一期病灶清除人工关节置换治疗晚期活动性全膝关节结核

发布时间：2018-04-18 22:09

本文选题：膝关节 + 结核　；参考：《新疆医科大学》2015年硕士论文

【摘要】：目的：探讨一期病灶清除人工关节置换对成人晚期活动性全膝关节结核可行性和疗效。方法：回顾性分析2005年06月至2013年06月行一期病灶清除人工关节置换治疗成人全膝关节结核22例,男9例(9个膝),女13例(13个膝)；年龄23～66岁,平均45.23岁。患者均有膝关节疼痛症状,患膝肿胀,主动及被动活动疼痛均加重。膝关节不同程度伸屈功能受限,膝关节内外侧间隙压痛均阳性,8例膝关节强直。红细胞沉降率27-72mm/h,平均47.77mm/h。X线及CT检查均示：关节间隙变窄或消失,骨质不可逆性受损。膝关节结核诊断术后病理检查证实。术前系统抗结核四联强化治疗2周-4周；术后继续四联强化治疗2周,出院后三联维持9～18月。结果：全部病例随访14～110月,平均30.46月。手术切口均一期愈合,1例术后2月结核复发,1例术后6年假体无菌性松动,余病例随访期间X线检查未见假体松动及结核复发现象,红细胞沉降率均在术后半年内恢复正常。AKS膝关节评分由术前(25.59±5.07)分提高到末次随访时(85.09±4.23)分,差异有统计学意义。结论：在规范的抗结核化疗下,一期病灶清除人工关节置换治疗成人晚期活动性全膝关节结核可达到控制感染,解除疼痛,安全、可行,术后远期复发率低。
[Abstract]:Objective: to investigate the feasibility and effect of one-stage debridement artificial joint replacement for late active total knee tuberculosis in adults.Methods: 22 adult patients with total knee joint tuberculosis were treated with one-stage debridement artificial joint replacement from June 2005 to June 2013. There were 9 males (9 knees) and 13 females (13 knees), aged 2366 years (mean 45.23 years).All patients had knee joint pain symptoms, knee swelling, active and passive pain aggravated.The extension and flexion function of the knee joint were limited to different degrees, and 8 cases of knee ankylosis were positive for tenderness in the internal and external space of the knee joint.The erythrocyte sedimentation rate was 27-72 mm / h, and the mean 47.77mm/h.X and CT showed that the joint space became narrow or disappeared, and the bone was irreversibly damaged.Diagnosis of knee tuberculosis postoperative pathological examination confirmed.The patients were treated with systemic anti-tuberculosis quadruple intensive therapy for 2 weeks to 4 weeks before operation, and for 2 weeks after operation, and for 9 to 18 months after discharge.Results: all patients were followed up from 14 to 11 months, with an average of 30.4 months.All the incisions were healed in one case with recurrence of tuberculosis at 2 months after operation and 1 case with aseptic loosening of prosthesis 6 years after operation. During the follow-up period of the remaining cases, there was no loosening of prosthesis and recurrence of tuberculosis.The erythrocyte sedimentation rate was increased from 25.59 卤5.07 to 85.09 卤4.23 at the last follow-up.Conclusion: under the standard anti-tuberculosis chemotherapy, one-stage debridement artificial joint replacement can control infection, relieve pain, safety and feasibility, and lower long-term recurrence rate in adult patients with active total knee tuberculosis.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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