156例膝关节结核临床流行病学特征及关节镜手术疗效分析

Clinical features of knee tuberculosis and curative effect of arthroscopic surgery in 156 cases

目的分析膝关节结核临床流行病学特征,探讨膝关节镜手术结合抗痨治疗膝关节结核的疗效。方法回顾性分析2001年1月至2010年12月本院关节中心收治的156例膝关节结核病例资料,对患者性别、侧别、并发其他部位结核、年龄分布、时间段分布、病变程度、关节镜手术疗效等情况进行分析。结果在156例157侧膝关节结核中,男性占59.6%,女性占40.4%,男女性别比1.47∶1(P<0.05);左膝占45.86%,右膝占54.14%,双侧比较差异无统计学意义(P>0.05);单发膝结核占90.38%,多发结核占9.62%;有全身症状的膝关节结核占27.6%;实验室检查中血沉异常患者占92.18%,PPD阳性率为86.67%,结核抗体阳性率为59.70%,PCR阳性率为33.96%;病理报告为结核的占56.41%;高发年龄段为30～39岁;滑膜结核(无软骨损伤)占21.15%,滑膜结核(有软骨损伤)占29.49%,全膝关节结核占49.36%,三者术前Lysholm平均评分分别为(73.32±22.45)、(48.56±24.67)、(24.78±23.43)分,术后6个月的99位患者Lysholm平均评分分别为(91.72±30.56)、(88.62±29.43)、(85.03±28.65)分。结论膝关节结核男性多于女性,以单发结核最常见,各年龄段均有发病,30～39岁为高发年龄段;结核对膝关节的破坏巨大;膝关节结核的诊断需要多种诊断方法进行综合考虑;膝关节镜手术配合正规抗痨药物治疗疗效显著。

Objective To investigate and analysis the clinical features of knee tuberculosis and the efficacy of arthroscopic surgery in knee tuberculosis.Methods Clinical datas of the patients from January 2001 to December 2010 were retrospectively analyzed.ResultsThere are 59.6% man and 40.4% woman in the 156 cases of 157 knees,and the sex ratio is 1.47 ︰ 1（P0.05）.With 45.86% of left side and 54.14% of right side,it is of no significant difference between sides（P0.05）.There are 90.38% accounted in single knee and 9.62% accounted in multiple nodules.There are 27.6% of knee tuberculosis with systemic symptoms and 92.18% with elevated in ESR.The positive rate is 86.67% in PPD,59.70% in TB antibody,and 33.96% in PCR.There are 56.41% cases with the report of tuberculosis and age from 30 to 39 is the highest group.Synovial tuberculosis with no cartilage damage accounted for 21.15% while synovial tuberculosis with cartilage damage accounted for 29.49%,and total knee tuberculosis accounted for 49.36%.The average Lysholm score of the three are（73.32±22.45）,（48.56±24.67） and（24.78±23.43） points before surgery,and the average Lysholm score of the three are（91.72±30.56）,（88.62±29.43）,（85.03±28.65） points 6 months after surgery in 99 case.Conclusion Tuberculosis of knee joint is more popular in men than in women;the single knee tuberculosis is the most common one;30-39 years-old is the high-risk age;arthroscopic with regular tuberculosis drug treatment is a significant effect method for knee tuberculosis which is a huge damage to the knee and requires more than one diagnostic method.