Campbell J A, Hoffman E B
Maitland Cottage Hospital, Cape Town, Republic of South Africa.
J Bone Joint Surg Br. 1995 Mar;77(2):319-26.
We have reviewed 74 tuberculous hips in 73 children treated from 1950 to 1991. From 1979 to 1991 we treated 28 patients with rifampicin, isoniazid and pyrazinamide given for nine months (series A), using active mobilisation for the more recent cases. Before this, 46 hips had been treated with streptomycin and isoniazid with or without para-aminosalicyclic acid given for a mean of 18 months (series B), and all these patients were immobilised for a mean of 2.2 years. The radiological appearances at presentation as classified by Shanmugasundaram (1983) predicted the outcome. Most hips were of the 'normal' type (50% and 59% of series A and B respectively) followed by the dislocating type (25% and 13%) and the atrophic type (8% and 9%). There were good or excellent results in 93% of the 'normal' type. All the atrophic type had poor results. The dislocating type had a poor result if the joint space was narrow after reduction of the hip. Early mobilisation had no effect on the outcome of the 'normal' type of disease. The newer drug regimens allowed for shorter courses of treatment, but did not necessarily give a better outcome.
我们回顾了1950年至1991年间接受治疗的73名儿童的74例结核性髋关节病例。1979年至1991年期间，我们对28例患者使用利福平、异烟肼和吡嗪酰胺进行了9个月的治疗（A组），对较近期的病例采用了主动活动疗法。在此之前，46例髋关节采用链霉素和异烟肼治疗，加或不加对氨基水杨酸，平均治疗18个月（B组），所有这些患者平均固定2.2年。按照Shanmugasundaram（1983年）的分类，初诊时的放射学表现可预测预后。大多数髋关节属于“正常”型（A组和B组分别为50%和59%），其次是脱位型（25%和13%）和萎缩型（8%和9%）。“正常”型中有93%的结果为良好或优秀。所有萎缩型的结果都很差。如果髋关节复位后关节间隙变窄，脱位型的结果也很差。早期活动对“正常”型疾病的预后没有影响。新的药物治疗方案允许缩短疗程，但不一定能取得更好的结果。
