踝关节结核合并窦道形成经不同术式治疗的临床结果与复发病例分析

Clinical analysis of different surgical treatment results and recurrent cases of ankle tuberculosis complicated with sinus formation

目的探讨踝关节结核合并窦道形成后手术治疗的临床疗效及复发病例。方法回顾性分析2007年7月至2020年12月在云南省第一人民医院行手术治疗的并发窦道形成的踝关节结核病例17例,在术前予以规范化抗结核药物治疗的基础上进行一期病灶清除、关节融合或不融合。将行关节融合的定为一组,共10例;将未行关节融合的定为二组,共7例。两组术后均规律抗结核治疗12~18个月。定期随访检查红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C reactive protein,CRP),并测评视觉模拟评分法(visual analogue scale,VAS)评分和美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足评分。结果术后随访12~56个月,平均(36.00±13.53)个月。一组术后2例再出现窦道,经二次清创治愈;二组术后1例再出现窦道,经二次清创后治愈。两组患者组内术前ESR、CRP、VAS评分与末次随访时比较差异有统计学意义(P<0.05),术后ESR、CRP、VAS与末次随访时比较差异有统计学意义(P<0.05);两组组间任何时间点比较差异无统计学意义(P>0.05)。两组患者组内复发病例数与未复发间差异无统计学意义(P>0.05),两组患者组间复发与未复发病例数间差异无统计学意义(P>0.05)。在相同时间点,两组间的AOFAS评分差异无统计学意义(P>0.05);两组组内术前和末次随访时的AOFAS评分比较差异有统计学意义(P<0.05)。两组患者在末次随访时复查后足力线位(Saltzman位)X线片,均提示后足力线良好。结论关节结核合并窦道形成的患者术前经规范抗结核药物治疗后,在病灶清除的基础上可根据患者的具体需求情况采取个性化的手术治疗,可获得满意的临床疗效。复发与否和是否一期行关节融合并无直接关联。

Objective To investigate the operative method and clinical effect of recurrent cases of ankle tuberculosis complicated with sinus formation.Methods On the basis of preoperative standardized antituberculous drug treatment,one-stage focus clearance,joint fusion or non fusion were performed,17 cases of joint tuberculosis complicated with sinus tract treated surgically from July 2007 to December 2020 were analyzed retrospectively.The cases of joint fusion were divided into a group of 10 cases;The patients without joint fusion were divided into two groups,a total of 7 cases.Both groups received regular anti tuberculosis treatment for 12-18 months.Objective examination(ESR,CRP)and subjective score(VAS)were performed during regular follow-up.There was no significant difference between AOFAS scores between the two groups at the same time point(P>0.05);At different time points,the difference between AOFAS scores in the same group was statistically significant(P<0.05).The X-rays of the Saltzman position that were repeated at the last follow-up in both groups showed a good posterior foot line.Results The patients were followed up for 12-56 months,with an average of 36.00±13.53 months.In the first group,2 cases recurred sinus tract after operation,were cured by secondary debridement.In the second group,1 case reappeared sinus tract after operation and was cured after secondary debridement.No matter the comparison between groups or within groups,the preoperative ESR,CRP,vas and the last follow-up were statistically significant(P<0.05),and the postoperative ESR,CRP,vas and the last follow-up were statistically significant(P<0.05);There was no significant difference in the number of recurrent and non recurrent cases between groups(P>0.05);There was no significant difference in the number of recurrent and non recurrent cases between the two groups(P>0.05);There was no significant difference in preoperative ESR and CRP between recurrent and non recurrent cases between the two groups(P>0.05).Conclusion Patients with joint tuberculosis complicated with sinus formation can obtain satisfactory clinical curative effect after standardized antituberculous drug treatment and personalized surgical treatment according to the specific situation.There is no direct correlation between recurrence and primary arthrodesis.