Su J Y, Huang T L, Lin S Y
Department of Orthopaedic Surgery, Kaohsiung Medical College Hospital, Taiwan, Republic of China.
Clin Orthop Relat Res. 1996 Feb(323):181-7. doi: 10.1097/00003086-199602000-00024.
Sixteen cases of tuberculosis of the knee treated by total knee arthroplasty with followup of 3.4 to 11 years were reviewed. Eight cases were treated with antituberculous chemotherapy for 2 to 20 months before and 1 year after the arthroplasty. Another 8 cases were not diagnosed primarily and therefore received only postoperative antituberculous chemotherapy. Five cases had a recurrence of tuberculosis. Four of these 5 cases did not receive preoperative antituberculous treatment. The infection in 1 case was controlled satisfactorily with chemotherapy alone, and for the other 3 cases, chemotherapy was supported by surgical debridements. The last case of recurrent infection occurred in a patient who had received long- standing corticosteroid therapy. He required an excisional arthroplasty to control the infection. The mean functional knee score was 30.5 points before surgery and 82.6 points at the time of the last followup. These results suggest that arthroplasty may be formed for knees badly damaged with tuberculous infection, and good results may be expected for those patients who have received effective antituberculous chemotherapy both before and after surgery. There is a substantial risk of reactivation of tuberculous infection for those patients not treated before surgery or for patients dependent on corticosteroids.
回顾了16例接受全膝关节置换术治疗的膝关节结核病例，随访时间为3.4至11年。8例在关节置换术前及术后1年接受了2至20个月的抗结核化疗。另外8例最初未被诊断出来，因此仅接受了术后抗结核化疗。5例出现结核复发。这5例中有4例未接受术前抗结核治疗。1例感染仅通过化疗得到满意控制，另外3例化疗辅以手术清创。最后1例复发性感染发生在一名长期接受皮质类固醇治疗的患者身上。他需要进行关节切除置换术来控制感染。术前膝关节平均功能评分为30.5分，最后一次随访时为82.6分。这些结果表明，对于结核感染严重受损的膝关节可进行关节置换术，对于术前和术后均接受有效抗结核化疗的患者可能会有良好效果。对于未接受术前治疗的患者或依赖皮质类固醇的患者，结核感染复发的风险很大。
