关节镜下清理术后联合置管灌洗治疗膝关节化脓性关节炎的临床疗效
|
摘要
目的:观察关节镜下清理术后是否联合置管持续灌洗治疗膝关节化脓性关节炎的临床应用效果。方法:回顾性分析2013年1月至2016年12月中国人民解放军兰州总医院骨科中心收治的40例中老年化脓性膝关节炎患者的临床资料,其中男18例,女22例,均为单膝关节发病。将患者分为置管冲洗联合抗生素治疗组(置管组)与单纯抗生素治疗组(非置管组)。所有患者行关节镜下探查清理合并病变滑膜切除术,术中均取标本行病理诊断,术后均回报为慢性化脓性炎症。置管组患者术后均行置管持续灌洗治疗约1周,常规抗感染、镇痛,拔除引流管后早期行常规功能锻炼;非置管组患者关节镜清理术后常规抗感染、镇痛,并早期行膝关节功能恢复锻炼。通过随访比较患者不同随访时间CRP、ESR、疼痛视觉模拟量表(visual analogue scale,VAS)评分及Lysholm膝关节功能评分等。结果:患者均获得6~12个月的随访。术后置管组患者CRP、ESR恢复较非置管组快(P<0.05)。术后1个月时,置管组VAS评分较非置管组好转时间短(P<0.05);术后第1,3个月,置管组膝关节Lysholm评分较非置管组高(P<0.05)。所有患者术后1年时膝关节功能均已稳定,两组差异无统计学意义(P>0.05),但非置管组患者有3例在术后2个月时化脓性关节炎复发,经置管冲洗并联合抗生素治疗后好转,后期无复发。结论:关节镜下清理术对膝关节化脓性关节炎治愈率高。关节镜下滑膜切除术配合术后置管持续灌洗治疗对加强治疗效果与降低复发概率有一定帮助。
Objective: Investigate the clinical effect of arthroscopic debridement combined with continuous lavage in the treatment of pyogenic arthritis of the knee. Methods: Forty patients with suppurative knee arthritis were retrospectively analyzed from January 2013 to December 2016 in the Lanzhou General Hospital of the People's Liberation Army. Among them, 18 patients were male 22 were female. A patients suffered from single knee joint disease. The patients were divided into a drainage combined with antibiotic treatment group(the catheter group) and an antibiotic therapy alone group(the non-catheterization group). All patients underwent arthroscopic exploration cleaning combined lesion synovectomy, intraoperative specimen pathology diagnosis, postoperative return: chronic suppurative inflammation; catheter group patients underwent catheter lavage for about 1 week, conventional anti-inflammatory, analgesic, in the extraction of drainage tube after routine early functional exercise. The patients in the non-catheterization group received routine anti infection and analgesia after arthroscopic debridement, and the knee joint function was resumed at the early stage. Through the followup of patients with different follow-up time of CRP, erythrocyte sedimentation rate, visual analogue scale(VAS) score and Lysholm score of knee joint function evaluation of the therapeutic effect of two groups. Results: All patients were followed up for 6–12 months. The recovery of CRP and ESR in the postoperative group was faster than that in the non-catheterization group, and the data of the two groups were statistically significant(P<0.05). After the operation, the VAS score in the catheterization group was shorter than that in the non-catheterization group(P<0.05) after 1 month, and the knee joint Lysholm score in the catheterization group was higher than that in the non-catheterization group after 1 and 3 months(P<0.05). One year later, all patients after surgery of knee joint function were stable, no significant differences between the two groups; however, there were 3 cases in the non-catheter group that had recurrent suppurative arthritis 2 months after surgery, after flushing the catheter and combined with antibiotic treatment, there was no recurrence. Conclusion: Arthroscopic debridement has a high cure rate for pyogenic arthritis of the knee. Arthroscopic synovectomy combined with postoperative continuous lavage is helpful to enhance the therapeutic effect and reduce the recurrence probability.
