关节镜治疗髋关节布鲁氏杆菌感染△

Arthroscopic debridement and drainage with continuous suction irrigation for hip brucellosis

摘要:

［目的］ 回顾性分析关节镜微创治疗髋关节布氏杆菌感染患者的临床效果。［方法］ 2009 年 2 月—2018 年 12 月， 解放军总医院骨科采用关节镜术治疗髋关节布氏杆菌感染性关节炎患者 8 例。行髋关节镜探查清理、滑膜切除、病灶清除术， 术中置管，术后持续生理盐水灌洗，多西环素联合利福平，或者链霉素治疗，疗程 1.5~3 个月。［结果］ 所有患者均顺利手术，无严重并发症。平均（9.52±2.21）d 拔除吸引冲洗管。细菌培养均培养出布鲁氏杆菌，阳性率为 100%（8/8），病理学检查均发现杆菌，阳性率为 100%（8/8）。所有患者随访 24 个月以上，至末次随访，均无感染复发，无需行翻修手术者。随时间推移，8 例患者 VAS 评分显著下降（P<0.05），而 mHHS 评分显著增加（P<0.05）。与术前相比，末次随访时影像测量髋关节间隙无显著变化（P>0.05）。与术前相比，术后 ESR 和 CPR 均显著降低（P<0.05），术后 12 个月和 24 个月，ESR 和 CPR 均在正常范围。［结论］关节镜清创灌洗，滴注引流术可有效治疗髋关节布氏杆菌感染。

Abstract:

[Objective] To explore the clinical outcomes of arthroscopic debridement and drainage with continuous suction irrigation for hip brucellosis. [Methods] From February 2009 to December 2018, 8 patients with brucella arthritis of the hip were arthroscopically treated in Department of Orthopedics, General Hospital of CPLA. Synovial resection, debridement and catheterization were conducted dur- ing arthroscopy. After that, continuous suction irrigation was maintained to the inflammatory reaction subsided. In addition, doxycycline combined with rifampicin, or streptomycin was given for 1.5~3 months. [Results] All the 8 patients were successfully operated without seri- ous complications. The irrigation- drainage tubes were removed at (9.5±2.21) days on average. The positive rate of brucella proved of 8/8 (100%) in bacterial culture, and 8/8 (100%) in pathological observation. All patients were followed up for more than 24 months. No infec- tion recurrence and revision surgery occurred in anyone of them to the latest follow-up. The VAS scores decreased significantly (P＜0.05) , while the mHHS score increased significantly over time in the 8 patients (P＜0.05) . There were no significant changes in radiographically measured hip space at the latest follow-up compared with those preoperatively (P＞0.05) . The ESR and CPR were significantly decreased postoperatively compared with those before operation (P＜0.05) , and remained within the normal range at 12 and 24 months postoperatively. [Conclusion] Arthroscopic debridement and drainage with continuous suction irrigation does effectively treat hip brucellosis.