可活动式外固定治疗肘关节结核

Clinical study of movable external fixation for elbow tuberculosis

目的:比较可活动式外固定与融合固定治疗肘关节结核的临床疗效。方法:将2013年10月至2019年6月收治的52例肘关节结核患者按照治疗方法不同分为可活动外固定架治疗组和融合固定组,均给予标准抗结核治疗。可活动外固定架组25例,男11例,女14例;年龄24~75(42.81±9.01)岁;病程2~9(3.96±1.45)个月。融合固定组27例,男15例,女12例;年龄23~77(44.08±7.44)岁;病程2~7(3.88±1.67)个月。两组患者均行病灶清除术,比较两组患者术中出血量、手术时间,术前、术后2周及12个月采用视觉模拟疼痛评分(vasual analogue scale,VAS)评价疼痛缓解程度,术前、术后1、12个月采用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)进行疗效评价,比较两组患者术前与抗结核3周及术后1周、6个月的血沉(enythrocyte sedimentation rate,ESR),C-反应蛋白(C-reactive protein,CRP)变化。结果:52例患者获得随访,时间12~20(13.50±4.85)个月。所有患者未见混合感染、结核复发。两组患者手术出血量及手术时间比较差异无统计学意义(P>0.05)。可活动外固定架组术后2周VAS评分(5.15±0.95)与融合固定组(4.04±0.84)比较差异有统计学意义(P<0.01);术后12个月两组VAS评分比较差异无统计学意义(P>0.05)。两组患者手术前后各时间点ESR、CRP比较差异无统计学意义(P>0.05)。可活动外固定架组术后1、12个月Mayo评分分别为(78.15±7.83)分、(90.19±7.13)分;融合固定组Mayo评分分别为(70.40±7.61)分、(82.60±8.38)分;两组比较差异有统计学意义(P<0.01)。结论:可活动式外固定与融合固定治疗肘关节结核在手术时间、出血量及结核炎症指标控制方面疗效相当;可活动外固定治疗术后需要早期功能锻炼,不利于早期疼痛减轻,但其有利于肘关节功能的恢复,可能优于融合固定治疗,值得临床推广。

Objective:To compare clinical effect of movable external fixation and fusion fixation for the treatment of elbow tuberculosis.Methods:From October 2013 to June 2019,52 patients with elbow tuberculosis treated with standard antituberculosis therapy were divided into movable external fixation group and fusion fixation group according to treatment methods.In group A,there were 25 patients,including 11 males and 14 females,aged from 24 to 75 years old with an average of(42.81±9.01)years old;the courses of diseases ranged from 2 to 9 months with an average of(3.96±1.45)months.In group B,there were 27 patients,including 15 males and 12 females,aged from 23 to 77 years old with an average of(44.08±7.44)years old;the courses of diseases ranged from 2 to 7 months with an average of(3.88±1.67)months.All patients were performed focus debridement.Intraoperative blood loss,operative time were compared between two groups.VAS score before operation,2 weeks and 12 months after operation were applied to evaluate pain relieve;Mayo elbow performance score(MEPS)before operation,1 and 12 months after operation were used to evaluate clinical effect;changes of erythrocyte sedimentation rate(ESR)and C-reactive protein,(CRP)before operation,3 weeks after antituberculosis therapy,1 week and 6 months after operation were compared between two groups.Results:All patients were followed up from 12 to 20 months with an average of(13.50±4.85)months.No mixed infection and recurrence of tuberculosis occurred.There were no statistical differences in intraoperative blood loss and operative time(P>0.05).There was difference in postoperative VAS score at 2 weeks between movable external fixation group(5.15±0.95)and fusion fixation group(4.04±0.84)(P<0.01);while no difference in postoperative VAS score at 12 months between two groups(P>0.05).No difference in ESR and CRP level between two groups before and after operation(P>0.05).Postoperative Mayo score at 1 and 12 months in movable external fixation group were(78.15±7.83)and(90.19±7.13);in fusion fixation group were(70.40±7.61)and(82.60±8.38);there were differences in Mayo score at different time points between two groups(P<0.01).Conclusion:For elbow tuberculosis,movable external fixation and fusion fixation have equal effect in operative time,amount of bleeding and control of tuberculosis infection indicator.Movable external fixation need earlier functional exercise,not conducive to pain relief at early stage,which may be better than fusion fixation,it is worth clinical promoting.