探讨微创手术治疗布鲁菌病髋关节炎合并早期股骨头坏死的疗效。

回顾性分析首都医科大学附属北京地坛医院骨科2012年11月至2016年3月收治的18例布鲁菌病髋关节炎合并早期股骨头坏死患者，术前采用四联抗布鲁菌病药物（多西环素+利福平+左氧氟沙星+头孢曲松钠）治疗2~3个疗程后，局部症状仍缓解欠佳，最后行微创手术钻孔减压+同种异体骨植骨+关节腔穿刺冲洗治疗。术后采用疼痛视觉模拟评分（VAS）、髋关节功能Harris评分、红细胞沉降率（ESR）和C-反应蛋白（CRP）以评估疗效。

18例患者术后手术切口Ⅰ期愈合。术后病理学发现骨质结构变性坏死和滑膜增生，且Gimesa染色均发现短球状布鲁杆菌。典型病例术前髋部X线显示右侧股骨头外形正常，存在关节间隙，股骨头内可见散在囊状影；CT可见右侧股骨头可见散在囊状影，边缘硬化；MRI显示右髋部骨和周围软组织异常信号改变，T1加权成像（T1WI）表现为低信号，T2加权成像（T2WI）及压脂T2WI表现为混杂高信号，增强后可见强化。患者术后12个月复查髋部X线显示囊状区域骨质填充；CT显示囊状坏死区域骨质填充；MRI显示骨与软组织异常信号改变较前恢复。18例患者术后髋关节疼痛和髋关节功能均有显著改善，患者术前、术后1个月、3个月、6个月、12个月和24个月VAS评分（F = 260.721、P < 0.001）和Harris评分（F = 157.585、P < 0.001）差异均有统计学意义；以上时间点患者ESR（F = 19.715、P < 0.001）和CRP（F = 34.882、P < 0.001）水平均具有统计学差异。

布鲁菌病髋关节炎合并早期股骨头坏死患者在药物治疗基础上，通过微创手术能缓解或解除疼痛，利于患者早期康复。

To investigate the efficacy of minimally invasive surgical treatment on brucellosis hip arthritis complicated with early femoral head necrosis.

Data of 18 patients with brucellosis hip arthritis and early femoral head necrosis from the Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University from November 2012 to March 2016 was collected. Local symptoms remained poor for the 18 cases after 2-3 courses of preoperative treatment with a four-linked anti-brucellosis agent (doxycycline + rifampicin + levefloxacin + sodium ceftreaxone), then all patients were treated with core decompression combined with allograft bone grafting and joint cavity puncture irrigation. Postoperatively, the clinical efficacy were assessed by pain visual analogue score (VAS), hip function Harris score, erythrocyte sedimentation rate (ESR) and C-response protein (CRP).

All 18 patients achieved post-surgical incision Ⅰ phase. Postoperative pathological observation showed that the 18 patients had bone structural necrosis and synovial hyperplasia, Moreover, B. glomeruli was found by Gimesa staining. Among the typical cases, the preoperative hip X line showed the normal appearance of the right femoral head and the presence of joint gaps, the scattered capsule shadow could be seen in the femoral head. CT showed that the right femoral head was visibly scattered in the capsule shadow, with edge hardening. MRI showed abnormal signal changes in the right hip bone and surrounding soft tissue, T1WI showed a low signal, T2-weighted imaging (T2WI) and T2-weighted imaging (T2WI) with pressure fat showed promiscuous high signals, and strengthening signals could be seen after enhancement. The hip X line was reviewed 12 months after surgery, which showed bone filling in the cystic region; CT showed bone packing in cystic necrotic region; MRI showed abnormal signal changes in bone and soft tissue. All 18 patients had significant improvements in hip pain and hip function. VAS scores (F = 260.721, P < 0.001) and Harris scores (F = 157.585, P < 0.001) of 18 cases at preoperative, 1, 3, 6, 12 and 24 months after surgery were significantly different. The levels of ESR (F = 19.715, P < 0.001) and CRP (F = 34.882, P < 0.001) of 18 cases were significantly different at the above time points.

Based on drug treatment, patients of brucellosis hip arthritis complicated with early femoral head necrosis could relieve or remove the pain through minimally invasive surgical treatment, which could benefit to the early recovery.