关节镜下踝关节融合术治疗终末期踝关节结核的疗效观察

战英; 袁振灿; 张强

doi:10.16766/j.cnki.issn.1674-4152.002935

关节镜下踝关节融合术治疗终末期踝关节结核的疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.002935

山东省胸科医院骨科, 山东济南 250014

基金项目:

山东省医药卫生科技发展计划项目 2018WS244

详细信息

通讯作者:
张强, E-mail: kgraeg22@163.com

中图分类号: R684 R687.4
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- 文章访问数: 195
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- 被引次数: 0
出版历程
- 收稿日期: 2022-04-20
- 网络出版日期: 2023-05-31

Efficacy of arthroscopic ankle fusion for the treatment of terminal stage ankle tuberculosis

Department of Orthopaedics, Shandong Chest Hospital, Jinan, Shandong 250014, China

摘要

摘要: 目的随访踝关节镜下融合术治疗踝关节结核的病例，评价其临床疗效和安全性。方法选择2010年1月—2016年12月于山东省胸科医院骨科接受踝关节融合术治疗的踝关节结核患者36例为研究对象，诊断经细菌培养或病理检查证实。通过关节镜获取组织样本，切除坏死组织、滑膜组织增生和脱落的软骨。关节软骨损伤面积>2 cm²者行踝关节融合术。术后给予持续营养支持和规范的抗结核药物治疗。对患者进行随访，观察指标包括视觉模拟（VAS）评分、美国骨科足踝协会（AOFAS）评分、红细胞沉降率和影像学检查。结果 36例患者随访至少2年，随访时间为24~94个月。全部患者切口愈合正常。4例(11.1%)患者术后出现新的窦道，通过更换药物治愈。螺钉固定12例(33.3%)，外固定架固定8例(22.2%)，单纯石膏固定16例(44.4%)。X线检查均证实骨性融合，融合时间为12~25周。治疗后VAS评分明显下降，AOFAS评分升高（P＜0.05）。所有患者均痊愈出院，疗程为10~42个月。根据末次随访AOFAS评分，优12例(33.3%)，良16例(44.4%)，可8例(22.2%)，无差级评分。综合优良率为77.8%。结论关节镜治疗踝关节结核具有创伤小、并发症少等优点，其可以用来准确地从结核病的特定区域获取样本，以供进一步诊断。根据关节软骨损伤的程度，外科医生可以决定是否进行关节融合术。
- 关节镜 /
- 踝关节结核 /
- 结核病 /
- 踝关节融合术
Abstract: Objective To evaluate the clinical efficacy and safety of arthroscopic ankle fusion in the treatment of ankle tuberculosis. Methods A total of 36 patients with ankle tuberculosis treated by indirect ankle arthrodesis at the Department of Orthopaedics, Shandong Chest Hospital from January 2010 to December 2016 were selected as the research objects. The diagnosis was confirmed by bacterial culture or pathological examination. The tissue samples were obtained by arthroscopy, and the necrotic tissue, synovial tissue hyperplasia and abscission cartilage were removed. Ankle arthrodesis was performed in patients with articular cartilage injury area>2 cm². Continuous nutritional support and standard anti-tuberculosis drug treatment was given after operation. The patients were followed up with visual analogue (VAS) score, American Orthopaedic ankle association (AOFAS) score, erythrocyte sedimentation rate (ESR) and imaging examination. Results Thirty-six patients were followed up for at least 2 years, and the follow-up time ranged from 24 to 94 months. The wound healing was normal in all patients, and the suture was removed in time. Four patients (11.1%) developed new sinus tracts postoperatively, which were cured by changing the medication. Screw fixation was used in 12 cases (33.3%), external fixation in 8 cases (22.2%) and simple plaster fixation in 16 cases (44.4%). X-ray examination confirmed bony fusion in all cases, and the fusion time ranged from 12 to 25 weeks. The VAS score decreased significantly and the AOFAS score increased after treatment (P < 0.05). All patients were cured and discharged, and the course of treatment was 10-42 months. According to the AOFAS score of the final follow-up, 12 cases (33.3%) were excellent, 16 cases (44.4%) were good, and 8 cases (22.2%) were acceptable and there were no poor scores. The overall excellent and good rate was 77.8%. Conclusion Arthroscopic treatment of ankle tuberculosis has the advantages of being less invasive and with fewer complications. It can be used to accurately obtain samples from specific areas of tuberculosis for further diagnosis. According to the degree of articular cartilage damage, the surgeon can decide whether to perform an arthrodesis.
- Arthroscopy /
- Ankle tuberculosis /
- Tuberculosis /
- Ankle arthrodesis

HTML全文

图 1 踝关节融合术联合半圆形外固定器固定治疗

注：A为术前MRI提示踝关节间隙破坏；B为关节镜下清创关节腔内的病变：C为术后应用半圆外固定器将踝关节固定到功能位；D为术后X线复查；E为术后7年X线片提示踝关节骨性融合。

Figure 1. Ankle arthrodesis combined with semicircular external fixator fixation

下载: 全尺寸图片幻灯片

图 2 踝关节融合术联合空心螺钉踝关节固定治疗

注：A为术前MRI提示踝关节亲吻征和关节腔积液；B为关节镜下距骨软骨损伤和不稳定；C为术后3年X线片提示踝关节骨性融合。

Figure 2. Ankle joint fusion combined with ankle joint fixation with hollow screw

下载: 全尺寸图片幻灯片

图 3 踝关节融合术联合石膏固定治疗

注：A为术前磁共振成像T₁加权图像提示距下后区破坏(矢状面)；B为术前MRI脂肪抑制图像提示踝关节亲吻征和关节腔积液；C为术后7年X线片提示踝关节骨性融合。

Figure 3. Ankle arthrodesis combined with plaster fixation

下载: 全尺寸图片幻灯片

表 1 36例终末期踝关节结核患者治疗前后ESR、VAS和AOFAS评分(x±s)

Table 1. ESR, VAS and AOFAS scores of 36 patients with end-stage tuberculosis of ankle joint before and after treatment(x±s)

指标	治疗前	末次随访	t值	P值
ESR(mm/h)	54.35±8.01	13.03±2.08	29.958	＜0.001
VAS评分(分)	7.12±1.01	2.04±0.36	28.426	＜0.001
AOFAS评分(分)	43.00±5.09	90.34±6.36	34.868	＜0.001

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