2026 年第 2 期 第 21 卷

全关节镜下清理术治疗肩关节结核的效果分析

Efficacy analysis of arthroscopic debridement in the treatment of shoulder joint tuberculosis

作者：李龙杰1刘畅1王春雷1刘朝晖1陈思1张海森1路建2李海滨3

英文作者：Li Longjie1 Liu Chang1 Wang Chunlei1 Liu Zhaohui1 Chen Si1 Zhang Haisen1 Lu Jian2 Li Haibin3

单位：1河北省沧州市中心医院运动医学科，沧州061001；2河北省沧州市人民医院骨科，沧州061001；3河北省沧州市第五医院（青县人民医院）骨科，沧州062650

英文单位：1Department of Sports Medicine Cangzhou Central Hospital Hebei Province Cangzhou 061001 China; 2Department of Orthopedics Cangzhou People′s Hospital Hebei Province Cangzhou 061001 China; 3Department of Orthopedics Cangzhou Fifth Hospital Qingxian People′s Hospital Hebei Province Cangzhou 062650 China

关键词：肩关节结核；关节镜；抗结核治疗

英文关键词：Shoulderjointtuberculosis;Arthroscopy;Anti-tuberculosistreatment

• 摘要：

• 目的 探讨全关节镜下清理术治疗肩关节结核的临床效果。方法 回顾性分析自2014年4月至2023年4月在河北省沧州市中心医院进行手术治疗的73例肩关节结核患者的临床资料。术前术后给予规范抗结核药物治疗，根据手术方法不同分为关节镜组（38例，采用肩关节镜技术治疗）和开放手术组（35例，采用开放手术清理方式治疗）。术前及术后3个月、术后2年进行复查，结合X线、磁共振成像检查评价病情稳定及复发情况。通过疼痛视觉模拟量表（VAS）评分、美国加州大学洛杉矶分校（UCLA）肩关节功能评分及Constant-Murley评分评价肩关节功能改善情况；记录术前、术后3个月、术后2年的C反应蛋白（CRP）及红细胞沉降率（ESR）评估炎症控制情况。结果 73例患者均完成随访。关节镜组术后早期复发率为2.6%（1/38），开放手术组复发率为5.7%（2/35），但本研究样本量下未发现2组复发率差异有统计学意义(P＞0.05)。术前、术后3个月及术后2年2组间VAS评分差异均无统计学意义(均P＞0.05)。术后3个月，关节镜组UCLA肩关节功能评分和Constant-Murley评分均高于开放手术组［25(21,26)分比20(19,23)分、60(51,69)分比52(47,58)分］(均P＜0.05)。2组患者术后3个月、术后2年CRP、ESR均明显低于术前(均P＜0.05)，但术前、术后3个月及术后2年2组间CRP、ESR水平差异均无统计学意义(均P＞0.05)。结论 全关节镜下清理术联合抗结核药物治疗肩关节结核可以获得满意的临床效果，尤其在术后短期功能康复中有一定优势，但是需要把握合适适应证。

• Objective To explore the clinical efficacy of arthroscopic debridement in the treatment of shoulder joint tuberculosis. Methods A retrospective analysis was performed on the clinical data of 73 patients with shoulder joint tuberculosis who underwent surgical treatment at Cangzhou Central Hospital, Hebei Province from April 2014 to April 2023. Standard anti-tuberculosis drug therapy was administered before and after surgery. The patients were divided into arthroscopic group (38 cases, treated with shoulder arthroscopy) and open surgery group (35 cases, treated with open debridement) according to the surgical method. Re-examinations were conducted preoperatively, 3 months postoperatively, and 2 years postoperatively. Disease stability and recurrence were evaluated by X-ray and magnetic resonance imaging examinations. The improvement of shoulder joint function was assessed using the visual analogue scale (VAS) score, University of California, Los Angeles (UCLA) shoulder score, and Constant-Murley score. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were recorded preoperatively, 3 months postoperatively, and 2 years postoperatively to evaluate the inflammatory control. Results All 73 patients completed the follow-up. The early postoperative recurrence rate was 2.6%(1/38) in the arthroscopic group and 5.7%(2/35) in the open surgery group, but no statistically significant difference in recurrence rate was found between the two groups under the sample size of this study (P>0.05). There were no statistically significant differences in VAS scores between the two groups preoperatively, 3 months postoperatively, or 2 years postoperatively (all P>0.05). At 3 months postoperatively, the UCLA shoulder score and Constant-Murley score in the arthroscopic group were significantly higher than those in the open surgery group ［25(21, 26) vs 20(19, 23), 60(51, 69) vs 52(47, 58), respectively］(both P<0.05). The CRP and ESR levels in both groups at 3 months and 2 years postoperatively were significantly lower than those preoperatively (all P<0.05), but there were no statistically significant differences in CRP and ESR levels between the two groups preoperatively, 3 months postoperatively, or 2 years postoperatively (all P>0.05). Conclusion Arthroscopic debridement combined with anti-tuberculosis drug therapy can achieve satisfactory clinical outcomes in the treatment of shoulder joint tuberculosis, especially with certain advantages in short-term postoperative functional rehabilitation, but appropriate indications need to be strictly grasped.