Debridement, bone graft fusion and internal fixation with one-stage operation in the treatment of advanced wrist joint tuberculosis: a report of 14 cases

Abstract

Figures/Tables 5

References 12

doi:10.3969/j.issn.1000-6621.2019.04.010

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

Zhen-can YUAN,Ying ZHAN,Jing-chao LI,Qing WANG,Xiao-bo YANG. Debridement, bone graft fusion and internal fixation with one-stage operation in the treatment of advanced wrist joint tuberculosis: a report of 14 cases[J]. Chinese Journal of Antituberculosis, 2019, 41(4): 421-425. doi: 10.3969/j.issn.1000-6621.2019.04.010

31. 用以往惯用的方式演奏乐器或进行体育活动

32. 肩、臂或手部疼痛影响演奏乐器或进行体育活动

33. 可以达到您要求的那样演奏乐器或进行体育活动

34. 能像以往一样长时间演奏乐器或进行体育活动

[1]	中国防痨协会结核病临床专业分会骨关节结核学组. 脊柱结核手术治疗临床路径. 中国防痨杂志, 2016,38(8):609-614. doi: 10.3969/j.issn.1000-6621.2016.08.001 URL
[2]	夏云峰, 彭喜林, 董亚军 , 等. 后路病灶清除混合颗粒骨打压植骨并椎弓根螺钉固定治疗腰骶椎体结核效果分析. 结核病与肺部健康杂志, 2017,6(3):212-217.
[3]	《中国组织工程研究与临床康复》学术部. 让昨天告诉今天:人工腕关节置换的学术研究与技术进展. 中国组织工程研究与临床康复, 2009,13(26):5011-5012. doi: 10.3969/j.issn.1673-8225.2009.26.001 URL
[4]	盛杰 , 吐尔松江·胡达拜尔迪,古甫丁 ,等. 线性探针技术在骨关节结核快速诊断中的应用价值. 结核病与肺部健康杂志, 2017,6(3):208-211. doi: 10.3969/j.issn.2095-3755.2017.03.005 URL
[5]	宋婧, 车南颖 . 结核病分子病理学诊断技术临床应用进展. 中国防痨杂志, 2018,40(11):1221-1225.
[6]	Houshian S, Schrøder HA . Wrist arthrodesis with the AO titanium wrist fusion plate: a consecutive series of 42 cases. J Hand Surg Br, 2001,26(4):355-359. doi: 10.1054/jhsb.2001.0600 URL pmid: 11469839
[7]	陈振兵, 洪光祥, 王发斌 . 上肢功能评定表. 中国修复重建外科杂志, 2004,18(6):520-521.
[8]	林羽 . 骨、关节结核专题讲座——第19讲腕关节结核. 中国农村医学, 1998,26(8):5-6.
[9]	Johnson R, Barnes KL , Owen R . Reactivation of tuberculosis after total hip replacement. J Bone Joint Surg Br, 1979, 61-B(2):148-150. doi: 10.1302/0301-620x.61b2.438263 URL pmid: 438263
[10]	Gale DW, Harding ML . Total knee arthroplasty in the pre-sence of active tuberculosis. J Bone Joint Surg Br, 1991,73(6):1006-1007. doi: 10.1016/0020-1383(91)90146-6 URL pmid: 1955424
[11]	De Nayer P, Hartono F . Active tuberculous coxarthritis in the adult. 2 cases treated by total arthroplasty with a follow-up of 7 and 3 years. Acta Orthop Belg, 1989,55(1):17-21. URL pmid: 2801057
[12]	Field J, Herbert TJ, Prosser R . Total wrist fusion. A functional assessment. J Hand Surg Br, 1996,21(4):429-433. doi: 10.1016/S0266-7681(96)80039-8 URL

项目	活动能力
项目	无困难	有点困难	有明显困难但能做到	很困难	不能
1. 拧开已拧紧的或新的玻璃瓶盖	1	2	3	4	5
2. 写字	1	2	3	4	5
3. 用钥匙开门	1	2	3	4	5
4. 准备饭菜	1	2	3	4	5
5. 推开一扇大门	1	2	3	4	5
6. 将物品放入头部上方的小柜子里	1	2	3	4	5
7. 繁重的家务劳动(擦地板等)	1	2	3	4	5
8. 花园及院子的劳动	1	2	3	4	5
9. 铺床	1	2	3	4	5
10. 拎购物袋或文件箱	1	2	3	4	5
11. 搬运重物(超过5kg)	1	2	3	4	5
12. 更换头部上方的灯泡	1	2	3	4	5
13. 洗发或吹干头发	1	2	3	4	5
14. 擦洗背部	1	2	3	4	5
15. 穿毛衣	1	2	3	4	5
16. 用刀切食品	1	2	3	4	5
17. 轻微体力的业余活动(打牌等)	1	2	3	4	5
18. 使用臂部力量或冲击力的业余活动(打网球等)	1	2	3	4	5
19. 灵活使用臂部的业余活动(打羽毛球等)	1	2	3	4	5
20. 驾驶、乘坐交通工具	1	2	3	4	5
21. 性功能	1	2	3	4	5
22. 影响你与家人、朋友、邻居及其他人群社会交往的程度	1	2	3	4	5
23. 影响你的工作或其他日常活动的程度	1	2	3	4	5

项目	症状严重程度
项目	无	轻微	中度	重度	极度
24. 休息时肩、臂或手部疼痛	1	2	3	4	5
25. 活动时肩、臂或手部疼痛	1	2	3	4	5
26. 肩、臂或手部麻木、针刺样疼痛	1	2	3	4	5
27. 肩、臂或手部无力	1	2	3	4	5
28. 肩、臂或手部僵硬	1	2	3	4	5
29. 肩、臂或手部疼痛对睡眠的影响	1	2	3	4	5
30. 肩、臂或手部功能障碍使你感到能力下降、缺乏自信	1	2	3	4	5

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