单独病灶清除术或联合植骨融合外固定术治疗膝关节结核的临床疗效
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摘要
目的探讨单独病灶清除术或联合植骨融合外固定术治疗膝关节结核的临床疗效。方法选取2014年1月～2016年1月期间收治入院的膝关节结核患者83例,按照随机数字表法将其分为单独结核病灶清除术组39例(单独组)和病灶清除联合植骨融合外固定术组44例(联合组)。对比两组手术时间、住院时间、术中出血量情况及术后低蛋白血症及贫血发生情况,并观察两组患者手术前后膝关节功能评分、生理健康及心理健康评分情况。结果术前组间膝关节功能评分无统计学差异,术后两组患者整体膝关节功能变化均存在统计学差异(F值分别为126.356和82.032,P均<0.01)。且术后不同时间点单独组膝关节功能评分显著较联合组高,组间差异显著(P<0.05)。术前组间生理健康评分及心理健康评分差异无统计学意义(P>0.05),术后3个月生理健康评分及心理健康评分单独组均显著高于联合组。单独组手术时间及住院时间较联合组短,术中出血量较联合组少,组间差异有显著性(P<0.05),且单独组术后低蛋白血症及贫血发生率较联合组低,组间差异有统计学意义(P<0.05)。单独组术后18个月随访复发率10.26%,联合组11.36%,组间差异无统计学意义(P>0.05)。结论两种方法术后患者膝关节功能及生活质量均得到有效改善,且对术后复发无影响。相较而言,单纯膝关节结核病灶清除术组手术时间更短,术后恢复更快。膝关节结核采用单纯结核病灶清除术或联合植骨融合外固定术治疗均可有效改善患者膝关节功能及生活质量,故术式的选择应结合患者病情严重程度决定,继而提高疗效,促进术后康复。
Objective To investigate clinical effects of debridement alone or combined with bone grafting and external fixation in the treatment of knee tuberculosis.Methods Eighty-three patients with knee joint tuberculosis who admitted to hospital from January 2014 to January 2016 were enrolled.According to the random number table,39 cases were divided into separate tuberculosis group and 39 cases with clear-cut union bone graft and external fixation group,separate groups and joint groups.The operative time,hospitalization time,intraoperative blood loss and postoperative hypoalbumin and anemia were compared between the two groups.The scores of knee function,physical health and mental health of the two groups before and after operation were observed.Results There was no significant difference in knee function scores between the two groups before operation.There were significant differences in overall knee function between the two groups(F= 126.356 and 82.032,respectively,P<0.01).At different time points after operation,the score of knee joint function in individual group was significantly higher than that in combined group(P<0.05).There were no significant differences in the scores of physical health and mental health between the two groups before surgery(P>0.05).The physical health scores and mental health scores of the two groups were significantly higher than those of the control group at 3 months after operation(P<0.05).There were no significant differences in the scores of physical health and mental health between the two groups before surgery(P> 0.05).The physical health scores and mental health scores of the two groups were significantly higher than those of the control group at 3months after operation(P>0.05).The operation time and hospital stay in the simple group were shorter than those in the combined group,and the amount of bleeding during the operation was less than that in the combined group(P<0.05).The incidences of postoperative hypoproteinemia and anemia in the simple group were significantly lower than those in the combined group,The difference between the groups was statistically significant(P<0.05).The recurrence rate was 10.26% in the simple group and 11.36%in the combined group at 18 months after operation.There was significant difference between the two groups(P> 0.05).Conclusion The knee joint function and quality of life of both patients were effectively improved after operation,and had no effect on postoperative recurrence.In contrast,the operation time was shorter and the postoperative recovery was faster in patients with knee joint debridement alone.Knee tuberculosis using simple tuberculosis sclerosis or bone graft fusion combined with external fixation can effectively improve the patient's knee function and quality of life,so the choice of surgical procedures should be based on the severity of the patient's choice,and then improve the efficacy and promote postoperative Rehabilitation.
