疗手段。
[Abstract]:Objective: to investigate the effect of one-stage debridement total hip arthroplasty on active hip tuberculosis. Methods: from December 2009 to July 2012, 9 patients with active hip tuberculosis, including 7 males and 2 females, with an average age of 40 years (16-63 years) and 3 cases with pulmonary tuberculosis, were retrospectively analyzed. The average of 14 days (7-20 days) was treated with regular antituberculous therapy before operation. 8 cases of total hip arthroplasty were treated with one-stage debridement and 1 case with bone cement prosthesis. The average of postoperative regular antituberculosis treatment was 11 months (8-12 months). The hip function was evaluated by Harris hip scoring system (HHS), and the hip prosthesis was evaluated by X-ray examination. And regular check ESR C-reactive protein and other related examinations to adjust anti-tuberculosis treatment. Results: all the incisions healed in the first stage. There were no complications such as prosthesis loosening, sinking, dislocation, infection, and no complications of blood vessels and nerves. The mean preoperative HHS score was 33 (24-48), the last follow-up was 92 (88-96), the average follow-up time was 20 months (8-36 months). There was no recurrence of hip tuberculosis. Conclusion: total hip replacement can completely clear the focus, reconstruct the function of the hip, relieve the pain and improve the quality of life of the patients. It is safe for patients with active hip tuberculosis to improve their nutritional status by comprehensive preoperative evaluation, early, combined, moderate, regular, total anti-tuberculosis treatment and complete debridement during operation. An effective treatment.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R529.2;R687.4

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