一期全髋置换与关节融合治疗晚期髋关节结核

One-stage total hip arthroplasty versus hip arthrodesis for advanced hip tuberculosis

摘要:

[目的] 比较一期全髋关节置换（total hip arthroplasty, THA） 与关节融合治疗晚期髋结核的临床结果。[方法] 回顾性分析2017 年1 月—2019 年1 月本院收治的88 例晚期髋关节结核患者的临床资料，根据医患沟通结果，44 例采用一期THA，另外44 例采用髋关节融合术。比较两组围手术期、随访及辅助检查资料。[结果] 两组患者均顺利手术，无严重并发症。置换组在手术时间[(90.3±9.3) min vs (97.1±8.6) min, P＜0.05]、术中失血量[(206.5±60.5) ml vs (231.5±54.3) ml, P＜0.05]、住院时间[(14.4±1.9) d vs (15.3±1.3) d, P＜0.05]、下地行走时间[(8.4±1.3) d vs (9.1±1.2) d, P＜0.05] 均显著优于融合组。随访时间平均（18.2±3.2） 个月，两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）。随访过程中，局部结核复发置换组2 例，融合组3 例，经再次行病灶清除，并规律抗结核治疗后治愈。与术前相比，末次随访两组Harris 评分均显著增加（P＜0.05），置换组屈-伸及内收-外展ROM 显著增加（P＜0.05），而末次随访时融合组屈-伸及内收-外展ROM 丧失。末次随访时，置换组在Harris 评分[(93.2±8.4) vs (85.6±7.4), P＜0.05]、屈-伸ROM [(102.9±9.6)° vs 0°, P＜0.05]、内收-外展ROM [(164.1±13.2)° vs 0°, P＜0.05] 均显著优于融合组。辅助检查方面，与术前相比，两组双侧肢长差均显著减小（P＜0.05）。相应时间点，两组间辅助检查指标的差异均无统计学意义（P＞0.05）。[结论] 一期THA 及髋关节融合术对晚期髋关节结核均有较好疗效，相比之下THA 手术创伤更小，功能恢复更好。

Abstract:

[Objective] To compare the clinical outcomes of total hip arthroplasty (THA) versus hip arthrodesis (HA) in the treatment ofadvanced hip tuberculosis. [Methods] A retrospective study was performed on 88 patients who received surgical treatment for advanced hiptuberculosis in our hospital from January 2017 to January 2019. According to the doctor-patient communication, 44 patients received onestageTHA, while the other 44 received HA. The documents regarding perioperative period, follow-up and auxiliary examination were com-pared between the two groups. [Results] All patients in both group had corresponding surgical procedures performed successfully withoutserious complications. The THA group proved significantly superior to the HA group in terms of operation time [(90.3±9.3) min vs (97.1±8.6) min, P＜0.05], intraoperative blood loss [(206.5±60.5) ml vs (231.5±54.3) ml, P＜0.05], hospital stay [(14.4±1.9) days vs (15.3±1.3) days,P＜0.05] and postoperative walking time [(8.4±1.3) days vs (9.1±1.2) days, P＜0.05]. The mean follow-up time lasted for (18.2±3.2) monthson an average, and there was no significant difference in the time to return to full weight-bearing activities between the two groups (P＞0.05). During the follow-up, local tuberculosis recurrence was noted in 2 cases of the THA group, while 3 cases in the HA group, whichwere cured after repeated debridement and regular anti-tuberculosis therapy. Compared with those preoperatively, the Harris scores in bothgroups improved significantly, while the flexion-extension and adduction-abduction range of motions (ROMs) in the THA group significant-ly increased (P＜0.05), whereas the ROMs in the HA group were lost at the last follow-up. At the latest follow-up, the THA group was signif-icantly better than the HA groups in terms of Harris score [(93.2±8.4) vs (85.6±7.4), P＜0.05], flexion-extension ROM [(102.9±9.6)° vs 0°,P＜0.05] and adduction-abduction ROM [(164.1±13.2)° vs 0°, P＜0.05]. Regarding auxiliary examination, the leg length discrepancy in bothgroups significantly decreased at the last follow-up compared with that before surgery (P＜0.05). At the corresponding time points, therewere no significant differences in auxiliary examination parameters between the two groups (P＞0.05). [Conclusion] Both one-stage THAand HA do effectively treat advanced hip tuberculosis. In contrast, the THA has less iatrogenic trauma and better functional recovery over the HA.