关节镜下膝关节清理术后持续冲洗对急性化脓性关节炎的治疗效果  

Effect of postoperative continuous irrigation and drainage on treatment of acute suppurative arthritis in patients undergoing arthroscopic knee joint debridement

作　　者：王平[1] 刘效伟 康丽 杨晶娟 徐娟[2] WANG Ping;LIU Xiao-wei;KANG Li;YANG Jing-juan;XU Juan(Affiliated Hospital of Binzhou Medical College,Binzhou,Shandong 25660,China)

机构地区：[1]滨州医学院附属医院骨关节外科,山东滨州256600 [2]滨州医学院附属医院手(显微)外科,山东滨州256600

出　　处：《中华医院感染学杂志》2023年第18期2815-2819,共5页Chinese Journal of Nosocomiology

基　　金：山东省医药卫生科技发展计划项目(2019WS042)。

摘　　要：目的探讨关节镜下膝关节清理术后持续冲洗引流对急性化脓性关节炎的疗效及预后的影响,为急性化脓性关节炎的治疗提供参考。方法回顾性分析2019年1月-2021年6月于滨州医学院附属医院因急性化脓性膝关节炎入院治疗的102例患者的临床资料,根据治疗方案分为研究组52例和对照组50例,研究组在关节镜手术后予以持续冲洗引流,对照组予以单纯关节镜下清理,比较两组术后炎症指标水平、视觉模拟评分法(VAS)疼痛评分及膝关节功能。结果86例患者关节液培养阳性,分离出86株病原菌,其中革兰阳性菌占55.81%,以金黄色葡萄球菌、表皮葡萄球菌为主;革兰阴性菌占44.19%,以大肠埃希菌、鲍氏不动杆菌为主;两组患者术后3 d及14 d D-二聚体、C-反应蛋白(CRP)、红细胞沉降率(ESR)及降钙素原(PCT)水平较术前降低,且研究组低于对照组(P<0.05);术后随访发现研究组疼痛症状及膝关节功能改善情况均优于对照组(P<0.05),研究组膝关节屈曲活动度优良率为86.54%(45/52),高于对照组的60.00%(30/50),两组比较有统计学差异(χ^(2)=9.224,P=0.002)。结论关节镜下清理术后持续冲洗引流治疗在早期可显著缓解疼痛,改善膝关节功能和屈曲活动度,值得在临床上推广应用。OBJECTIVE To explore the curative effect of postoperative continuous irrigation and drainage on acute suppurative arthritis in the patients undergoing arthroscopic knee joint debridement and observe the influence on prognosis so as to provide guidance for treatment of acute suppurative arthritis.METHODS A total of 102 patients who were hospitalized for treatment in the Affiliated Hospital of Binzhou Medical College due to acute suppurative arthritis from Jan 2019 to Jun 2021 were enrolled in the study and were divided into the study group with 52 cases and the control group with 50 cases according to the therapeutic schedules,and the clinical data of the enrolled patients were retrospectively analyzed.The study group was treated with continuous irrigation and drainage after the arthroscopic surgery,while the control group was simply given arthroscopic debridement.The postoperative inflammatory indexes,visual analogue scale(VAS)score and knee joint function were compared between the two groups.RESULTS The joint fluid specimens were cultured positive in 86 patients;totally 86 strains of pathogenswere isolated,55.81%of which were gram-positive bacteria,and 44.19%were gram-negative bacteria.Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of the gram-positive bacteria;Escherichia coli and Acinetobacter baumanni were dominant among the gram-negative bacteria.The levels of D-dimer,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and procalcitonin(PCT)of the two groups were lower after the surgery for 3 and 14 days than before the surgery,and the levels of above indexes of the study group were lower than those of the control group(P<0.05).The postoperative follow-up showed that the symptoms of pain and knee joint function were improved more remarkably in the study group than in the control group(P<0.05);the excellent and good rate of knee flexion range of motion was 86.54%(45/52)in the study group,higher than 60.00%(30/50)in the control group,and there was significant differenc

关 键 词：急性化脓性膝关节炎 关节镜 膝关节清理术 持续冲洗引流 病原菌 疗效 

分 类 号：R684[医药卫生—骨科学]