Therapeutic effect of debridement and bone grafting combined with external fixation for the treatment of wrist joint tuberculosis

doi:10.3969/j.issn.1000-6621.2019.12.005

Abstract

Abstract:

Objective To analyze the effectiveness of debridement and bone grafting combined with external fixation for the treatment of wrist joint tuberculosis.Methods A total of 32 patients with wrist joint tuberculosis who admitted to the Fourth People’s Hospital of Qinghai Province and the Beijing Chest Hospital of Capital Medical University from January 2016 to January 2019 were retrospectively analyzed. Among these patients, 17 cases were treated with conventional wrist joint debridement as a control group; and 15 cases were treated with debridement and bone grafting combined with external fixation as the observation group. The excellent rate of wrist function after treatment, the score of visual analog scale (VAS scale), the improvement of the quality of life scale (QOL) score, and the incidence of complications were compared between two groups.Results After 1 month of treatment, the excellent rate of wrist function in the observation group was 93.3% (14/15), which was significantly higher than that in the control group (58.8%, 10/17), with the statistically significant difference (χ ²=5.06, P=0.024); the VAS score of the observation group was (1.21±0.13), which was significantly lower than that of the control group (3.18±0.49), with the statistically significant difference (t=15.08, P<0.001); and the complication rate was 6.7% (1/15) in the observation group, which was significantly lower than that in the control group (41.2% (7/17)), with the statistically significant difference (χ ²=4.75, P=0.029). After 3 months of treatment, the QOL score of the observation group was (50.14±3.52), which was significantly higher than that of the control group (41.01±1.57), and the difference was statistically significant (t=9.67, P=0.000). Conclusion Debridement and bone grafting combined with external fixation can effectively improve the wrist function of patients with wrist joint tuberculosis, reduce pain, reduce the incidence of complications and improve the quality of life.

Key words: Tuberculosis, osteoarticular, Wrist joint, Surgical procedures, elective, Comparative effectiveness research

Shang-sheng XU,Shi-bing QIN,Jun FAN,Yong-chao HUO,Sheng-lu BAI,Chun-wei WANG. Therapeutic effect of debridement and bone grafting combined with external fixation for the treatment of wrist joint tuberculosis[J]. Chinese Journal of Antituberculosis, 2019, 41(12): 1258-1262. doi: 10.3969/j.issn.1000-6621.2019.12.005

Figures/Tables 2

References 14

[1]	Pattamapaspong N, Muttarak M, Sivasomboon C . Tuberculosis arthritis and tenosynovitis. Semin Musculoskelet Radiol, 2011,15(5):459-469.
[2]	岳跃兵, 沈杰 . 腕关节结核误诊为痛风1例. 广东医学, 2016,37(20):3156.
[3]	Luke WANV, Gunathilake MPML, Munidasa D , et al. Tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report. BMC Res Notes, 2017,10(1):343.
[4]	李海亚, 黄山, 张教堂 . 骨肽注射液联合早期训练对促进桡骨近腕关节处骨折愈合和改善腕关节功能的临床效果. 中国骨质疏松杂志, 2018,24(1):64-67.
[5]	苏钟毅, 胡宏亮, 季兴华 , 等. 尺骨茎突固定与否对桡骨远端骨折并尺骨茎突骨折患者腕关节功能影响的观察分析. 中国药物与临床, 2018,18(S1):91-92.
[6]	唐恺, 秦世炳, 董伟杰 , 等. 一期后路病灶清除植骨内固定治疗化脓性脊柱炎的疗效观察. 中国防痨杂志, 2018,40(5):466-471.
[7]	Bowman MA, Victoria Neale A, Seehusen DA . In this issue: opiates, tobacco, social determinants of health, social accountability for non-profit hospitals, more on PCMH, and clinical topics. J Am Board Fam Med, 2017,30(4):399-401.
[8]	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. 中国防痨杂志, 2016,38(4):296-299.
[9]	陆维举, 褚立涛, 闫韵飞 , 等. 外固定架联合克氏针固定治疗锁骨感染性骨折不愈合. 中国骨与关节损伤杂志, 2017,32(9):975-976.
[10]	Watanabe K, Yamazaki Y, Sugawara M . Tuberculosis of the wrist accompanied with calcium pyrophosphate: a case report. Intern Med, 2017,56(24):3389-3394.
[11]	龚亚莉, 罗毅, 陈宏 , 等. 藏族骨关节结核患者的构成比和类型分布特点. 西部医学, 2016,28(8):1104-1106.
[12]	袁振灿, 战英, 李敬朝 , 等. 一期病灶清除植骨融合内固定术治疗晚期腕关节结核(附14例报告). 中国防痨杂志, 2019,41(4):421-425.
[13]	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.
[14]	任忠明, 张远, 张翊 , 等. 一期前路病灶清除植骨联合前路或后路内固定重建术治疗胸腰椎结核. 中国矫形外科杂志, 2016,24(19):1774-1779.

组别	优	良	中	差
观察组(15例)	5(33.3)	9(60.0)	1(6.7)	0(0.0)
对照组(17例)	3(17.6)	7(41.2)	5(29.4)	2(11.8)

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