Department of Orthopaedics and Traumatology, Universitas Padjadjaran Medical School/Hasan Sadikin Hospital, Jalan Pasteur 38, Bandung, 40161, Indonesia.
Eur J Orthop Surg Traumatol. 2023 Apr;33(3):587-592. doi: 10.1007/s00590-022-03376-y. Epub 2022 Aug 26.
Tuberculosis remains a worldwide health problem, as well as its complications including arthritis in various joints. End-stage arthritis in weight-bearing joint would require surgery either arthroplasty or arthrodesis, in order to achieve painless and stable gait. In general, staged surgery consisted of debridement and subsequent definitive procedure is accepted. However, multiple surgery would be disadvantageous in terms of clinical and economic burdens. This study reported the short-term result of one-stage debridement and fusion for ankle joint tuberculosis.
Retrospective evaluation of twenty-six patients with history of one-stage debridement and ankle fusion was conducted. Basic anthropometric measurement, local status, and surgical technique were recorded. Functional score using Foot and Ankle Ability Measures (FAAM) activities of daily living (ADL) was assessed pre-operatively and at two and half year post-surgery follow-up visit along with radiological fusion rate. Paired t test was used to analyse the improvement of the clinical scores.
There was improvement in FAAM score from 43.38 ± 9.51 to 62.19 ± 6.63% (p < 0.001). All sinuses had been subsided, albeit at various time spans. Modified radiographic union score for tibia (RUST) revealed various fusion rate results, ranged from 5 to 11.
One-stage debridement and fusion is proven efficacious for end-stage joint tuberculosis, with less surgery occasion compared with staged surgery. However, patient selection is important since any comorbidities or secondary infection may complicate the fusion.
结核病仍然是一个全球性的健康问题，其并发症包括各种关节的关节炎。承重关节的终末期关节炎需要进行关节置换术或关节融合术，以实现无痛和稳定的步态。一般来说，分期手术包括清创术，随后接受确定性手术是可以接受的。然而，多次手术在临床和经济负担方面都不利。本研究报告了一期清创和踝关节结核融合术的短期结果。
回顾性评估了 26 例一期清创和踝关节融合术的患者。记录了基本的人体测量学测量、局部状况和手术技术。使用足踝能力测量（FAAM）日常生活活动（ADL）功能评分在术前和术后两年半随访时进行评估，同时评估放射融合率。采用配对 t 检验分析临床评分的改善情况。
FAAM 评分从 43.38±9.51 提高到 62.19±6.63%（p<0.001）。所有窦道均已消退，尽管消退时间不同。胫骨改良放射学愈合评分（RUST）显示出不同的融合率结果，范围从 5 到 11。
一期清创和融合术对终末期关节结核是有效的，与分期手术相比，手术次数较少。然而，患者选择很重要，因为任何合并症或继发感染都可能使融合复杂化。
