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[肘关节结核的外科治疗进展]

[Progress on surgical treatment for elbow tuberculosis].

作者信息

Hu Fei-Jian, Li Qiao, Bi Da-Wei, Zu Gang

机构信息

Department of Orthopaedics, Hospital of Integrated Traditional Chinese and Western Medicine of Zhejiang Province, Hangzhou 310003, Zhejiang, China;

出版信息

Zhongguo Gu Shang. 2019 Nov 25;32(11):1072-1076. doi: 10.3969/j.issn.1003-0034.2019.11.019.

Abstract

Elbow tuberculosis is a rare disease of infectious osteoarthritis. The aim of operation for elbow tuberculosis is to maintain joint function, ensure stability of joint and improve quality of life, while there were controversies about the implementation details of different procedures. For elbow tuberculosis at an advanced stage, the clinical effect of forked osteotomy arthroplasty is effective and could meet with most patients without demand of strength. However, arthrodesis is only recommended for heavy manual workers with high demand of strength, and making research on the optimal fusion angle could improve satisfaction of patients. For elbow tuberculosis at the early stage, there were few reports about interposition arthroplasty, which has a recommendation of lower degree. Otherwise, hinged external fixator with arthrolysis is main procedure for its safety, effective clinical effects, and less recurrence of inflammation, the optimal approach of arthrolysis is the research focus at present. Elbow arthroscopic surgery could not only treat the simple synovial tuberculosis of elbow joint under arthroscope, but also improve positive rate under arthroscopic, and it is recommended to be used at the early unclear diagnosis of swelling and pain of chronic elbow joint. In addition, total elbow arthroplasty may be an option for patients with high functional requirements in the future.

摘要

肘关节结核是一种罕见的感染性骨关节炎疾病。肘关节结核手术的目的是维持关节功能、确保关节稳定性并提高生活质量,然而不同手术方式的实施细节存在争议。对于晚期肘关节结核,叉状截骨成形术的临床效果良好,能满足大多数对力量要求不高的患者。然而,关节融合术仅推荐给对力量要求较高的重体力劳动者,研究最佳融合角度可提高患者满意度。对于早期肘关节结核,关于间置成形术的报道较少,其推荐程度较低。否则,带关节松解的铰链式外固定器因其安全性、有效的临床效果和较低的炎症复发率而成为主要手术方式,目前关节松解的最佳方法是研究重点。肘关节镜手术不仅可以在关节镜下治疗单纯的肘关节滑膜结核,还能提高关节镜下的阳性率,建议在慢性肘关节肿胀疼痛早期诊断不明确时使用。此外,全肘关节置换术未来可能是对功能要求较高患者的一种选择。

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