Objective To investigate clinical effects of debridement alone or combined with bone grafting and external fixation in the treatment of knee tuberculosis.Methods Eighty-three patients with knee joint tuberculosis who admitted to hospital from January 2014 to January 2016 were enrolled.According to the random number table,39 cases were divided into separate tuberculosis group and 39 cases with clear-cut union bone graft and external fixation group,separate groups and joint groups.The operative time,hospitalization time,intraoperative blood loss and postoperative hypoalbumin and anemia were compared between the two groups.The scores of knee function,physical health and mental health of the two groups before and after operation were observed.Results There was no significant difference in knee function scores between the two groups before operation.There were significant differences in overall knee function between the two groups(F= 126.356 and 82.032,respectively,P<0.01).At different time points after operation,the score of knee joint function in individual group was significantly higher than that in combined group(P<0.05).There were no significant differences in the scores of physical health and mental health between the two groups before surgery(P>0.05).The physical health scores and mental health scores of the two groups were significantly higher than those of the control group at 3 months after operation(P<0.05).There were no significant differences in the scores of physical health and mental health between the two groups before surgery(P> 0.05).The physical health scores and mental health scores of the two groups were significantly higher than those of the control group at 3months after operation(P>0.05).The operation time and hospital stay in the simple group were shorter than those in the combined group,and the amount of bleeding during the operation was less than that in the combined group(P<0.05).The incidences of postoperative hypoproteinemia and anemia in the simple group were significantly lower than those in the combined group,The difference between the groups was statistically significant(P<0.05).The recurrence rate was 10.26% in the simple group and 11.36%in the combined group at 18 months after operation.There was significant difference between the two groups(P> 0.05).Conclusion The knee joint function and quality of life of both patients were effectively improved after operation,and had no effect on postoperative recurrence.In contrast,the operation time was shorter and the postoperative recovery was faster in patients with knee joint debridement alone.Knee tuberculosis using simple tuberculosis sclerosis or bone graft fusion combined with external fixation can effectively improve the patient's knee function and quality of life,so the choice of surgical procedures should be based on the severity of the patient's choice,and then improve the efficacy and promote postoperative Rehabilitation.
引文
[1]李元,董伟杰,兰汀隆,等.膝关节结核病灶清除术及联合植骨融合外固定术的临床治疗效果观察[J].中国防痨杂志,2016,38(4):296-299.
[2]廖伟,杨国强,覃一珏.结核病灶清除术联合植骨融合外固定术治疗膝关节结核的疗效分析[J].广西医学,2017,39(3):302-304.
[3]谭远超.骨伤整复术(精)[M].人民卫生出版社,2008.
[4]陈天辉,李鲁,Joerg M.Single,等.健康相关生命质量测量工具SF-36第二版和第一版的比较[C]//中华预防医学会第八次社会医学学术年会.2005.
[5]张连平.内固定联合病灶清除植骨融合术治疗脊柱结核的效果分析[J].临床研究,2016,24(8):86-87.
[6] Yu H,Jin L,Chen X,et al.A Posterior versus anterior debridement in combination with bone graft and internal fixation for lumbar and thoracic tuberculosis[J].Journal of OrthoPaedic Surgery&Research,2017,12(1):150.
[7] Yang B H,Ouyang Z,Zhao J L,et al.One stage anterior debridement,bone fusion and internal fixation for the treatment of lumbosacral tuberculosis[J].China Journal of OrthoPaedics&Traumatology,2013,26(7):546.
[8]傅维德,何杰,米东,等.一期经后路固定联合侧前方入路病灶清除植骨融合术治疗老年下腰椎结核临床效果观察[J].现代生物医学进展,2013,13(29):5746-5749.
[9]曹武臣.后路椎弓根内固定联合经椎弓根病灶清除植骨融合术治疗脊柱结核的临床观察[J].齐齐哈尔医学院学报,2016,37(25):3187-3188.
[10] Xiangqin S,Ma H,Sun Y,et al.Clinical efficacy of one-stage posterior debridement,bone graft and instrumentation intreatment of thoracolumbar tuberculosis[J].Chinese Journal of Nosocomiology,2013,23(19):4709-4711.
[11]陈云坤,秦凯,孙林.膝关节结核58例手术治疗效果分析[J].现代医药卫生,2013,29(20):3070-3071.
[12] Yan Y Q,Xia M L,Dai J P,et al.Treatment of thoracolumbar spinal tuberculosis with single Posterior debridement,bone grafting,internal fixation and local chemotherapy.[J].Zhongguo Gu Shang,2015,28(4):323-326.
[13] Chen L,Cheng J,Bo L I,et al.Posterior debridement and interbody bone grafting fusion combined with internal fixation in treatment of lumbar tuberculosis[J].Journal of Spinal Surgery,2015,13(7):1-9.
[14]贾晨光,姚黎明,李秀武,等.病灶清除手术联合持续多管闭式引流法与单纯引流法治疗早期全膝关节结核的疗效比较[J].河北医科大学学报,2014,35(9):1010-1014.
[15] Lan X,Xu J Z,Luo F,et al.One-stage debridement and bone grafting with internal fixation via Posterior aPProach for treatment of children thoracic spine tuberculosis[J].China Journal of OrthoPaedics&Traumatology,2013,26(4):320-323.
[16]程鸿鑫,陈何.关节镜治疗早、中期膝关节结核与切开病灶清除术治疗的疗效对比[J].中国伤残医学,2017,25(18):34-35.
