关节镜下清创及灌洗引流治疗急性化脓性膝关节炎  

Arthroscopic debridement and drainage for the treatment of septic knee arthritis

作　　者：宋长志 徐小卒 吴亚 徐磊 陈康 成意 刘云飞 秦玲 Song Changzhi;Xu Xiaozu;Wu Ya;Xu Lei;Chen Kang;Cheng Yi;Liu Yunfei;Qin Ling(Department of Orthopaedic,the First People’s Hospital of Yancheng,Yancheng 224006,China)

机构地区：[1]江苏省盐城市第一人民医院骨科

出　　处：《中华关节外科杂志（电子版）》2019年第2期237-241,共5页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：江苏省盐城市医学创新团队基金项目(YC2017007)

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.

关 键 词：膝 感染 关节镜 引流术 

分 类 号：R687.4[医药卫生—骨科学]