关节镜下前交叉韧带重建术后膝关节感染的预防与治疗  

Prevention and management of septic arthritis after arthroscopic anterior cruciate ligament reconstruction

作　　者：龚继承[1] 汪群力[1] 邹重文[1] 杨柏林[1] 罗伟国[1] 陈奇[1] 李锋[1] 尹浩[1] 钱超[1] 

机构地区：[1]解放军第187中心医院骨科,海南海口571159

出　　处：《中国骨与关节损伤杂志》2015年第6期603-605,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨膝关节镜下前交叉韧带（ACL）重建术后膝关节化脓性感染的预防与治疗方法。方法回顾性分析自2007-01—2014-01关节镜下ACL重建术后膝关节化脓性感染6例。对于高度怀疑ACL重建术后膝关节化脓性感染的患者立即行关节腔穿刺抽液,每次送一式2份标本,然后尽早大剂量静脉使用广谱抗生素（四代头孢类抗生素）,并积极做好术前准备,在硬膜外麻醉下行关节镜下探查清理和冲洗术,术后抗生素溶液（主要是庆大霉素溶液）关节腔持续灌洗。结果本研究286例中有6例发生了膝关节化脓性感染,感染发生率为2.1%。感染患者接受关节镜下探查清理和冲洗术后第2～4天症状明显缓解,经过正规治疗后没有复发病例。术后关节活动度恢复至与健侧一致,前抽屉试验和Lachman试验均为阴性。KT-2000检查与健侧比较：30°位（1.7±0.6）mm,90°位（1.0±0.9）mm。6例随访时间12～24个月,平均16个月,膝关节活动度及韧带功能良好。结论关节镜下ACL重建术后膝关节化脓性感染可能会导致严重后果,采取严格的预防措施可以有效降低感染发生率。对于疑似或者确诊感染患者,尽早行关节镜下清理手术和抗生素溶液关节腔持续灌洗,术后结合抗生素治疗,辅以积极有效的功能训练,可以取得良好的临床效果。Objective To investigate the prevention and management of septic arthritis after arthroscopic anterior cruciate ligament（ACL） reconstruction. Methods A retrospective review was given to the data from 6 patients experienced septic arthritis after ACL reconstruction between Jan. 2007 and Jan. 2014. The high suspected patients were aspirated immediately,two copies of samples were sent to the microbiological laboratory each time, and high-dose intravenous broad-spectrum antibiotics were used, meanwhile, preoperative preparation were already done, then, arthroscopic debridement and lavage were performed under epidural anesthesia, the joint cavity lavage was conducted with antibiotic solution（Gentamicin solution）postoperatively. Results There were 6 out of 286 patients undergoing postoperative septic arthritis, and the infection incidence was 2.1%. The symptom of the infected patients was significantly relieved at about 2-4 days after arthroscopic debridement and continuous lavage without recurrent case. The postoperative joint ROM（range of movement） return to be in line with the healthy side. Anterior drawer test and Lachman test were negative. The KT-2000 measurements were（1.7 ±0.6）mm（30° position） and（1.0 ±0.9）mm（60° position）. The duration of the follow up was 12-24 months, average 16 months. The ROM of the knee joint and the function of the ligaments were good. Conclusion Septic arthritis after ACL reconstruction could bring the dysfunction of the joint.With the effective prevention and early management, the infected patient could regain an good ultimate clinical outcome.

关 键 词：前交叉韧带 重建 关节感染 膝关节镜 

分 类 号：R686.5[医药卫生—骨科学]