关键词: 腕关节, 结核, 骨关节, 关节融合术, 内固定器, 治疗结果

Abstract:

Objective To explore the feasibility and clinical efficacy of debridement, bone graft fusion and internal fixation with one-stage operation in the treatment of advanced wrist joint tuberculosis. Methods The clinical data from 14 patients with advanced tuberculosis of wrist joint treated with debridement, bone graft fusion and internal fixation were analyzed retrospectively in Shandong Provincial Chest Hospital Affiliated to Shandong University from April 2010 to May 2017. Among them, 11 cases were male and 3 cases were female, the average age was (41.0±18.5) years old ranged from 7 to 85 years old. The pericarpal focus was completely debrided in all patients, the bone defect was implanted into allogeneic bone, microtitanium plate was placed on the radius and metacarpal for internal fixation, and the distal ulna about 1 cm was removed at the same time. All patients underwent systematic and standardized chemotherapy with anti-tuberculosis drugs for 12 months. The healing of surgical incision, complications, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were analyzed. The functional recovery of wrist joint were analyzed using the score table of Buck-Gramcko/Lohmannn (scoring criteria: 9-10 scores was excellent, 7-8 scores was good, 5-6 scores was general, low than 5 scores was poor) and upper limb dysfunction (DASH table: 0 score was normal and 100 scores was extremely limited). Results The average time of follow-up was (14.0±2.1)months ranged from 12 to 18 months in all patients. Surgical incision was healing with one-stage in all patients. The ESR was decreased from (28.0±23.5)mm/1h to (6.1±2.1)mm/1h with which the average recovery time of ESR was (3.5±1.3)months ranged from 2 to 6 months. The CRP was decreased from (27.0±35.1)mg/L to (3.4±1.3)mg/L with which the average recovery time of ESR was (2.4±1.2)months ranged from 2 to 5 months. The score was increased from average (4.6±0.8) ranged from 3 to 6 before operation to (8.5±0.9) ranged from 7 to 10 after operation with the score table of Buck-Gramcko/Lohmannn. The assessment was improved satisfactory from poor in all patients before operation to excellent in 7 patients and good in the other 7 patients after operation. The score with DASH table was improved from the average (68.0±1.9) ranged from 65 to 70 to the average (30.0±2.8) ranged from 26 to 35 in all patients. All patients had good internal fixation position, no swelling and pain, and no complications at the follow-up. Conclusion The better clinical efficacy can achieved with debridement, bone graft fusion and internal fixation with one-stage operation based on effective chemotherapy in the treatment of advanced wrist joint tuberculosis.

Key words: Wrist joint, Tuberculosis, osteoarticular, Arthrodesis, Internal fixators, Treatment outcome