本文選題：關(guān)節(jié)結(jié)核 + 結(jié)核分枝桿菌��； 參考：《河北北方學(xué)院》2013年碩士論文

【摘要】：髖關(guān)節(jié)結(jié)核(Tuberculosis of the hip)是一種常見的關(guān)節(jié)結(jié)核。其發(fā)病率僅次于脊柱結(jié)核,約占全身骨關(guān)節(jié)的15%,在下肢關(guān)節(jié)中發(fā)病率居第一位。發(fā)病人群年紀(jì)多半集中在20-40歲的青年,如果診斷不及時(shí),變?yōu)橥砥隗y關(guān)節(jié)結(jié)核,主要病理表現(xiàn)為骨質(zhì)缺損,軟骨破壞、關(guān)節(jié)間狹窄而造成下肢運(yùn)動(dòng)障礙,嚴(yán)重地影響著人們的生活質(zhì)量。目前國(guó)內(nèi)主要采用手術(shù)治療,通過一期病灶清除,二期人工全髖關(guān)節(jié)置換或關(guān)節(jié)融合術(shù)。但假體材料的選擇是保障一期病灶清除人工關(guān)節(jié)置換術(shù)治療活動(dòng)期髖關(guān)節(jié)結(jié)核的重要條件。有研究表明,人工假體材料與結(jié)核分枝桿菌的粘附性明顯較普通細(xì)菌差,脊柱結(jié)核病灶清除同時(shí)使用內(nèi)固定是安全的,這也為我們可以在結(jié)核病灶內(nèi)放置人工關(guān)節(jié)假體提供了依據(jù)。但是我們的前期研究顯示結(jié)核分枝桿菌在不同的假體表面的粘附性還是有差異的,這樣,選擇合適的假體就顯得非常重要,可以大大降低活動(dòng)期髖結(jié)核人工全髖關(guān)節(jié)置換術(shù)后的復(fù)發(fā)率。因此本研究擬在前期研究的基礎(chǔ)上,通過假體材料表面結(jié)核菌粘附力和圍手術(shù)期治療方法等研究,為活動(dòng)期髖關(guān)節(jié)結(jié)核患者行一期人工全髖關(guān)節(jié)置換術(shù)的治療提供臨床依據(jù)。觀察何種人工關(guān)節(jié)假體更為安全,希望能夠?yàn)榛顒?dòng)期髖關(guān)節(jié)結(jié)核患者的一期病灶清除并行人工全髖關(guān)節(jié)置換的假體選擇提供基礎(chǔ)依據(jù)。 我們從細(xì)菌粘附的角度出發(fā),通過對(duì)結(jié)核分枝桿菌與四種不同人工關(guān)節(jié)介面的實(shí)驗(yàn)研究,探討結(jié)核分枝桿菌粘附特性,為關(guān)節(jié)結(jié)核患者一期關(guān)節(jié)置換選擇假體提供理論依據(jù)。將表面多孔涂層、鈦涂層、噴砂涂層和羥基磷灰石涂層實(shí)驗(yàn)材料每組各取40片,將每片實(shí)驗(yàn)材料在無菌條件下懸吊于M960培養(yǎng)基中,與結(jié)核分枝桿菌共同培養(yǎng)。每個(gè)M960培養(yǎng)基培養(yǎng)28天。用比濁法測(cè)定培養(yǎng)基菌液的OD (Optical Density)值：以期觀察結(jié)核分枝桿菌在培養(yǎng)基中生長(zhǎng)情況,并用掃描電鏡觀察結(jié)核分枝桿菌與四種介面的粘附情況。通過測(cè)得的OD(Optical Density)與菌液濃度的關(guān)系可以看出,四種材料對(duì)結(jié)核分枝桿菌生長(zhǎng)無明顯影響,差別無統(tǒng)計(jì)學(xué)意義(P0.05)。掃描電鏡結(jié)果提示,結(jié)核分枝桿菌在多孔介面粘附量為(14.91±0.47)和鈦涂層粘附量為(14.68±0.35)高于噴砂涂層粘附量為(6.48±0.50)和羥基磷灰石涂層介面粘附量為(6.23±0.26),差異有統(tǒng)計(jì)學(xué)意義(P0.05),結(jié)核分枝桿菌與多孔涂層和鈦涂層粘附明顯多于噴砂涂層和羥基磷灰石涂層,在為關(guān)節(jié)結(jié)核患者做人工關(guān)節(jié)置換時(shí),選擇羥基磷灰石涂層和噴砂涂層比多孔涂層和鈦涂層更有優(yōu)勢(shì)。
[Abstract]:Hip tuberculosis of the is a common joint tuberculosis. Its incidence is second only to spinal tuberculosis, accounting for about 15% of the whole body bone and joints, the first incidence of lower extremity joints. Most of the patients are young people aged 20-40 years. If the diagnosis is not timely, they will become advanced hip tuberculosis. The main pathological manifestations are bone defect, cartilage destruction, and interarticular stenosis, resulting in lower limb motor disorders. Seriously affect people's quality of life. At present, the main domestic surgical treatment, through one-stage debridement, two-stage total hip replacement or arthrodesis. However, the selection of prosthetic materials is an important condition for the treatment of active hip tuberculosis by primary debridement of artificial joint replacement. Studies have shown that the adhesiveness of artificial prosthesis materials to Mycobacterium tuberculosis is significantly worse than that of common bacteria, and it is safe to use internal fixation for the removal of spinal tuberculosis foci. This also provides the basis for the placement of artificial joint prostheses in tuberculosis foci. But our previous studies have shown that the adhesion of Mycobacterium tuberculosis to different prosthesis surfaces is still different, so it is very important to choose the right prosthesis. It can greatly reduce the recurrence rate after total hip arthroplasty. Therefore, based on the previous studies, this study aims to provide clinical evidence for the treatment of active hip tuberculosis patients with total hip arthroplasty through the study of the adhesion of tuberculous bacteria on the surface of prosthetic materials and perioperative treatment. The purpose of this study is to observe which artificial joint prosthesis is more safe and to provide the basis for the selection of prosthesis in patients with active tuberculosis of hip joint after primary debridement and total hip replacement. From the point of view of bacterial adhesion, we studied the adhesion characteristics of Mycobacterium tuberculosis with four different artificial joint interfaces in order to provide a theoretical basis for the selection of prosthesis for joint replacement in patients with joint tuberculosis. The porous coating, titanium coating, sandblasting coating and hydroxyapatite coating were taken from each group of experimental materials. Each material was suspended in M960 medium under aseptic condition and cultured with Mycobacterium tuberculosis. Each M960 medium was cultured for 28 days. The OD optical Density of the culture medium was measured by turbidimetry. The growth of Mycobacterium tuberculosis in the medium was observed and the adhesion of mycobacterium tuberculosis to the four interfaces was observed by scanning electron microscope. The relationship between the concentration of OD(Optical density and the concentration of mycobacterium tuberculosis showed that the four materials had no significant effect on the growth of Mycobacterium tuberculosis, but the difference was not statistically significant (P 0.05). The results of scanning electron microscopy indicate that, The adhesion of mycobacterium tuberculosis to porous interface was 14.91 鹵0.47) and that of titanium coating was 14.68 鹵0.35), which was higher than that of sandblasting coating (6.48 鹵0.50) and hydroxyapatite coating (6.23 鹵0.26). The difference was statistically significant (P 0.05). The adhesion between the coating and the titanium coating was much more than that of the sand blasting coating and hydroxyapatite coating. Hydroxyapatite coating and sand blasting coating are better than porous coating and titanium coating in arthroplasty for patients with joint tuberculosis.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R529.2

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