一期全髋置换与关节融合治疗晚期髋结核的比较
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河南省胸科医院

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Comparison of one-stage total hip replacement and joint fusion in the treatment of advanced tuberculosis of the hip
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河南省胸科医院

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    摘要:

    [目的]比较一期全髋关节置换(total hip arthroplasty,THA)与关节融合对晚期髋结核患者关节功能及结核复发的影响。[方法]选取2017年1月—2019年1月本院收治的88例晚期髋关节结核患者为研究对象,根据医患沟通结果分为融合组(n=44,髋关节融合术治疗)和置换组(n=44,一期THA治疗)。比较两组围手术期、随访及辅助检查资料。[结果]置换组手术时间、术中失血量、住院时间、下地行走时间均短于或少于融合组(P<0.05);术后随访12~24个月,平均(18.15±3.23)个月。置换组完全负重活动时间早于融合组(P<0.05);末次随访两组VAS评分均显著降低(P<0.05),Harris评分显著增加,置换组ROM增加、融合组ROM减少(P<0.05),且置换组上述指标均显著优于融合组(P<0.05);辅助检查方面,随访过程中所有患者假体位置良好,无局部疼痛、翻修及假体脱位松动现象,两组结核影像复发率及ESA、CRP恢复正常时间比较,差异无统计学意义(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,经彻底病灶清除手术后复发率较低,一期THA对患者造成的创伤及手术风险较小,且可较好改善髋关节功能,减轻疼痛。

    Abstract:

    [Objective]To compare the effects of one-stage total hip replacement (THA) and joint fusion on joint function and tuberculosis recurrence in patients with advanced hip tuberculosis.[Methods]Eighty-eight patients with advanced hip tuberculosis admitted to our hospital from January 2017 to January 2019 were selected as the research objects. According to the different surgical methods, they were divided into fusion group (n=44, hip fusion treatment) and replacement group ( n=44, one-stage THA treatment). The perioperative period, follow-up and auxiliary examination data were compared between the two groups.[Results]The operation time, intraoperative blood loss, hospitalization time, and walking time in the replacement group were shorter or less than those in the fusion group (P<0.05); the postoperative follow-up was 12-24 months, with an average of (18.15±3.23) months. The full weight-bearing activity time of the replacement group was lower than that of the fusion group (P<0.05); 作者简介:许斌,主治医师,研究方向:骨科疾病(脊柱与四肢关节骨折、骨结核等);电话:13613828163,邮箱:guixi0814@163.com At the last follow-up, the VAS scores of the two groups were significantly decreased (P<0.05), the Harris score was significantly increased, the ROM of the replacement group increased, and the ROM of the fusion group decreased (P<0.05), and the above indicators in the replacement group were significantly better than those in the fusion group (P<0.05); in terms of auxiliary examination, there was no significant difference in the recurrence rate of tuberculosis and the time to return to normal ESA and CRP between the two groups (P>0.05).[Conclusions] Hip fusion and one-stage THA have good curative effects in the treatment of advanced hip tuberculosis. The recurrence rate after thorough debridement surgery is lower. The first-stage THA treatment causes less trauma and surgical risks to patients, and can be better. Improve hip joint function and relieve pain.

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  • 收稿日期:2022-09-14
  • 最后修改日期:2023-03-23
  • 录用日期:2023-05-05
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