[17]张宏其,王龙杰,唐明星,等.脓肿清除术联合置管小剂量灌洗处理胸腰椎结核术后复发的临床疗效[J].中国矫形外科杂志,2016,24(5):401-405.
[18]周湘桂,李思云,魏水崽,等.关节镜手术诊治早、中期单纯膝关节结核的临床体会[J].中国内镜杂志,2013,19(1):50-52.
[19] Vijay Kumar,Bhavuk Garg,Rajesh Malhotra.Total hip replacement for arthritis following tuberculosis of hip[J].World Journal of Orthopedics,2015,6(08):636-640.
[20] Qu Liuxin,Xing Liyang,Wanda Norman,et al.Clinical effect of traditional Chinese spinal orthopedic manipulation in treatment of chondromalacia patellae[J].Journal of Traditional Chinese Medicine,2016,36(06):718-723.
[2]廖伟,杨国强,覃一珏.结核病灶清除术联合植骨融合外固定术治疗膝关节结核的疗效分析[J].广西医学,2017,39(3):302-304.
[3]谭远超.骨伤整复术(精)[M].人民卫生出版社,2008.
[4]陈天辉,李鲁,Joerg M.Single,等.健康相关生命质量测量工具SF-36第二版和第一版的比较[C]//中华预防医学会第八次社会医学学术年会.2005.
[5]张连平.内固定联合病灶清除植骨融合术治疗脊柱结核的效果分析[J].临床研究,2016,24(8):86-87.
[6] Yu H,Jin L,Chen X,et al.A Posterior versus anterior debridement in combination with bone graft and internal fixation for lumbar and thoracic tuberculosis[J].Journal of OrthoPaedic Surgery&Research,2017,12(1):150.
[7] Yang B H,Ouyang Z,Zhao J L,et al.One stage anterior debridement,bone fusion and internal fixation for the treatment of lumbosacral tuberculosis[J].China Journal of OrthoPaedics&Traumatology,2013,26(7):546.
[8]傅维德,何杰,米东,等.一期经后路固定联合侧前方入路病灶清除植骨融合术治疗老年下腰椎结核临床效果观察[J].现代生物医学进展,2013,13(29):5746-5749.
[9]曹武臣.后路椎弓根内固定联合经椎弓根病灶清除植骨融合术治疗脊柱结核的临床观察[J].齐齐哈尔医学院学报,2016,37(25):3187-3188.
[10] Xiangqin S,Ma H,Sun Y,et al.Clinical efficacy of one-stage posterior debridement,bone graft and instrumentation intreatment of thoracolumbar tuberculosis[J].Chinese Journal of Nosocomiology,2013,23(19):4709-4711.
[11]陈云坤,秦凯,孙林.膝关节结核58例手术治疗效果分析[J].现代医药卫生,2013,29(20):3070-3071.
[12] Yan Y Q,Xia M L,Dai J P,et al.Treatment of thoracolumbar spinal tuberculosis with single Posterior debridement,bone grafting,internal fixation and local chemotherapy.[J].Zhongguo Gu Shang,2015,28(4):323-326.
[13] Chen L,Cheng J,Bo L I,et al.Posterior debridement and interbody bone grafting fusion combined with internal fixation in treatment of lumbar tuberculosis[J].Journal of Spinal Surgery,2015,13(7):1-9.
[14]贾晨光,姚黎明,李秀武,等.病灶清除手术联合持续多管闭式引流法与单纯引流法治疗早期全膝关节结核的疗效比较[J].河北医科大学学报,2014,35(9):1010-1014.
[15] Lan X,Xu J Z,Luo F,et al.One-stage debridement and bone grafting with internal fixation via Posterior aPProach for treatment of children thoracic spine tuberculosis[J].China Journal of OrthoPaedics&Traumatology,2013,26(4):320-323.
[16]程鸿鑫,陈何.关节镜治疗早、中期膝关节结核与切开病灶清除术治疗的疗效对比[J].中国伤残医学,2017,25(18):34-35.
[17]张宏其,王龙杰,唐明星,等.脓肿清除术联合置管小剂量灌洗处理胸腰椎结核术后复发的临床疗效[J].中国矫形外科杂志,2016,24(5):401-405.
[18]周湘桂,李思云,魏水崽,等.关节镜手术诊治早、中期单纯膝关节结核的临床体会[J].中国内镜杂志,2013,19(1):50-52.
[19] Vijay Kumar,Bhavuk Garg,Rajesh Malhotra.Total hip replacement for arthritis following tuberculosis of hip[J].World Journal of Orthopedics,2015,6(08):636-640.
[20] Qu Liuxin,Xing Liyang,Wanda Norman,et al.Clinical effect of traditional Chinese spinal orthopedic manipulation in treatment of chondromalacia patellae[J].Journal of Traditional Chinese Medicine,2016,36(06):718-723.