封闭式负压引流技术治疗腕关节结核

Treatment of Carpal Tuberculosis With Vacuum Sealing Drainage

目的探讨封闭式负压引流技术(vacuum sealing drainage,VSD治疗腕关节结核的临床疗效。方法 2012年6月—2017年12月,收治腕关节结核患者16例。男12例,女4例;年龄41～82岁,平均(60.70±14.01)岁。8例有结核病史,5例有腕部外伤史。其中6例局部软组织破溃,窦道形成,部分皮肤缺损。手腕部有缓慢性、进行性增大的包块,手腕部有不同程度屈伸受限。X线检查显示:10例肺部陈旧性肺结核,16例患者腕部骨质均有破坏,部分死骨形成。MRI显示:手腕部滑膜增厚、水肿、死骨及脓肿形成。HERZ抗结核治疗3～4周后行病灶彻底清除同时给予VSD负压吸引治疗,并且每日予以利福平溶液雨衣冲洗创面,后以负压吸出,期间更换一次负压吸引装置。结果术后2周拆除负压吸引装置,予以伤口拆线,10例患者伤口均一期愈合。6例皮肤缺损者创面肉芽组织丰富,血运良好,二期予以植皮治疗,愈合满意。16例均获随访,随访时间10～18个月,16例患者血沉、C反应蛋白指标均恢复正常,放射学检查显示无死骨形成,创面愈合未发生破溃显现,其中8例腕关节功能恢复较满意。结论 VSD对于腕关节结核的治疗效果明显。

Objective To investigate the clinical efficacy of vacuum sealing drainage(VSD) in the treatment of carpal joint tuberculosis. Methods From June 2012 to December 2017, 16 patients with carpal joint tuberculosis were admitted. There were 12 males and 4 females with an average age of (60.70±14.01) years(range 41 ~ 82 years). 8 cases had a history of tuberculosis and 5 cases had a history of carpal trauma. Among them, 6 cases of local soft tissue rupture, sinus tract formation, part of the skin defect. The wrist joint has a slow, more aggressive package, and the wrist has varying degrees of flexural limit. X-ray examination showed: 10 cases of old pulmonary tuberculosis, all of the 16 patients had destruction of carpal bone and partial dead bone formation. MRI showed: thickening of the carpal synovial membrane, edema, death bone and abscess formation.After 3 ~ 4 weeks of HERZ anti-tuberculosis treatment, the lesion was completely cleared and VSD negative pressure suction therapy was given, and rifampicin solution was given daily to wash the wound surface, then the rifampicin was sucked out with negative pressure, and the negative pressure suction device was replaced once during the period. Results The vacuum sealing drainage was removed 2 weeks after operation, and take out stitches wound. The wound 10 patients were healed in one stage. 6 patients with skin defects had abundant wound granulation tissue, good blood transport, two stage skin grafting treatment, healing satisfaction. All of the 16 cases were followed up, the follow-up time was 10 ~ 18 months,16 patients blood sink and C-reactive protein indexes returned to normal, radiology examination showed no dead bone formation, wound healing did not break out, and 8 cases of carpal joint function recovery is more satisfactory. Conclusion VSD is effective in the treatment of carpal joint tuberculosis.