半环形外固定支架在膝关节结核关节融合术中的应用

摘要/Abstract

摘要：

目的　探讨应用半环形外固定支架行晚期全膝关节结核关节融合术的临床疗效及并发症。方法　回顾性分析2007年2月～2009年1月在我院行半环形外固定支架膝关节融合术的8例晚期全膝关节结核病例，其中男性6例，女性2例，平均年龄 35.4 岁（28～40岁），病程 3.1年（9月～5.1年）。8例患者均采用前正中切口，彻底清除结核病灶后使用半环形外固定支架加压融合,并使膝关节处于功能位，术后继续正规抗结核化疗18个月，以获得骨性融合为观察终点。结果　本组8例晚期全膝关节结核患者术后全部获得骨性融合，平均融合时间为20.5周（16～24周），患肢平均缩短4.9cm（3 cm～5 　cm），膝关节外翻角度 5.2° (4°～7°)，屈曲15.3°（10°～20°），无病例发生明显的旋转畸形，无切口感染、不愈合及延迟愈合病例，无外固定支架失败病例，其中3例患者发生针道感染。结论　半环形外固定支架膝关节融合术是治疗晚期全膝关节结核的一种有效方法。

关键词: 膝关节, 结核, 关节融合术, 半环形外固定支架

Abstract:

Objective　To discuss the efficacy and complications of hemicircular external fixator for joint fusion of the knee with tuberculosis.　Medthods　A total of 8 patients with late total knee tuberculosis treated by hemicircular external fixator were retrospectively analyzed between February 2007 and January 2009. 6 men and 2 women were investigated, with the average age of 35.4 years (28～40 years), and the average duration of disease of 3.1 years (9 months to 5.1 years). An anterior median incision was performed for all patients, then followed by the fusing of knee joint in functional position using hemicircular external fixator after complete debridement, taking osseous fusion as the end point of observation. Regular chemotherapy was applied post-operation for 18 months.　Results　Osseous fusion were achieved in all 8 patients post-operation, with the mean fusion period of 20.5 weeks(16～24 weeks), the length of affected limb of 4.9cm (3 cm～5 cm) shorter than the unaffected limb post-operation, the mean knee joint valgus angle of 5.2°( 4°～7°), and the mean knee joint flexion angle of 15.3°（10°～20°）. No patient had significant rotational deformity. There was no incision infection, nonunion, delayed union, external fixation failure happened, however, 3 patients appeared pin infection.　Conclusions　Hemicircular external fixator is an effective method to treat late total knee tuberculosis.

Key words: Knee, Tuberculosis, Arthrodesis, Hemicircular external fixator

中图分类号:

曾伟南, 周宗科, 杨静, 沈彬, 康鹏德, 裴福兴. 半环形外固定支架在膝关节结核关节融合术中的应用[J]. 中国临床解剖学杂志, 2012, 30(6): 698-700.

CENG Wei-Na, ZHOU Zong-Ke, YANG Jing, CHEN Ban, KANG Feng-De, FEI Fu-Xin. The application of hemicircular external fixator for knee joint arthrodesis with tuberculosis [J]. Chinese Journal Of Clinical Anatomy, 2012, 30(6): 698-700.

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