全髋关节型占位器一期旷置术治疗中晚期髋关节结核疗效评价

doi:10.19982/j.issn.1000-6621.20230139

摘要/Abstract

摘要：

目的: 在常规抗结核治疗的情况下,评价应用抗生素骨水泥结合股骨柄术中制作全髋关节型占位器治疗中晚期髋关节结核的疗效。方法: 回顾性分析2016年1月至2021年1月河南省传染病医院收治的96例中晚期髋关节结核患者的临床资料。根据治疗方法将患者分为观察组52例(采用全髋关节型占位器)和对照组44例(采用常规压力模垫片)。收集研究对象临床资料,包括血红细胞沉降率(ESR)、X线摄影、CT扫描及MRI检查等结果。比较两组研究对象手术相关指标、术后并发症发生情况、Harris髋关节功能评分优良率、患者满意度、ESR水平。结果: 观察组手术时间[(132.26±26.55)min]、术中出血量[(635.68±253.45)ml]、引流管拔除时间[(8.35±3.38)d]均明显多于对照组[(107.65±21.62)min、(590.38±241.63)ml和(7.80±2.53)d],差异均有统计学意义(t值分别为2.487、2.536、1.690,P值分别为0.013、0.016、0.042)。观察组住院时间[(25.53±5.36)d]和下床活动时间[(7.42±2.38)d]均明显短于对照组[ (28.61±6.35)d和(12.67±2.53)d],差异均有统计学意义(t值分别为1.590和2.659,P值分别为0.048和0.011)。观察组患者术后并发症发生率为13.5%(7/52),明显低于对照组的45.5%(20/44),差异有统计学意义(χ²=6.356, P=0.009);观察组Harris髋关节功能评分优良率为94.2%(49/52),明显高于对照组的70.5%(31/44),差异有统计学意义(χ²=8.762,P<0.05)。观察组患者满意度为94.2%(49/52),明显高于对照组的79.5%(35/44),差异有统计学意义(χ²=7.100,P=0.008)。结论: 全髋关节型占位器治疗中晚期髋关节结核疗效较好,患者满意度高,具有较好的临床应用价值。

关键词: 结核,骨关节, 关节成形术,置换,髋, 评价研究

Abstract:

Objective: To evaluate the therapeutic efficacy of using an antibiotic-loaded cement spacer combined with femoral stem in total hip joint reconstruction for late-stage hip tuberculosis, under the context of conventional anti-tuberculosis treatment. Methods: A retrospective study was conducted in 96 patients with late-stage hip tuberculosis admitted to Henan Infectious Disease Hospital from January 2016 to January 2021. According to the treatment methods, the patients were divided into an observation group of 52 cases (treated with a total hip joint spacer) and a control group of 44 cases (treated with conventional pressure pads). Clinical data of the study subjects were collected, including erythrocyte sedimentation rates (ESR), X-ray imagings, CT scans, and MRI examinations. The surgical-related indicators, postoperative complication rates, Harris hip joint function score, patient satisfaction, and ESR levels were compared between the two groups. Results: The operation time ((132.26±26.55) min), intraoperative blood loss ((635.68±253.45) ml), and drainage tube removal time ((8.35±3.38) days) in the observation group were significantly higher than those in the control group ((107.65±21.62) min, (590.38±241.63) ml, and (7.80±2.53) days), with statistically significant differences (t-values of 2.487, 2.536, and 1.690, P-values of 0.013, 0.016, and 0.042, respectively). The length of hospital stay ((25.53±5.36) days) and the time to ambulation ((7.42±2.38) days) in the observation group were significantly shorter than those in the control group ((28.61±6.35) days, (12.67±2.53) days), with significant differences (t=1.590,2.659, P=0.048 and 0.011, respectively). The incidence of postoperative complications in the observation group was 13.5% (7/52), significantly lower than the control group (45.5% (20/44)), with significant difference (χ²=6.356, P=0.009). The excellent rate of Harris hip joint function score in the observation group was 94.2% (49/52), significantly higher than the control group (70.5% (31/44)), with significant difference (χ²=8.762, P<0.05). The patient satisfaction rate in the observation group was 94.2% (49/52), significantly higher than the control group (79.5% (35/44)), with significant difference (χ²=7.100, P=0.008). Conclusion: The treatment of late-stage hip tuberculosis with a total hip joint spacer has shown favorable therapeutic efficacy, high patients’ satisfaction, and significant clinical value for application.

Key words: Tuberculosis,osteoarticular, Arthroplasty,replacement,hip, Evaluation studies

中图分类号:

R529.2

宋宏阁, 刘维高. 全髋关节型占位器一期旷置术治疗中晚期髋关节结核疗效评价[J]. 中国防痨杂志, 2023, 45(8): 781-785. doi: 10.19982/j.issn.1000-6621.20230139

Song Hongge, Liu Weigao. Evaluation of the curative effect of total hip joint type space holder in the treatment of middle and advanced hip joint tuberculosis[J]. Chinese Journal of Antituberculosis, 2023, 45(8): 781-785. doi: 10.19982/j.issn.1000-6621.20230139

图/表 3

图1

表1

两组研究对象手术相关指标的比较

组别	手术时间 (min, $x ˉ$ ±s )	术中出血量 (ml, $x ˉ$ ±s)	引流管拔除时间 (d, $x ˉ$ ±s)	下床活动时间 (d, $x ˉ$ ±s)	住院时间 (d, $x ˉ$ ±s)
观察组	132.26±26.55	635.68±253.45	8.35±3.38	7.42±2.38	25.53±5.36
对照组	107.65±21.62	590.38±241.63	7.80±2.53	12.67±2.53	28.61±6.35
t值	2.487	2.536	1.690	2.659	1.590
P值	0.013	0.016	0.042	0.011	0.048

表1

图2~5

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