骨关节结核中红细胞沉降率与预后的临床分析

The clinical analysis about the erythrocyte sedimentation rate and prognosis in the patients with osteoarticular tuberculosis

目的探讨红细胞沉降率对骨关节结核手术预后的影响。方法选取接受手术治疗的403例骨结核患者,脊柱结核178例,膝关节结核83例,髋关节结核79例,肘关节结核14例,踝关节结核11例,腕关节结核38例。脊柱、髋关节结核部分患者适当控制红细胞沉降率,膝、踝、肘、腕关节结核患者中红细胞沉降率>85 mm/1h的患者给予化疗药物治疗控制红细胞沉降率至85mm/1h以内,其他患者术前未给予长期抗结核药物。按照术前红细胞沉降率分为<40mm/1h,40~85mm/1h,>85mm/1h3组,根据患者病灶、脓肿大小行手术清理。比较3组患者术前术后VAS评分、一期愈合率、复发率。结果 31例患者病理结果回报为急慢性炎症,其余术后病理或结核菌培养结果均证实为结核。3组术前、术后VAS评分差异均无统计学意义(P>0.05)。3组临床疗效差异无统计学意义(P>0.05)。结论手术治疗是骨关节结核治疗中的重要方法,红细胞沉降率对远期复发率及功能恢复无明显影响,手术指征可综合考虑,高红细胞沉降率不再作为单一绝对禁忌证。

Objective To investigate influence of the erythrocyte sedimentation rate（ESR）of postoperative of bone joint tuberculosis and to determine the factors correlating with the prognosis.Methods Total 403 cases accepting surgical treatment for bone tuberculosis were selected in our department,among them,178 cases of spinal tuberculosis,knee joint tuberculosis,83 patients,79 cases of hip joint tuberculosis and 14 cases with elbow joint tuberculosis,11 cases with ankle tuberculosis,wrist joint tuberculosis in 38 cases.The ESR was controlled properly in Spine,hip joint tuberculosis patients,and if ESR85 mm/1 h,the patients were treated in knee,ankle,elbow,wrist joint tuberculosis with the chemotherapy drug.Other patients before operation didn′t give the chemotherapy drugs for a long time.The patients were divided into three groups according to the preoperative ESR（Group A ESR40 mm/1 h,Group B ESR 40 mm/1 h-85 mm/1 h,and Group C ESR85 mm/1 h）.All the patients underwent debridement surgery according to the size of the lesions or abscess.The VAS score,primary healing rate,recurrence rate of three groups were compared.Results The pathological results of 31 patients were reported as acute and chronic inflammation,and the rest were confirmed as tuberculosis by postoperative pathology or tuberculous culture.There were no statistically significant differences in VAS scores before and after operation in the 3 groups（P〈0.05）,and the clinical efficacy differences of 3 groups were not statistically significant（P〈0.05）.Conclusion Surgical treatment is an important method in the treatment of bone and joint tuberculosis.ESR had no obvious effect on the long-term recurrence rate and functional recovery.Surgical indications can be consider comprehensive,and high ESR is no longer as a single absolute contraindications.