UNASSIGNED: To investigate the effectiveness of one-stage total knee arthroplasty (TKA) in the treatment of advanced active knee tuberculosis.
UNASSIGNED: The clinical data of 38 patients with advanced active knee tuberculosis who received one-stage TKA between January 2011 and December 2020 were retrospectively analyzed. There were 20 males and 18 females. The age ranged from 20 to 84 years, with an average of 52.8 years. The body mass index ranged from 17 to 36 kg/m 2, with an average of 23.05 kg/m 2. The preoperative C reactive protein (CRP) was (23.49±4.72) mg/L, erythrocyte sedimentation rate (ESR) was (45.95±8.82) mm/1 h. The Hospital for Special Surgery (HSS) score was 48.8±9.1. During the operation, the infected lesions of the knee joint were completely removed, and the operative area was repeatedly soaked with 3% hydrogen peroxide solution and 0.5% povidone iodine solution. The intraoperative pathological examination confirmed the tuberculosis of the knee joint, and systemic anti-tuberculosis treatment was performed. The operation time, postoperative hospitalization stay, postoperative anti-tuberculosis chemotherapy time, and complications were recorded. CRP and ESR were recorded and compared before and after operation. Anteroposterior and lateral X-ray films of the knee joint were taken to evaluate whether the prosthesis had signs of loosening and sinking, and to determine whether there was recurrence of tuberculosis. The knee joint function was evaluated by HSS score. With treatment failure due to any reason as the end event, the survival time of prosthesis was analyzed by Kaplan-Meier survival curve.
UNASSIGNED: All operations were successfully completed without fracture, vascular and nerve injury, deep vein thrombosis, and other complications. All incisions healed by first intention after operation. The operation time ranged from 80 to 135 minutes, with an average of 102.76 minutes; postoperative hospitalization stay was 5-16 days, with an average of 9.7 days; the duration of postoperative anti-tuberculosis chemotherapy ranged from 1 to 18 months, and the median duration was 12 months. All 38 cases were followed up 3-133 months (mean, 63.7 months). At last follow-up, CRP was (4.88±1.24) mg/L and ESR was (13.00±2.97) mm/1 h, both of which were significantly lower than those before operation ( t=20.647, P<0.001; t=20.886, P<0.001). During the follow-up, 3 patients (7.89%) had tuberculosis recurrence. Two patients had tuberculosis recurrence due to withdrawal of anti-tuberculosis chemotherapy at 1 and 2 months after operation, respectively. One patient was cured after debridement, preservation of prosthesis and anti-tuberculosis chemotherapy for 12 months, and 1 patient was cured after oral administration of anti-tuberculosis drugs for 12 months. Another 1 patient had recurrent tuberculosis and mixed infection ( Corynebacterium gehreni) at 2 months after operation, and the infection was not controlled after debridement, and finally the thigh was amputated. Except for the patients with recurrent infection, no complications such as prosthesis loosening, periprosthetic fracture, and periprosthetic infection were found. At last follow-up, the HSS score of the knee joint was 86.8±4.8, and the knee joint function significantly improved when compared with that before operation ( t=-31.198, P<0.001). Prosthesis survival time was (122.57±5.77) months [95% CI (111.25, 133.88) months], and the 10-year survival rate was 92.1%.
UNASSIGNED: One-stage TKA combined with postoperative antituberculous chemotherapy in the treatment of advanced active knee tuberculosis can achieve satisfactory infection control and joint function.
UNASSIGNED: 探讨一期人工全膝关节置换术(total knee arthroplasty,TKA)治疗晚期活动性膝关节结核的临床疗效。.
UNASSIGNED: 回顾分析2011年1月—2020年12月接受一期TKA治疗的38例晚期活动性膝关节结核患者临床资料。男20例,女18例;年龄20~84岁,平均52.8岁。身体质量指数17~36 kg/m 2,平均23.05 kg/m 2。术前C反应蛋白(C reactive protein,CRP)为(23.49±4.72)mg/L,红细胞沉降率(erythrocyte sedimentation rate,ESR)为(45.95±8.82)mm/1 h,美国特种外科医院(HSS)评分为(48.8±9.1)分。术中彻底清除膝关节感染病灶,用3%过氧化氢溶液、0.5%聚维酮碘溶液反复浸泡术区,术中病理检查证实为膝关节结核,术后系统抗结核化疗治疗。记录手术时间、术后住院时间、术后抗结核化疗时间及并发症发生情况;记录并比较手术前后CRP、ESR;摄膝关节正侧位X线片评估假体是否松动、下沉,并判断结核是否复发;采用HSS评分评价膝关节功能。以任意原因导致治疗失败为终点事件,采用Kaplan-Meier生存曲线分析术后假体生存时间。.
UNASSIGNED: 手术均顺利完成,未发生术中骨折、血管神经损伤及术后下肢深静脉血栓形成等并发症,术后切口均Ⅰ期愈合。手术时间80~135 min,平均102.76 min;术后住院时间5~16 d,平均9.7 d;术后抗结核化疗时间1~18个月,中位时间12个月。38例均获随访,随访时间3~133个月,平均63.7个月。末次随访时,CRP为(4.88±1.24)mg/L、ESR为(13.00±2.97)mm/1 h,均较术前明显下降( t=20.647, P<0.001; t=20.886, P<0.001)。随访期间3例结核复发(7.89%),2例于术后1、2个月自行停用抗结核化疗导致结核复发,其中1例经清创保留假体及抗结核化疗12个月后治愈,1例继续口服抗结核药物12个月后治愈;1例术后2个月结核复发合并混合感染(杰氏棒状杆菌),行清创术后感染未控制,最终行大腿截断术。除感染复发患者外,余均未见假体松动、假体周围骨折及假体周围感染等并发症。末次随访时膝关节HSS评分为(86.8±4.8)分,膝关节功能较术前明显改善( t=−31.198, P<0.001)。假体生存时间(122.57±5.77)个月 [95% CI(111.25,133.88)个月],10年生存率92.1%。.
UNASSIGNED: 一期TKA联合术后抗结核化疗治疗晚期活动性膝关节结核可获得满意的感染控制和关节功能。.