关节镜下前交叉韧带重建术后膝关节感染的临床诊断与治疗  

Diagnosis and management of septic arthritis after arthroscopic anterior cruciate ligament （ACL） reconstruction

作　　者：王成[1] 敖英芳[1] 王健全[1] 胡跃林[1] 崔国庆[1] 余家阔[1] 田得祥[1] 印钰[1] 焦晨[1] 郭秦炜[1] 闫辉[1] 王永健[1] 

机构地区：[1]北京大学第三医院运动医学研究所,100083

出　　处：《中华外科杂志》2008年第10期745-748,共4页Chinese Journal of Surgery

摘　　要：目的探讨前交叉韧带重建术后膝关节感染的临床诊断与治疗方法。方法回顾性研究1997年1月至2007年7月关节镜下前交叉韧带重建术后膝关节感染的患者，通过对术后关节感染的发病率、危险因素、临床表现、实验室检查结果、治疗方法及临床预后情况的观察，分析总结临床诊断与治疗方法。结果关节镜下前交叉韧带重建手术共3638例，术后关节感染者16例，感染率0．44％。临床表现有体温增高，膝关节肿胀、疼痛，关节活动度受限。细菌培养阳性11例，以表皮葡萄球菌最多见。治疗包括静脉抗炎、关节冲洗注药、关节镜下清理术等方法，所有患者均治愈。清创术后1年以上的12例患者中失访3例，9例术后获得随访，随访时间平均19．7个月，膝关节活动度及韧带功能良好。结论前交叉韧带重建术后膝关节感染的发生率较低，但可能会导致关节功能障碍、软骨破坏及韧带移植物失效等严重后果。因此早期诊断、早期治疗尤为重要。尽早行关节镜下清理手术，术后结合抗生素治疗，辅以积极有效的功能康复，可以取得很好的临床效果。Objective To summary the experience in the diagnosis and management of septic arthritis after anterior cruciate ligament （ACL） reconstruction. Methods The knee joint infections after arthroscopic anterior cruciate ligament reconstruction were retrospectively studied. From January 1997 to July 2007, 16 of 3638 patients undergoing anterior cruciate ligament reconstructions experienced postoperative septic arthritis. The incidence, cause, presentation, laboratory results, treatment, and outcome of all infected patients were analyzed. The experiences of diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction were summarized. Results The incidence of septic arthritis after ACL reconstruction was 0. 44%, The most common symptoms of the infected patients were fever, swelling, severe pain, tenderness, restricted motion. Eleven （68.8%） patients were positive for bacteria cultures, and Staphylococcus epidermidis was the most common bacteria. Nine of the 16 patients were performed arthroscopic debridement, and the other 7 patients were conservatively treated. All patients regained full range of motion and normal stability at the 19. 7 months follow-up. Conclusions Septic arthritis, which could bring the dysfunction of the joint, is subsequent with cartilage injury and the failure of the ACL grafts. Early diagnosis and treatment of arthroscopic debridement in time are essential to the ultimate clinical outcome.

关 键 词：前交叉韧带 骨-髌韧带-骨组织移植重建术 手术后并发症 关节感染 

分 类 号：R686[医药卫生—骨科学]