关键词: 髋关节, 结核, 关节成形术, 生活质量, 对比研究

Abstract:

Objective: To evaluate and compare the quality of life in patients with advanced hip joint tuberculosis (TB), who received one-stage open placement treatment with a total hip joint type spacer device (composite prosthesis composed of bone cement, femoral stem, ceramic joint head, etc.) and a conventional pressure model spacer device, within 5 years after surgery. Methods: A retrospective analysis was conducted. The clinical data of 52 patients with advanced hip joint TB admitted at Henan Provincial Infectious Disease Hospital from January 2016 to December 2018 were analyzed. Within 2-5 years after surgery, 2 cases died due to other reasons or illness, and the remaining 50 cases received follow-up and their relevant data were completely collected. According to the treatment method, the patients were divided into two group, namely: 22 cases were in the total hip joint type group, who were treated with a total hip joint type spacer device; 28 cases were in the pressure model group, who were treated with conventional pressure model spacer. Compare the Harris joint scores, completion rate of the 20 kg walking test as well as the incidence of postoperative complications such as pain, dislocation and rupture of the spacer device between two groups of patients before surgery and at 1, 3, 6, 12, 24, 36, 48, 60 months after surgery. Results: Due to the high incidence of dislocation and fracture in the pressure model group during the period of 6 to 24 months after surgery, Harris joint scores and completion rates of the 20 kg walking test were no longer compared between the two groups at different time periods of 36 to 60 months after surgery. The Harris joint scores in the total hip joint type group (76.45±5.23, 86.55±3.78, 89.32±3.15, 92.05±2.72, 94.09±1.90) at 1, 3, 6, 12 and 24 months after surgery were respectively higher than those in the pressure model group (61.00±6.13, 71.93±5.38, 76.82±11.41, 81.75±15.00 and 78.93±15.75). The differences were statistically significant (t-values were 9.427, 10.809, 4.978, 3.558, and 5.047 respectively, with all P-values <0.001); at 1, 3, 6, 12 and 24 months after surgery, the completion rates of the 20 kg walking test in the total hip joint type group (27.3% (6/22), 81.8% (18/22), 100.0% (22/22), 100.0% (22/22) and 100.0% (22/22)) were significantly better than those in the pressure model group (0.0% (0/28), 7.1% (2/28), 17.9% (5/28), 21.4% (6/28) and 17.9% (5/28)), and the differences were statistically significant(χ² values were 9.416, 28.626, 33.466, 30.867 and 33.466 respectively, with P-values of 0.002, <0.001, <0.001, <0.001, <0.001); the dislocation rate (0.0% (0/22)) and fracture rate (0.0% (0/22)) of the total hip joint type group were significantly lower than those of the pressure model group (7.1% (2/28) and 21.4% (6/28)), with statistical significance(χ² values were 14.351 and 11.928 respectively, with all P-values <0.001). Conclusion: The use of total hip joint type spacer device can accelerate the recovery process of patients with hip joint TB after one-stage open placement surgery, reduce the occurrence of complications such as dislocation and fracture of open placement implants, and improve the quality of life of patients in mid to late stage who have long-term postoperative open placement implants.

Key words: Hip joint, Tuberculosis, Arthroplasty, Quality of life, Comparative study