关节镜下清创及灌洗引流治疗急性化脓性膝关节炎
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摘要
目的探讨关节镜下清创、持续闭式灌洗引流治疗急性化脓性膝关节炎的临床效果,研究其相关指标,提高急性化脓性膝关节炎的诊治水平。方法 2006年10月至2016年10月,盐城市第一人民医院骨科共对43例(43膝)急性化脓性膝关节炎患者进行了关节镜下清创、持续闭式灌洗引流治疗。纳入标准为关节疼痛、积液、体温高于38℃;排除标准为关节液白细胞少于<11×10~8个/L。男性,22例;女性,21例。年龄14～71岁,平均(43±12)岁。研究其术前及术后的相关指标,包括:体温、膝关节疼痛、活动度、C反应蛋白(CRP)、血沉(ESR)、降钙素原(PCT),关节液镜检,关节液一般细菌培养+药敏试验,组织培养。末次随访采用美国膝关节协会评分(KSS)进行功能评分。结果术后随访平均(22±10)个月,末次随访时KSS功能评分平均(85±11)分,治疗总有效率为95. 3%。术后患者体温在术后3～5 d均恢复正常,膝关节疼痛明显减轻,活动度明显改善,CRP、ESR、PCT明显下降。术后第3、5、7天关节液细菌培养共3次,均为无菌生长。结论关节镜下清创、持续闭式灌洗引流治疗膝关节腔感染,病原菌消失快,感染控制可靠,抗生素使用时间短,疗效满意。
Objective To investigate the effect of arthroscopy debridement and drainage on treating septic knee arthritis,and evaluated the related indexes,to improve the diagnosis and treatment of knee joint infection. Methods From October,2006 to October,2016,43 knees of 43 patients with septic arthritis of the knee in the orthopedic department of The First People 's Hospital of Yancheng accepted arthroscopy debridement and drainage. The inclusion criteria were joint pain and effusion,high fever; the exclusion criteria: white blood cell count in synovial fluid was less than 11 × 10~8/L. Among the cases,22 knees were in22 male patients and 21 knees were in 21 female patients. The age of patients ranged from 14 to 71 years,the mean age was( 43 ± 12) years. Related indicators of preoperative and postoperative include: temperature,knee pain,activity,C-reactive protein( CRP),erythrocyte sedimentation rate( ESR),procalcitonin( PCT),joint fluid microscopic examination,joint fluid general bacteria culture and drug sensitivity tests,tissue biopsy in microorganism cultures. Knee Society Score was used for functional score at the end of the last follow-up.Results The mean follow-up time was( 22 ± 10) months,KSS functional score at the last follow-up was( 85 ±11); The total effective rate was 95. 3%. Postoperative 3-5 d all the patients' body temperature returned to normal,knee pain significantly reduced and the activity was significantly improved. CRP、ESR and PCT decreased significantly. Postoperative 3 d,5 d,7 d joint fluid was cultured for the bacterial tests,all of which were aseptic growth. Conclusion Good outcomes can be reached by using arthroscopy debridement and drainage on treating septic arthritis of the knee,pathogenic bacteria disappear quickly,infection control is reliable,and can shorten the antibiotic use time.
Objective To investigate the effect of arthroscopy debridement and drainage on treating septic knee arthritis,and evaluated the related indexes,to improve the diagnosis and treatment of knee joint infection. Methods From October,2006 to October,2016,43 knees of 43 patients with septic arthritis of the knee in the orthopedic department of The First People 's Hospital of Yancheng accepted arthroscopy debridement and drainage. The inclusion criteria were joint pain and effusion,high fever; the exclusion criteria: white blood cell count in synovial fluid was less than 11 × 10~8/L. Among the cases,22 knees were in22 male patients and 21 knees were in 21 female patients. The age of patients ranged from 14 to 71 years,the mean age was( 43 ± 12) years. Related indicators of preoperative and postoperative include: temperature,knee pain,activity,C-reactive protein( CRP),erythrocyte sedimentation rate( ESR),procalcitonin( PCT),joint fluid microscopic examination,joint fluid general bacteria culture and drug sensitivity tests,tissue biopsy in microorganism cultures. Knee Society Score was used for functional score at the end of the last follow-up.Results The mean follow-up time was( 22 ± 10) months,KSS functional score at the last follow-up was( 85 ±11); The total effective rate was 95. 3%. Postoperative 3-5 d all the patients' body temperature returned to normal,knee pain significantly reduced and the activity was significantly improved. CRP、ESR and PCT decreased significantly. Postoperative 3 d,5 d,7 d joint fluid was cultured for the bacterial tests,all of which were aseptic growth. Conclusion Good outcomes can be reached by using arthroscopy debridement and drainage on treating septic arthritis of the knee,pathogenic bacteria disappear quickly,infection control is reliable,and can shorten the antibiotic use time.
