Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China.
School of Medicine, Nankai University, Tian Jin, People's Republic of China.
J Orthop Surg Res. 2020 Nov 20;15(1):550. doi: 10.1186/s13018-020-02086-7.
Due to atypical clinical symptoms, it is difficult to diagnose joint tuberculosis infection, which often results in misdiagnosis and missed diagnosis. It is easy to cause joint disability. And there are few reports of using arthroscopy to diagnose and treat shoulder tuberculosis. This case series aims to introduce the clinical outcomes of arthroscopic treatment of shoulder tuberculosis.
Twenty-nine patients with shoulder tuberculosis from September 2013 to February 2019 were included (10 males, 19 females; age range from 22 to 69; the average age is 37.6 years). All patients underwent arthroscopic lesion debridement, with preoperative and postoperative regular use of isoniazid, rifampicin, pyrazinamide, and streptomycin quadruple anti-tuberculosis drugs. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded before and at the last follow-up. The shoulder function was evaluated according to the visual analogue scoring method (visual analogue scale, VAS) pain score and Constant score.
Twenty-nine patients were followed up from 12 months to 2 years, and the average follow-up time was 15.7 months. The pathological diagnosis of all patients after surgery was shoulder tuberculosis. No serious complications were found at the last follow-up, and the incision healed well. VAS pain score, Constant score, ESR, and CRP at the last follow-up were significantly improved compared with those before treatment (P < 0.05).
On the basis of the standard use of anti-tuberculosis drugs before and after surgery, shoulder arthroscopy is used to treat early and mid-term shoulder tuberculosis, which can be diagnosed by direct observation under the arthroscope and postoperative pathological examination. It has the advantages of thorough lesion removal, minimal invasiveness, rapid recovery, and reliable clinical effect.
由于非典型的临床症状，关节结核感染的诊断较为困难，常导致误诊和漏诊，容易引起关节残疾。关节镜诊断和治疗肩结核的报道较少。本病例系列旨在介绍关节镜治疗肩结核的临床结果。
2013 年 9 月至 2019 年 2 月，共纳入 29 例肩结核患者（男 10 例，女 19 例；年龄 22～69 岁，平均 37.6 岁）。所有患者均行关节镜下病灶清理术，术前和术后常规使用异烟肼、利福平、吡嗪酰胺和链霉素四联抗结核药物。记录术前和末次随访时的红细胞沉降率（erythrocyte sedimentation rate，ESR）和 C 反应蛋白（C-reactive protein，CRP）。根据视觉模拟评分法（visual analogue scale，VAS）疼痛评分和 Constant 评分评估肩关节功能。
29 例患者获得 12 个月至 2 年的随访，平均随访时间为 15.7 个月。所有患者术后病理诊断均为肩结核。末次随访时未发现严重并发症，切口愈合良好。VAS 疼痛评分、Constant 评分、ESR 和 CRP 均较术前显著改善（P < 0.05）。
在术前和术后标准使用抗结核药物的基础上，关节镜用于治疗早期和中期肩结核，可通过关节镜下直接观察和术后病理检查进行诊断。具有病灶清除彻底、微创、恢复快、临床效果可靠等优点。
