Zhang Jin, Liang Liang, Yang Bo, Li Senlei, Yang Xianteng, Li Jianyang, Sun Li, Han Wei
Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China.
Department of Orthopaedics, Kaili City First People's Hospital, Kaili, China.
Ann Palliat Med. 2021 Jan;10(1):495-500. doi: 10.21037/apm-20-2544.
The purpose of this study is to investigate the optimal surgical options for different kinds of advanced hip tuberculosis, which are still controversial.
We reviewed seven advanced hip tuberculosis patients received operations from November 2014 to September 2018. All patients received anti-tubercular chemotherapy at least 2 weeks preoperatively and twelve months postoperatively. One active case with sinus tract of seven patients underwent three-stage operations including two debridements/cement spacer implantations and one total hip arthroplasty, while the other six cases received one = stage arthroplasty surgery. All patients are followed up based on Harris score, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and X-ray.
The mean follow-up time was 41.6 months, while no reactivation was detected. The average Harris score increased from 40.0 preoperatively to 89.4 at the final follow-up. ESR of 3 active hip tubercular cases decreased from 143.7 mm/L at diagnosis time to 6.7 mm/L at the final follow-up. CRP of 3 active hip tubercular cases decreased from 80.01 mg/L (range, 37.34-136.92 mg/L) at diagnosis time to 1.91 mg/L (range, 1.05-2.57 mg/L) at the final follow-up. The ESR and CRP of all patients had returned to normal level at the final follow-up. No prosthesis dislocation, loosening and neurovascular injury was found.
THA is an effective and safe option for hip tuberculosis. The essentials for good outcome include early diagnosis, regular perioperative anti-tubercular chemotherapy, radical debridement of inflamed tissue and necrotic bone, staged-operation if necessary.
本研究旨在探讨不同类型的晚期髋关节结核的最佳手术选择，目前这些选择仍存在争议。
我们回顾了2014年11月至2018年9月期间接受手术的7例晚期髋关节结核患者。所有患者在术前至少2周及术后12个月接受抗结核化疗。7例患者中有1例有窦道的活动期病例接受了三期手术，包括两次清创/骨水泥间隔物植入和一次全髋关节置换术，而其他6例患者接受了一期关节置换手术。所有患者均根据Harris评分、C反应蛋白（CRP）、红细胞沉降率（ESR）和X线进行随访。
平均随访时间为41.6个月，未发现复发。平均Harris评分从术前的40.0分提高到末次随访时的89.4分。3例活动期髋关节结核病例的ESR从诊断时的143.7mm/L降至末次随访时的6.7mm/L。3例活动期髋关节结核病例的CRP从诊断时的80.01mg/L（范围37.34 - 136.92mg/L）降至末次随访时的1.91mg/L（范围1.05 - 2.57mg/L）。所有患者的ESR和CRP在末次随访时均恢复至正常水平。未发现假体脱位、松动及神经血管损伤。
全髋关节置换术是治疗髋关节结核的一种有效且安全的选择。取得良好疗效的关键包括早期诊断、围手术期规律抗结核化疗、彻底清除炎性组织和坏死骨，必要时分期手术。
