关键词: 结核, 骨关节, 关节融合术, 关节成形术, 置换, 肘, 治疗效果

Abstract:

Objective To analyze the efficacy of arthrodesis and modified fork-like arthroplasty after elbow joint debridement for the treatment of elbow joint tuberculosis, and to explore the value of fork-like arthroplasty in the treatment of elbow joint tuberculosis.Methods From February 2009 to February 2018, 48 adult patients with total elbow joint tuberculosis who underwent surgical treatment and followed up for more than 12 months in Shaanxi Provincial Institute for Tuberculosis Control and Prevention were selected. Among them, 20 patients from February 2009 to July 2015 underwent arthrodesis after elbow joint debridement (defined as arthrodesis group), and 28 patients from August 2015 to February 2018, underwent modified fork-like arthroplasty after elbow joint debridement (defined as arthroplasty group). The flexion and extension and rotation mobility, visual analogue scale (VAS score) and Mayo elbow performance score (MEPS) before and 12 months after surgery were compared between the two groups, in order to assess the surgical outcome in elbow and forearm function (including exercise, stability, pain, and daily living function). All patients were observed during follow-up. Statistical analysis was performed using SPSS 21.0 software. t-test was used to compare measurement data between two groups, and χ² test was used for categorical data. The difference was statistically significant at P<0.05. Results All 48 patients were followed up for 12 to 24 months, with an average of (13.4±5.5) months. Forty-five patients were cured in one-stage surgery. The incisions in three patients were not closed; but after local dressing and second debridement, all incisions were closed. In the arthrodesis group, the degree of joint mobility was reduced from (7.8±6.8)° in flexion and extension and (5.5±5.1)° in rotation preoperatively to 0° at 12 months postoperatively (t=5.111 and 4.819, Ps<0.001), and the VAS and MEPS scores were improved from (7.3±1.4) and (7.3±5.0) preoperatively to (1.0±1.0) and (17.5±4.7) at 12 months postoperatively (t=21.642 and 5.832, Ps<0.001). In the arthroplasty group, the degree of joint mobility was increased from (8.8±6.9)° in flexion and extension and (6.4±5.9)° in rotation preope-ratively to (58.8±15.4)° and (37.0±11.8)° at 12 months postoperatively (t=16.733 and 11.569, Ps<0.001), and the VAS and MEPS scores were improved from (7.5±1.2) and (6.3±4.8) preoperatively to (1.1±0.9) and (20.5±3.9) at 12 months postoperatively (t=22.055 and 13.587, Ps<0.001). 12 months after surgery, the arthroplasty group showed superior joint mobility in flexion and extension and rotation and MEPS compared with the arthrodesis group (t=20.222, P<0.001; t=16.560, P<0.001; t=2.424, P=0.037). There was no significant difference in VAS score (t=0.527, P=0.076) between arthroplasty and arthrodesis group.Conclusion Based on the standardized anti-tuberculosis drug treatment, the fork-like arthroplasty after the first-stage debridement is better than the arthrodesis after debridement in improving elbow joint activity and daily living function, and is more conducive to the treatment of adults patients with advanced elbow joint tuberculosis.

Key words: Tuberculosis, osteoarticular, Arthrodesis, Arthroplasty, replacement, elbow, Treatment outcome