引文
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[8]Deirmengian C,Greenbaum J,Stern J,et al.Open debridement of acute gram-positive infections after totalknee arthroplasty[J].Clin Orthop Relat Res,2003,416(11):129-134.
[9]Kim SJ,Jung KA,Kwun JD,et al.Arthroscopic synovectomy of the knee joint in rheumatoid arthritis:surgical steps for complete synovectomy[J].Arthroscopy,2006,22(4):461-464.
[10]Kuo CL,Chang JH,Wu CC,et al.Treatment of septic knee arthritis:comparison of arthroscopic debridement alone or combined with continuous closed irrigation-suction system[J].JTrauma,2011,71(2):454-459.
[11]Strom RG,Pacione D,Kalhorn SP,et al.Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder[J].Spine(Phila Pa 1976),2013,38(12):991-994.
[12]Sweet FA,Roh M,Sliva C.Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions:efficacy,drug levels,and patient outcomes[J].Spine(Phila Pa 1976),2011,36(24):2084-2088.
[13]Gans I,Dormans JP,Spiegel DA,et al.Adjunctive vancomycin powder in pediatric spine surgery is safe[J].Spine(Phila Pa1976),2013,38(19):1703-1707.
[2]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.
[3]Schinsky MF,Della Valle CD,Sporer SM,et al.Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty[J].J Bone Joint Surg Am,2008,90(9):1869-1875.
[4]Parvizi J,Ghanem E,Sharkey P,et al.Diagnosis of infected total knee:findings of a multicenter database[J].Clin Orthop Relat Res,2008,466(11):2628-2633.
[5]曹力,阿斯哈尔江,张晓岗,等.一期翻修术治疗全膝关节置换术后感染[J].中华骨科杂志,2011,31(2):131-136.
[6]张宁,赵翔,周鑫叠,等.关节液与组织培养在髋膝关节置换术后感染诊断价值的Meta分析[J/CD].中华关节外科杂志(电子版),2014,8(1):72-76.
[7]孙长鲛,柴伟,潘勇卫,等.膝关节置换术后感染的微生物学及药敏分析[J].中华医学杂志,2014,94(45):3575-3578.
[8]Deirmengian C,Greenbaum J,Stern J,et al.Open debridement of acute gram-positive infections after totalknee arthroplasty[J].Clin Orthop Relat Res,2003,416(11):129-134.
[9]Kim SJ,Jung KA,Kwun JD,et al.Arthroscopic synovectomy of the knee joint in rheumatoid arthritis:surgical steps for complete synovectomy[J].Arthroscopy,2006,22(4):461-464.
[10]Kuo CL,Chang JH,Wu CC,et al.Treatment of septic knee arthritis:comparison of arthroscopic debridement alone or combined with continuous closed irrigation-suction system[J].JTrauma,2011,71(2):454-459.
[11]Strom RG,Pacione D,Kalhorn SP,et al.Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder[J].Spine(Phila Pa 1976),2013,38(12):991-994.
[12]Sweet FA,Roh M,Sliva C.Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions:efficacy,drug levels,and patient outcomes[J].Spine(Phila Pa 1976),2011,36(24):2084-2088.
[13]Gans I,Dormans JP,Spiegel DA,et al.Adjunctive vancomycin powder in pediatric spine surgery is safe[J].Spine(Phila Pa1976),2013,38(19):1703-1707.