Objective: Investigate the clinical effect of arthroscopic debridement combined with continuous lavage in the treatment of pyogenic arthritis of the knee. Methods: Forty patients with suppurative knee arthritis were retrospectively analyzed from January 2013 to December 2016 in the Lanzhou General Hospital of the People's Liberation Army. Among them, 18 patients were male 22 were female. A patients suffered from single knee joint disease. The patients were divided into a drainage combined with antibiotic treatment group(the catheter group) and an antibiotic therapy alone group(the non-catheterization group). All patients underwent arthroscopic exploration cleaning combined lesion synovectomy, intraoperative specimen pathology diagnosis, postoperative return: chronic suppurative inflammation; catheter group patients underwent catheter lavage for about 1 week, conventional anti-inflammatory, analgesic, in the extraction of drainage tube after routine early functional exercise. The patients in the non-catheterization group received routine anti infection and analgesia after arthroscopic debridement, and the knee joint function was resumed at the early stage. Through the followup of patients with different follow-up time of CRP, erythrocyte sedimentation rate, visual analogue scale(VAS) score and Lysholm score of knee joint function evaluation of the therapeutic effect of two groups. Results: All patients were followed up for 6–12 months. The recovery of CRP and ESR in the postoperative group was faster than that in the non-catheterization group, and the data of the two groups were statistically significant(P<0.05). After the operation, the VAS score in the catheterization group was shorter than that in the non-catheterization group(P<0.05) after 1 month, and the knee joint Lysholm score in the catheterization group was higher than that in the non-catheterization group after 1 and 3 months(P<0.05). One year later, all patients after surgery of knee joint function were stable, no significant differences between the two groups; however, there were 3 cases in the non-catheter group that had recurrent suppurative arthritis 2 months after surgery, after flushing the catheter and combined with antibiotic treatment, there was no recurrence. Conclusion: Arthroscopic debridement has a high cure rate for pyogenic arthritis of the knee. Arthroscopic synovectomy combined with postoperative continuous lavage is helpful to enhance the therapeutic effect and reduce the recurrence probability.
引文
1.魏民,刘玉杰,李众利,等.关节镜清理结合灌注冲洗治疗前交叉韧带重建术后关节感染[J].中国骨伤,2015,28(3):279-281.WEI Min,LIU Yujie,LI Zhongli,et al.Clinical effect of arthroscopic debridement and infusion-drainage on septic arthritis after arthroscopic anterior cruciate ligament reconstruction[J].China Journal of Orthopaedics and Traumatology,2015,28(3):279-281.
2 .陆慧杰,顾晓民,陈之青,等.膝关节骨关节炎关节镜下有限清理和广泛清理术的治疗效果研究[J].中国内镜杂志,2015,21(7):753-756.LU Huijie,GU Xiaomin,CHEN Zhiqing,et al.Efficacy of limited arthroscopic debridement and thorough arthroscopic debridement in treatment of osteoarthritis[J].China Journal of Endoscopy,2015,21(7):753-756.
3 .Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
4 .Carr A J,Price A J,Glyn-Jones S,et al.Advances in arthroscopy indications and therapeutic applications[J].Nat Rev Rheumatol,2015,11(2):77-85.
5 .Ilahi OA,Al-Habbal GA,Bocell JR,et al.Arthroscopic debridement of acute per prosthetic septic arthritis of the knee[J].Arthroscopy,2005,21(3):303-306.
6 .B?hler C,Dragana M,Puchner S,et al.Treatment of septic arthritis of the knee:a comparison between arthroscopy and arthrotomy[J].Knee Surg Sports Traumatol Arthrosc,2016,24(10):3147-3154.
7 .Wirtz DC,Marth M,Miltner O,et al.Septic arthritis of the knee in adults:treatment by arthroscopy or arthrotomy[J].Int Orthop,2001,25(4):239-241.
8 .Johnson MW.Acute knee eff usions:a systematic approach to diagnosis[J].Am Fam Physician,2000,61(8):2391-2400.
2 .陆慧杰,顾晓民,陈之青,等.膝关节骨关节炎关节镜下有限清理和广泛清理术的治疗效果研究[J].中国内镜杂志,2015,21(7):753-756.LU Huijie,GU Xiaomin,CHEN Zhiqing,et al.Efficacy of limited arthroscopic debridement and thorough arthroscopic debridement in treatment of osteoarthritis[J].China Journal of Endoscopy,2015,21(7):753-756.
3 .Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
4 .Carr A J,Price A J,Glyn-Jones S,et al.Advances in arthroscopy indications and therapeutic applications[J].Nat Rev Rheumatol,2015,11(2):77-85.
5 .Ilahi OA,Al-Habbal GA,Bocell JR,et al.Arthroscopic debridement of acute per prosthetic septic arthritis of the knee[J].Arthroscopy,2005,21(3):303-306.
6 .B?hler C,Dragana M,Puchner S,et al.Treatment of septic arthritis of the knee:a comparison between arthroscopy and arthrotomy[J].Knee Surg Sports Traumatol Arthrosc,2016,24(10):3147-3154.
7 .Wirtz DC,Marth M,Miltner O,et al.Septic arthritis of the knee in adults:treatment by arthroscopy or arthrotomy[J].Int Orthop,2001,25(4):239-241.
8 .Johnson MW.Acute knee eff usions:a systematic approach to diagnosis[J].Am Fam Physician,2000,61(8):2391-2400.