Zhu Rang-Teng, Shen Li-Ping, Chen Ling-Lin, Jin Gang, Jiang Han-Tao
Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China.
Clinical Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China.
World J Clin Cases. 2021 Oct 6;9(28):8587-8594. doi: 10.12998/wjcc.v9.i28.8587.
A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip (DDH) and a drainage sinus is a rare condition. There are no previous reports of this condition, and it is a complex challenge for surgeons to develop a treatment scheme.
We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month. Approximately 40 years ago, a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy. After the sinus healed, gradual pain occurred in the left hip for 40 years. Approximately one month prior, hip pain was sharply aggravated, and a drainage sinus reoccurred in the left hip. The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur, as well as an acetabular deformity. The results of antibody and Xpert were positive. Therefore, the patient was diagnosed with advanced TH combined with Crowe type IV DDH. After 22 d of treatment with anti-tuberculosis chemotherapy, the sinus healed, and the patient underwent one-stage total hip arthroplasty (THA) surgery consisting of debridement, osteotomy, and joint replacement. After surgery, the patient received anti-tuberculosis chemotherapy drugs for nine months, with no recurrent infection. After one year of follow-up, the Harris score of the patient increased from 21 pre-THA to 86.
Although drainage sinuses are a contraindication to one-stage THA, one-stage THA is still an effective and safe surgical method after the sinus heals.
一名髋关节晚期结核合并Crowe IV型发育性髋关节发育不良（DDH）且伴有引流窦的患者较为罕见。此前尚无关于这种情况的报道，对外科医生来说，制定治疗方案是一项复杂的挑战。
我们报告一名73岁男性患者，左髋部严重疼痛并伴有引流窦1个月。大约40年前，左髋外侧出现引流窦，在当地医院接受抗感染治疗后愈合。窦愈合后，左髋逐渐疼痛40年。大约1个月前，髋部疼痛急剧加重，左髋再次出现引流窦。X线和计算机断层扫描检查显示左股骨头颈破坏以及髋臼畸形。抗体和Xpert检测结果均为阳性。因此，该患者被诊断为晚期髋关节结核合并Crowe IV型DDH。经过22天的抗结核化疗后，窦愈合，患者接受了包括清创、截骨和关节置换的一期全髋关节置换术（THA）。术后，患者接受了9个月的抗结核化疗药物治疗，无感染复发。随访1年后，患者的Harris评分从THA术前的21分提高到了86分。
尽管引流窦是一期THA的禁忌证，但在窦愈合后，一期THA仍然是一种有效且安全的手术方法。
