成人腕关节结核的临床特征和治疗结果- 84 例连续病例的回顾性研究，随访时间至少 2 年。

Clinical features and treatment outcome of wrist tuberculosis in adult- a retrospective study of 84 consecutive cases with minimum of 2 years follow up.

机构信息

Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.

出版信息

BMC Musculoskelet Disord. 2022 Jun 28;23(1):618. doi: 10.1186/s12891-022-05563-8.

DOI:10.1186/s12891-022-05563-8

PMID:35761223

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9238136/

Abstract

BACKGROUND

Wrist tuberculosis (TB) is a rare disease that may result in residual deformity, pain, or stiffness even after proper antitubercular chemotherapy (ATT) and surgical intervention. The aim of our study is to present clinical features and functional outcomes of wrist TB in a consecutive series of 84 adult patients with a minimum of 2 years of follow-up.

METHODS

Clinical features and treatment outcomes of 84 consecutive adult patients with wrist TB from January 2003 to June 2018 including 45 men and 39 women, with a mean age of 46.8 years (18-84) were retrospectively analyzed. Data were collected on participants' demographic details. The primary outcome measures were QuickDASH score, grip strength, Visual Analogue Scale (VAS), and PRWHE. Secondary outcomes include health-related quality of life was evaluated using the EuroQol five-dimension five-level (EQ-5D-5L), assessment and postoperative complications of patients who underwent operation were also recorded.

RESULTS

All 84 patients with an average follow-up of 50.8 (24-105) months. The mean duration of symptoms before treatment was 10.5 months (2-21). There were 27 patients with bony and 57 with primarily soft-tissue involvement based on preoperative evaluation of plain radiographs and MRI. There were 33 patients treated with ATT and 51 patients were treated with surgery followed by ATT. Among them, 13 patients (15.5%) underwent incision and decompression, 14 patients (16.7%) underwent wrist synovectomy, 13 patients (15.5%) underwent wrist joint fusion by plate fixation, and 11 patients (13.1%) underwent wrist joint fusion by external fixation. At the last clinical visit, the QuickDASH, and PRWHE scores of all patients decreased significantly, the VAS improved from 5.9 to 1.4, EQ-5D-5L utility index improved from 0.36 to 0.88, EQ-VAS improved from 40.2 to 89.1. All patients indicated good wrist recovery at the last follow-up, and the treatment achieved satisfactory clinical outcomes.

CONCLUSION

The onset of wrist TB is insidious; early diagnosis, good patient compliance, and surgery combined with ATT are crucial steps for treatment of wrist TB, and also essential for the patient's postoperative recovery. Wrist arthrodesis has achieved satisfactory results in the treatment of severe wrist TB.

摘要

背景

腕关节结核（TB）是一种罕见疾病，即使经过适当的抗结核化疗（ATT）和手术干预，也可能导致残留畸形、疼痛或僵硬。我们的研究目的是在 84 例连续接受治疗的成年腕关节结核患者中，报告其临床特征和功能结局，这些患者的随访时间均至少为 2 年。

方法

对 2003 年 1 月至 2018 年 6 月期间的 84 例连续成年腕关节结核患者的临床特征和治疗结果进行回顾性分析，包括 45 例男性和 39 例女性，平均年龄为 46.8 岁（18-84 岁）。收集参与者的人口统计学资料。主要结局指标是 QuickDASH 评分、握力、视觉模拟量表（VAS）和 PRWHE。次要结局包括使用 EuroQol 五维五水平（EQ-5D-5L）评估健康相关的生活质量，记录接受手术的患者的术后并发症。

结果

84 例患者平均随访 50.8（24-105）个月。治疗前症状平均持续时间为 10.5 个月（2-21）。根据术前 X 线和平片及 MRI 评估，27 例患者有骨受累，57 例患者主要为软组织受累。33 例患者接受 ATT 治疗，51 例患者接受 ATT 联合手术治疗。其中，13 例（15.5%）患者行切开减压术，14 例（16.7%）患者行腕关节滑膜切除术，13 例（15.5%）患者行腕关节融合术，11 例（13.1%）患者行腕关节融合术外固定。末次临床就诊时，所有患者的 QuickDASH 和 PRWHE 评分均显著降低，VAS 从 5.9 分降至 1.4 分，EQ-5D-5L 效用指数从 0.36 提高到 0.88，EQ-VAS 从 40.2 提高到 89.1。所有患者末次随访时均表示腕关节恢复良好，治疗取得了满意的临床效果。