关节镜技术对膝关节结核的诊疗分析

摘要

Objective To evaluate the clinical value and efficacy of arthroscope in the diagnosis and treatment of knee joint tuberculosis. Methods Thirteen patients with knee tuberculosis in our hospital from January 2012 to May 2017 were retrospectively analyzed, including 4 males and 9 females, aged from 25-64 years old, with the average age of (44.3±12.1) years. All the patients were treated with anti-tuberculosis drugs for 3-4 weeks before operation. Arthroscopy and debridement were performed, pathological tissues were taken for pathological examination, and anti-tuberculosis drugs were given continuously postoperatively. The American hospital for special surgery (HSS) scores and erythrocyte sedimentation rate (ESR) of 13 patients before and after operation were collected and compared. Results There were 7 cases of synovial tuberculosis of the knee joint, 4 cases of bone tuberculosis and 2 cases of total knee joint tuberculosis. Thirteen patients were followed up for 6-36 months (mean 19.5 ± 4.7 months). One case of bone tuberculosis was illness deferred and got the surgical incision fistula because of noncompliance, no standard anti-tuberculosis treatment and no periodic reviews, who was healed after re-surgery and anti-tuberculosis treatment. No postoperative recurrence occurred in the rest patients. At the last follow-up, the HSS score of the knee joint was significantly increased and ESR value significantly decreased in 13 patients after operation as compared with those before the operation (both P<0.05). Conclusion Arthroscopic therapy has a great value in the diagnosis and treatment of knee joint tuberculosis. Combined with medication and appropriate perioperative management, arthroscopic surgery can achieve a favorable therapeutic effect for knee joint tuberculosis.%目的 探讨运用关节镜技术对膝关节结核进行诊疗的价值与疗效.方法 对2012年1月至2017年5月我科收治的13例膝关节结核病人进行回顾性分析,其中男4例,女9例,年龄为25~64岁,平均年龄为(44.3±12.1)岁;术前均行抗结核药物治疗3~4周;行关节镜检查、清理术,术中取病变组织送病理检查;术后续行抗结核药物治疗.收集并比较13例病人术前及随访时的美国特种外科医院(the American hospital for special surgery,HSS)膝关节评分以及红细胞沉降率(erythrocyte sedimentation rate,ESR).结果 经术中所见及术后病理结果,本组确诊为膝关节滑膜结核7例,骨结核4例,全膝关节结核2例.13例病人随访6~36个月,平均(19.5±4.7)个月.1例骨结核病人因未遵医嘱,未进行规范抗结核治疗及规律复查,术后病情迁延并沿原手术切口形成窦道,经二次手术和术后抗结核治疗后窦道愈合;其他病人病情均无复发,疗效良好.末次随访时,13例病人的HSS膝关节评分值及ESR值均显著优于术前,差异均具有统计学意义(P均<0.05).结论 关节镜技术对于膝关节结核的诊断与治疗均具有重要意义,合理的围术期处理以及术后规范抗结核治疗可以获得良好的治疗效果.