全髋关节置换术治疗结核性髋关节退变

Total Hip Arthroplasty for Hip Degeneration following Tuberculosis

目的:探讨采用全髋关节置换术治疗结核感染后髋关节退变的适应证和临床疗效。方法:自2003年3月至2006年2月收治6例有既往髋关节结核病史的髋关节退变,男5例,女1例;年龄40～65岁,平均50.8岁;感染静息期均达12年以上,平均19.5年。术前采用Kim方法评估髋关节畸形的严重程度,其中I型3例,II型2例,III型1例。术前主要依据体格检查以及检测血沉和C反应蛋白来排除活动性结核。手术采用髋外侧切口,彻底切除关节周围的瘢痕组织,松解软组织;全部选择非骨水泥固定的髋臼假体和股骨假体。围手术期没有进行抗结核药物治疗。采用Harris评分系统评价手术前后髋关节的功能。结果:术后随访18～50月,平均31.5月。所有病例无术后感染、下肢神经功能损伤或深静脉栓塞形成等并发症。到最后一次随访,所有病例无复发活动性结核;平均Harris评分由术前的42.5分提高到83分;没有出现假体的松动,或明显的假体周围骨溶解。结论:全髋关节置换术治疗结核感染后的髋关节退变,近期临床疗效满意。病例选择应在结核感染静息10年以上,而且术前排除活动性结核的可能,围手术期可以不进行抗结核药物治疗。

Objective：To explore the indications and clinical effect of total hip replacement for hip degeneration following tu- berculosis. Methods：From Mar. 2003 to Feb. 2006, 6 patients （5 males and 1 female） with hip degeneration following tu- berculosis were enrolled, aging from 40 to 65 years old with an average age of 50.8 years. The quiescent period of tubercu- losis all lasted over 12 years, 19.5 years on average. According to Kim classification, 3 cases were type Ⅰ, 2 were type Ⅱ and 1 was type Ⅲ Active tuberculosis was excluded by preoperative physical examination, tests of erythrocyte sedimentation rate and C-reactive protein level. The lateral incision was adopted in all cases, and cementless prosthesis of the hip joint was employed in the operation. Before or after the surgery, no patient was given anti-tuberculous chemotherapy. The clinical results of affected hips were assessed according to Harris scores. Results： The follow-up lasted from 18 to 50 months, with the mean duration of 31.5 months. No recurrence of infection, damage of nerve function or deep vein thrombosis of lower extremities occurred in any case. At the latest follow-up, no recurrence of active tuberculosis was observed, the mean Harris score before surgery was improved from 42.5 points to 83 points. And no prosthesis loosening or periprosthetic osteolysis was found. Conclusion：Total hip arthroplasty showed satisfactory short term results for degenerative hips with history of tuberculosis infection. It was important that the quiescent period of tuberculosis be more than 10 years and preoperative possibility of active tuberculosis be ruled out. If then, postoperative anti-tuberculous therapy was not a necessity.