本院是北京仅有的2家结核病定点收治医院之一、又是三甲综合医院,结核科和骨科是医院传统优势科室,分别于2006年3月、2011年3月获得总后勤部批准成立全军结核病研究所和全军骨科中心.早在1991年本院骨科组建了关节外科专业团队,以人工关节和关节镜技术为特色,在国内较早开展了关节外科与运动医学领域的前沿技术,依托全军结核病研究所,有机会收治较多关节结核患者,把人工关节技术和关节镜技术用于关节结核治疗,开展多项关节结核相关基础和临床研究,2006年开始探索晚期或毁损期活动性髋膝关节结核一期病灶清除、人工关节置换,已完成手术300余例,疗效令人鼓舞,在髋膝关节结核诊断和治疗方面取得了重要进展和突破.

Objective To investigate the therapeutic effect of 3D printed anatomical tibial prosthesis in the repair of bone defects after debridement of tibial osteomyelitis. Methods Five patients with bone defects after debridement of lower tibial osteomyelitis were treated between January 2015 and December 2020 in the Eighth Medical Center of Chinese PLA General Hospital. Their bone defects were repaired via 3D printed anatomical titanium alloy tibial prosthesis. The duration of surgery and volume of intraoperative bleeding were recorded. The patients were followed up regularly for 12 months. Visual analog scale (VAS) score, Hospital for Special Surgery (HSS) knee score, American Orthopedic Foot and Ankle Score (AOFAS) Ankle Hindfoot Scale and 6-minute walk distance (6MWD), Timed "Up and Go" (TUG) test and 36-Item Short Form Health Survey were used to assess the clinical efficacy. The wound healing and complications were observed, while leukocyte count, C-reactive protein level and erythrocyte sedimentation rate (ESR) were detected and calculated. Results The mean duration of operation was 156.75±32.40 min, while the mean amount of intraoperative bleeding was 490.00±84.06 mL. After 12 months of follow-up, the VAS pain score, HSS score and AOFAS score were significantly improved (P < 0.05). The time for TUG and 6MWD were significantly extended and lengthened after operation (P < 0.05). The scores of postoperative qualities of life were elevated (P < 0.05). During the 12-month follow-up, the leukocyte count, ESR and C-reactive protein level were all within the normal ranges. The wounds healed well without sinus formation. Conclusion 3D printed anatomical titanium alloy tibial prosthesis has the advantages of effectively restoring good function of the lower limbs, mitigating preoperative pain and reducing postoperative complications.

[目的]分析本院住院结核病患者中骨关节结核的特征及外科干预情况,为骨关节结核诊疗提供参考.[方法]描述性分析本院2007年1月～2019年12月收治的结核病患者,分析年度病例数、患者性别构成、发病年龄、病变累及解剖部位,以及是否进行外科干预等相关资料.[结果]本院13年共收治住院结核病患者42 215例,其中骨关节结核3 924例,占所有结核的9.30％,居第3位.骨关节结核基本特征是男女比例约1.23∶1,平均年龄(45.90± 18.57)岁(1～90岁),发病年龄呈双峰分布,分别为16～30岁和46～60岁.按侵犯部位:脊柱结核占76.86％,包括腰椎占40.32％,四肢骨关节占23.14％,膝、髋关节分别占6.29％、5.40％.按是否多病灶:多发脊柱结核为7.39％,而多发四肢结核为0.33％.所有骨关节结核患者采用保守单纯抗结核治疗1 167例,外科手术干预2757例,手术率占70.26％.[结论]骨关节结核是常见的肺外结核,男性多于女性,高发年龄段在16～30岁和46～60岁.骨关节结核累及部位变化很大,但脊柱、髋和膝是骨关节结核最常见部位;四肢大关节结核多为单关节发病,但四肢单纯骨结核少见.

OBJECTIVE:To study the clinical efficacy of double bundle posterior cruciate ligament (PCL) reconstruction with remnant preservation.METHODS:From January 2007 to November 2011, 50 patients with PCL rupture met the inclusion criteria were divided into two groups: remnant preservation group (RP group) and remnant resection group (RR group). There were 19 males and 7 females in the RP group, ranging in age from 18 to 55 years, with a mean of (32.250 +/- 11.085) years old. The duration from injury to operation ranged from 2 to 66 months, with an average of (17.481 +/- 3.568) months. Among the RR group, 17 patients were male and 7 patients were female, ranging in age from 20 to 54 years old, with an average of (31.458 +/- 9.569) years. The duration from injury to operation ranged from 3 to 72 months, with a mean of (19.354 +/- 3.950) months. The patients in both groups suffered from instability of knee joint, got a positive result of posterior drawer test. In the RP group, the intercondylar notch remnant fiber, scar tissue and synovial were preserved in operation, only the free ligament in the intercondylar notch was resected. In the RR group, the remnant fiber, scar tissue and synovial tissue of adhesive parts were resected. In both groups, autologous semitendinosus and gracilis tendon double-bundle PCL reconstruction were carried out, the tibia was fixed with an absorbable interference screw with post-tie fixation, and the femur side was compositely fixed with absorbable interference screws and suspending fixation. Each patient received both subjective assessment (IKDC subjective evaluation, Lysholm scoring and Cincinnati rating) and objective clinical assessment (IKDC objective evaluation and Kneelax 3 tibia backward measurement) before operation and two years after operation.RESULTS:IKDC subjective evaluation: 92.167 +/- 4.177 in the RP group,which was higher than 87.542 +/- 5.687 in the RR group (P = 0.010). Lysholm scores: 90.917 +/- 4.413 in the RP group, which was higher than 87.083 +/- 5.149 in the RR group (P = 0.027). Cincinnati knee scores: 92.125 +/- 4.003 in the RP group, which was higher than 87.791 +/- 6.665 in the RR group (P = 0.027). IKDC objective evaluation:no significant statistical differences between RP group and RR group. Kneelax 3 assessment : tibia backward test with Kneelax 3 under 132 N showed no significant statistical difference between RP group and RR group, which were (3.958 +/- 0.693) mm and (4.029 +/- 0.846) mm respectively (P = 0.795).CONCLUSION:The study shows a significant advantage of remnant fiber preservation than remnant fiber resection in double-bundle PCL construction in terms of subjective knee function recovery after operation. There is no significant difference in postoperative knee stability.

Objective To compare the adherence condition of mycobacterium tuberculosis on 2 kinds of artificial joint interface. Meth-ods The Chromium-Cobalt-Alloy with hydroxyapatite ceramic coating and porous coating were cocultured with the bacterial liquid of myco-bacterium tuberculosis. The optical density of mycobacterium tuberculosis in different interfaces were detected by turbidimetry. Adherence conditions were observed by electron microscope scanning. Results There was no significant difference between two groups in the optical density value (P>0.05). The electron microscope scanning showed that more mycobacterium tuberculosis adhered to the porous coating than hydroxyapatite ceramic coating (P<0.05). Conclusion The hydroxyapatite ceramic coating has more advantages to the porous coating in prosthetic replacement for patients with joint tuberculosis.