Knee joint tuberculosis debridement

The knee joint is more convenient and spacious, and it is easy to achieve the purpose of completely eliminating the lesion. The surgical cure rate can reach more than 95%. However, there is a lack of muscle around the knee joint, which is easy to adhere after operation and causes joint rigidity. Even if the synovial membrane is simply removed, the postoperative joint function is often poor. Because the knee joint is superficial, the early symptoms are obvious, and the diagnosis is relatively easy, which is beneficial to the application of non-surgical treatment such as early joint cavity puncture and perfusion anti-tuberculosis drugs. For simple synovial tuberculosis, if it can be treated early, it can cure the disease and preserve the joint function. It should be applied first. Treatment of diseases: knee joint tuberculosis Indication 1. Simple bone tuberculosis has obvious dead cavity, dead bone or even sinus, and should be removed in time. 2. Synovial resection should be performed immediately if the non-surgical treatment of synovial tuberculosis is not obvious or worse. 3. Total joint tuberculosis should not only be removed from the lesions in adults, but also should be used for joint fusion; if the age is less than 12 years old, in order to avoid osteophyte injury, only the lesions can be removed, and no joint fusion is allowed. Patients with co-infection should undergo surgery under antibiotic control. Preoperative preparation Knee tuberculosis patients often suffer from flexion deformity due to gastrocnemius tendon and contracture. Therefore, it should be corrected by skin traction before surgery. Surgical procedure 1. Position: supine position, diseased side of the ceremonial cerclage inflatable tourniquet. 2. Incision, exposure: See the anterior medial aspect of the knee joint. 3. Clear the lesion: the limb is blood-sucking, inflate the tourniquet with a pressure of about 33.2 kPa (250 mmhg), and then remove the lesion. Different methods of removal should be performed depending on the type of lesion. For patients with simple synovial tuberculosis, most synovectomy can be performed. The synovial sac and the synovial membrane on the inside of the knee joint were separated from the quadriceps tendon expansion. When separating the bursa on the hip, do not remove the periosteum and fat in front of the lower end of the femur to reduce postoperative adhesions. Then, cut the synovial membrane on the inside of the humerus, suck out the pus, separate the tibia from the synovium, and pull it to the outside, and then separate the synovium on the outside of the knee. The entire sacral sac and the synovial membrane on both sides of the joint were removed, and the residual synovial membrane and the underarm fat pad were removed as much as possible, but the bilateral collateral ligament, meniscus and cruciate ligament were retained. The posterior joint capsule is inserted into the squeegee from both sides with a sharp curette. Finally, the granulation in the joint cavity is carefully removed. Total joint tuberculosis requires joint fusion. The anterior incision of the knee joint can be directly used to cut the quadriceps tendon, and the tibia can be removed downward to fully expose the joint cavity. After clearing the lesions on the anterior side and both sides, the knee is bent at 90°, the lateral collateral ligament and the joint capsule are cut off from the joint side, the cruciate ligament is cut, and the femur and tibia are completely separated, and the synovium at the posterior part of the joint can be fully exposed and removed. After the lesion has been completely removed, the wound is flushed and the joint is fused (see knee joint compression fusion). 4. Stitching: The wound was thoroughly washed with physiological saline, and 1 g of streptomycin was injected and layered and sutured.

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