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单独病灶清除术或联合植骨融合外固定术治疗膝关节结核的临床疗效
霍永超,沈生军,徐尚胜,王春伟,黄贵成
0
(青海省第四人民医院外科;青海大学附属医院外科)
摘要:
【摘要】 目的 探讨单独病灶清除术或联合植骨融合外固定术治疗膝关节结核的临床疗效。方法 选取2014年1月~2016年1月期间收治入院的膝关节结核患者83例,按照随机数字表法将其分为单独结核病灶清除术组39例(单独组)和病灶清除联合植骨融合外固定术组44例(联合组)。对比两组手术时间、住院时间、术中出血量情况及术后低蛋白血症及贫血发生情况,并观察两组患者手术前后膝关节功能评分、生理健康及心理健康评分情况。结果 术前组间膝关节功能评分无统计学差异,术后两组患者整体膝关节功能变化均存在统计学差异(F值分别为126356和82032,P均<001)。且术后不同时间点单独组膝关节功能评分显著较联合组高,组间差异显著(P<005)。术前组间生理健康评分及心理健康评分差异无统计学意义(P>005),术后3个月生理健康评分及心理健康评分单独组均显著高于联合组。单独组手术时间及住院时间较联合组短,术中出血量较联合组少,组间差异有显著性(P<005),且单独组术后低蛋白血症及贫血发生率较联合组低,组间差异有统计学意义(P<005)。单独组术后18个月随访复发率1026%,联合组1136%,组间差异无统计学意义(P>005)。结论 两种方法术后患者膝关节功能及生活质量均得到有效改善,且对术后复发无影响。相较而言,单纯膝关节结核病灶清除术组手术时间更短,术后恢复更快。膝关节结核采用单纯结核病灶清除术或联合植骨融合外固定术治疗均可有效改善患者膝关节功能及生活质量,故术式的选择应结合患者病情严重程度决定,继而提高疗效,促进术后康复。
关键词:  膝关节结核  病灶清除术  植骨融合外固定术  临床疗效
DOI:
基金项目:青海省自然科学基金(2015-K-9P8)
Clinical effects of focal debridement alone or in combination with bone grafting and external fixation for the treatment of knee tuberculosis
HUO Yongchao,SHEN Sheng Jun,XU Shangsheng,WANG Chunwei,HUANG Guicheng
(Department of Surgery, Qinghai Fourth People's Hospital, Xining 810000;Department of Surgery, The Affiliated Hospital of Qinghai University)
Abstract:
【Abstract】 Objective To investigate clinical effects of debridement alone or combined with bone grafting and external fixation in the treatment of knee tuberculosis. Methods Eightythree patients with knee joint tuberculosis who admitted to hospital from January 2014 to January 2016 were enrolled. According to the random number table, 39 cases were divided into separate tuberculosis group and 39 cases with clearcut union bone graft and external fixation group , separate groups and joint groups. The operative time, hospitalization time, intraoperative blood loss and postoperative hypoalbumin and anemia were compared between the two groups. The scores of knee function, physical health and mental health of the two groups before and after operation were observed. Results There was no significant difference in knee function scores between the two groups before operation. There were significant differences in overall knee function between the two groups (F= 126356 and 82032, respectively, P<001). At different time points after operation, the score of knee joint function in individual group was significantly higher than that in combined group (P<005). There were no significant differences in the scores of physical health and mental health between the two groups before surgery (P> 005). The physical health scores and mental health scores of the two groups were significantly higher than those of the control group at 3 months after operation (P<005). There were no significant differences in the scores of physical health and mental health between the two groups before surgery (P> 005). The physical health scores and mental health scores of the two groups were significantly higher than those of the control group at 3 months after operation (P> 005). The operation time and hospital stay in the simple group were shorter than those in the combined group, and the amount of bleeding during the operation was less than that in the combined group (P<005). The incidences of postoperative hypoproteinemia and anemia in the simple group were significantly lower than those in the combined group , The difference between the groups was statistically significant (P<005). The recurrence rate was 1026% in the simple group and 1136% in the combined group at 18 months after operation. There was significant difference between the two groups (P> 005). Conclusion The knee joint function and quality of life of both patients were effectively improved after operation, and had no effect on postoperative recurrence. In contrast, the operation time was shorter and the postoperative recovery was faster in patients with knee joint debridement alone. Knee tuberculosis using simple tuberculosis sclerosis or bone graft fusion combined with external fixation can effectively improve the patient's knee function and quality of life, so the choice of surgical procedures should be based on the severity of the patient's choice, and then improve the efficacy and promote postoperative Rehabilitation.
Key words:  Knee tuberculosis  Lesions  Fusion of bone graft  Clinical curative effect

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