一期病灶清除人工全髋关节置换术治疗活动性髋关节结核

ONE-STAGE RADICAL DEBRIDEMENT AND TOTAL HIP ARTHROPLASTY FOR TREATMENT OF ACTIVE TUBERCULOSIS OF THE HIP

目的探讨一期病灶清除、人工全髋关节置换术（total hip arthroplasty，THA）治疗活动性髋关节结核的近期疗效。方法2006年1月－2011年6月，行一期病灶清除THA治疗活动性髋关节结核12例（12髋）。其中男7例，女5例；年龄18～60岁，平均46.3岁。病程6～24个月，平均10.5个月。根据Babhulkar和Pande髋关节结核分期：Ⅲ期5例，Ⅳ期7例。1例并发窦道，2例有肺结核病史。术前髋关节屈伸活动度为（35.83 ± 9.25） °，Harris评分为（36.83 ± 6.44）分。红细胞沉降率为45～90 mm/1h，平均62.4 mm/1h；C反应蛋白为19～50 mg/L，平均33.6 mg/L。手术前后均接受正规抗结核治疗。 结果病理学检查及结核杆菌PCR检测均为阳性。术后切口均Ⅰ期愈合，无手术相关并发症发生。患者均获随访，随访时间25～60个月，平均40.8个月。患者红细胞沉降率及C反应蛋白均恢复至正常水平，无肝损害表现。随访期间11例无结核复发；1例于术后4个月复发，行二次翻修术后痊愈。X线片检查示，术后无假体移位及松动和窦道形成；18～24个月双侧骨质密度基本相同，至末次随访时双侧骨质密度无明显变化。末次随访时，髋关节屈伸活动度为（107.08 ± 13.56）°，与术前比较差异有统计学意义（t=14.571，P=0.000）；Harris评分为（88.00 ± 10.78）分，与术前比较差异有统计学意义（t=16.750，P=0.000）。 结论一期病灶清除THA治疗活动性髋关节结核，可有效缓解关节疼痛、改善关节功能，结核复发率低，近期疗效满意。

Objective To investigate the short-term effectiveness of onestage radical debridement and total hip arthroplasty （THA） in the treatment of active tuberculosis of the hip. Methods Between January 2006 and June 2011, one-stage radical debridement and THA were performed on 12 cases （12 hips） of active tuberculosis of the hip. There were 7 males and 5 females, aged 18-60 years （mean, 46.3 years）. The disease duration ranged from 6 to 24 months （mean, 10.5 months）. According to Babhulkar and Pande staging criteria, 5 cases were at stage III and 7 cases were at stage IV. One case had sinus, and 2 cases had previous pulmonary tuberculosis. Preoperative hip range of motion was （35.83 ± 9.25）°; hip Harris score was 36.83 ± 6.44. Erythrocyte sedimentation rate （ESR） was 45-90 mm/1 h （mean, 62.4 mm/1h）; C-reactive protein （CRP） was 19-50 mg/L （mean, 33.6 mg/L）. Perioperatively all the patients accepted the regular anti-tuberculous medication. Results The results of histopathological examination and PCR detection were positive for tuberculosis bacillus. Postoperatively the incisions healed primarily. All the patients were followed up 25-60 months （mean, 40.8 months）. The ESR and CRP returned to normal level with no liver injury. Tuberculosis recurrence occurred in 1 patient at 4 months after operation, which was cured after revision. X-ray film showed no prosthesis shift, prosthesis loosening, or sinus tract. At 18-24 months after operation, the bilateral sides had the same bone density, which was similar to that at the final follow-up. Hip range of motion was significantly improved to （107.08 ± 13.56）° （t=14.571, P=0.000）. Hip Harris score was significantly increased to 88.00 ± 10.78 （t=16.750, P=0.000）. Conclusion A combination of one-stage radical debridement and THA is a safe method to treat active tuberculosis of the hip, which can relief symptoms and improve hip function, with low recurrence and satisfactory short-term effectiveness.