病灶清除联合融合外固定术治疗晚期活动性膝关节结核的效果及对预后的影响

Clinical Efficacy of Focal Debridement Combined with Fusion and External Fixation in Treatment of Patients with Advanced Active Tuberculosis of the Knee Joint and Its Effect on Prognosis

目的探讨病灶清除联合融合外固定术治疗晚期活动性膝关节结核的效果及对预后的影响。方法选取2019年2月—2021年2月收治的晚期活动性膝关节结核81例,据治疗方法的不同分为观察组43例和对照组38例,对照组在常规四联抗结核治疗基础上行病灶清除术治疗,观察组在对照组基础上行融合外固定术治疗。比较2组术前及术后18个月膝关节功能Lysholm评分、生活质量,比较手术时间、术中出血量,膝关节结核复发率及术后并发症发生情况。结果术后18个月,2组膝关节功能Lysholm、生活质量均升高,且观察组高于对照组(P<0.01)。术后随访18个月,观察组膝关节结核复发率低于对照组,术后低蛋白血症、贫血发生率高于对照组(P<0.05)。结论病灶清除术联合融合外固定术治疗晚期活动性膝关节结核可改善患者患膝关节功能和生活质量,降低短期复发率,但术后低蛋白血症及贫血发生率较高,临床应重视并及时干预。

Objective To investigate clinical efficacy of focal debridement combined with fusion and external fixation in treatment of patients with advanced active tuberculosis of the knee joint and its effect on prognosis.Methods A total of 81 patients with advanced active tuberculosis of the knee joint admitted between February 2019 and February 2021 were selected and divided into observation group(n=43)and control group(n=38)according to different therapeutic methods.Control group was treated with focus clearance on the basis of conventional quadruple antituberculosis treatment,while observation group was treated with fusion and external fixation on the basis of treatment for control group.Lysholm scores of knee joint function and quality of life scores were compared before and after operation for 18 months,and operative duration,volume of intraoperative bleeding,recurrence rate of knee joint tuberculosis and incidence rate of postoperative complications were also compared between two groups.Results After operation for 18 months,Lysholm scores of knee joint function and quality of life scores were significantly increased in two groups,and the scores in observation group were significantly higher than those in control group(P<0.01).During postoperative follow-up for 18 months,in observation group,recurrence rate of knee joint tuberculosis was significantly lower,while incidence rates of hypoproteinemia and anemia were significantly higher than those in control group(P<0.05).Conclusion Focal debridement combined with fusion and external fixation in treatment of patients with advanced active tuberculosis of the knee joint may improve the knee joint function and quality of life,and reduce the short-term recurrence rate,but the incidence rates of postoperative hypoproteinemia and anemia are high,and therefore clinical attention should be given and timely intervention should be provided.