关节镜清理联合静脉抗生素治疗膝关节革兰阳性菌感染的疗效观察  

Effect of arthroscopic debridement in combination with intravenous antibiotics on Gram-positive bacterial knee infections

作　　者：王琪[1] 李众利[2] 刘玉杰[2] 魏民[2] 王志刚[2] 蔡谞[2] 朱娟丽[2] 刘洋[2] 

机构地区：[1]武警医学院附属医院骨科,天津300162 [2]解放军总医院骨科,北京100853

出　　处：《军医进修学院学报》2011年第6期579-581,共3页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的探究关节镜清理、关节腔灌洗联合静脉应用糖肽类抗菌药物治疗革兰阳性菌所致膝关节感染的疗效。方法 2008年2月-2010年7月应用关节镜清理、关节腔灌洗联合静脉糖肽类抗菌药物治疗革兰阳性菌所致膝关节感染患者21例,其中耐甲氧西林金黄色葡萄球菌(MRSA)感染5例,耐甲氧西林表皮葡萄球菌(MRSE)感染6例,肠球菌感染4例,凝固酶阴性葡萄球菌(CONS)感染6例,药敏试验显示培养菌群均对糖肽类抗菌药物万古霉素及替考拉宁敏感,观察药物治疗过程中不良反应情况,评价临床疗效。结果治疗期间未发现药物过敏反应和其他与药物有关的不良反应记录,治疗有效率为100%。本组患者均获得随访,时间4-29个月,平均17.6个月,随访期间患者均无复发感染症状。结论关节镜清理、关节腔灌洗联合静脉应用糖肽类抗菌药物是治疗膝关节革兰阳性菌感染的一种有效方法。Objective To study the therapeutic effect of arthroscopic debridement and continuous lavage in combination with intravenous glycopeptide antibiotics on Gram-positive bacterial knee infections.Methods Twenty-one patients with Gram-positive bacterial knee infection were treated with arthroscopic debridement and continuous lavage in combination with intravenous glycopeptide antibiotics.All bacteria,including methicillin-resistant staphylococcus aureus（MRSA） in 5 knees,meticillin-resistant staphylococcus epidermidis（MRSE） in 6 knees,enterococcus-resistant in 4 knees,coagulase-negative staphylococci（CONS） in 6 knees,were sensitive to vancomycin or teicoplanin.Adverse reactions of the drugs used were recorded during treatment and therapeutic effects of the drugs were evaluated after treatment.Results No adverse reaction of glycopeptide antibiotics occurred during the treatment.The effective rate of arthroscopic debridement and continuous lavage in combination with glycopeptide antibiotics was 100%.All the patients were followed up for an average time of 17.6 months（range 4-29 months） during which recurred knee injection was not found.Conclusion Arthroscopic debridement and continuous lavage in combination with intravenous glycopeptide antibiotics are effective against Gram-positive bacterial knee infection.

关 键 词：关节镜 灌洗 膝关节感染 糖肽类抗生素 

分 类 号：R684[医药卫生—骨科学]