前交叉韧带重建后的感染

背景：前交叉韧带重建后感染的发生率比较低,但这种感染会导致灾难性的结果,目前对这种感染的诊断和治疗还没有取得一致的意见。目的：探讨导致前交叉韧带重建术后感染的原因、如何早期诊断,并探讨合适的治疗方案,以尽量保护膝关节的功能。方法：以＂anterior cruciate ligament,reconstruction,infection＂为检索词,检索Pubmed数据库（2007至2012年）;以＂前交叉韧带,重建,感染＂为检索词,检索万方数据库（2007至2012年）。以与前交叉韧带重建后感染的相关文献为评价指标,纳入与前交叉韧带重建后感染相关的内容,排除重复研究。结果与结论：细菌污染手术工具或者韧带移植物是导致前交叉韧带重建后感染的最常见原因,移植物固定的方式和重建后感染之间可能有一定的关系。典型的前交叉韧带重建术后感染的症状和普通的化脓性关节炎的症状类似,但有的前交叉韧带重建后感染的病例并没有感染的典型表现。前交叉韧带重建后感染的诊断需要依靠临床症状、实验室检查（C-反应蛋白和血沉）、膝关节穿刺等方法。大多数外科医师选择静脉使用敏感的抗生素、膝关节灌洗并保留移植物作为自体移植物重建前交叉韧带后感染的首选治疗方法。当感染难以控制或者移植物看起来确实有感染迹象时应该考虑取出移植物。

Infection after anterior cruciate ligament reconstruction

BACKGROUND： The incidence of infection after anterior cruciate ligament reconstruction is relatively low. However, this infection can lead to disastrous results, and the diagnosis and treatment of this infection have not yet achieved a consensus. OBJECTIVE： To explore the causes of infection after anterior cruciate ligament reconstruction and how to diagnosis and cure the infection, and to investigate the appropriate treatment program, in order to protect the knee functions. METHODS： The PubMed database and Wanfang database were searched for articles published between 2007 and 2012 with the key words of ＂anterior cruciate ligament, reconstruction, infection＂ in English and Chinese. Infection after anterior cruciate ligament reconstruction was used as the evaluation index. Articles related to infection after anterior cruciate ligament reconstruction were included, and repeated studies were excluded. RESULTS AND CONCLUSION： Bacterial contaminations of surgical devices or ligament grafts were the most likely causes of infection after anterior cruciate ligament reconstruction, and the fixation method of graft may be related with the infection after reconstruction. The classic clinical symptoms and signs of infection after anterior cruciate ligament reconstruction were similar to general septic arthritis. But classic symptoms of infection were frequently missing. The diagnosis of infection after anterior cruciate ligament reconstruction depended on clinical symptoms and signs, laboratory test such as erythrocyte sedimentation rate and C-reactive protein, and knee aspiration. For the treatment of the infected knee after anterior cruciate ligament reconstruction, culture-specific intravenous antibiotics and surgical joint irrigation with graft retention were considered the overwhelming treatment of choice. Graft removal was recommended if it appeared infected or if there was any difficulty controlling the infection.