关节镜下前交叉韧带重建术后感染的诊断与治疗要点

目的探讨前交叉韧带（ACL）重建术后关节内感染的诊断标准、预防及治疗关键点。方法回顾性分析2007-01—2012-12关节镜下行ACL重建术后关节内感染5例患者的临床资料。术后关节内感染的诊断标准：膝疼痛在术后再度加重,伴体温升高;膝肿胀、积液或切口红肿;血液白细胞、中性粒细胞比例、ESR、CRP升高;关节液白细胞、中性粒细胞比例升高,葡萄糖浓度降低,以及细菌培养。总结5例感染者诊断、治疗过程及结果并回顾相关文献。结果关节镜下ACL重建术102例中5例术后发生关节内感染（4.9%）,其中仅1例细菌培养阳性（0.98%）。采取清创后持续冲洗引流或间断穿刺冲洗治疗后保留移植韧带4例。结论 ACL重建术后关节内感染的治疗原则：早期干预以提高韧带保留率;清创后持续冲洗引流;使用敏感抗生素足疗程治疗;石膏或支具制动,延迟功能锻炼。

The diagnosis and treatment of postoperative infection after arthroscopic ACL reconstruction

Objective To investigate the diagnosis criteria, the prophylaxis and treatment key points of the infection after anterior cruciate ligament（ACL） reconstruction. Methods Five cases of postoperative infection after arthroscopic ACL reconstructions performed between Jan. 2007 and Dec. 2012 were retrospectively reviewed. The diagnosis criteria of postoperative infection were as followed： knee pain recurred postoperatively with temperature rised; increased swelling or hydrarthrosis of knee joint, or hyperemia around the incision; elevated erythrocyte sedimentation rate（ESR）, C-reactive protein（CRP）, blood white cell count; elevated intra-articular white cell count, decreased glucose density, and the culture result. The clinic appearances, diagnosis and treatment of the infected cases were analyzed, and the related reports were reviewed.Results Of the 102 cases, according to our criteria, 5 patients（4.9%） were found to have developed deep infection after ACL reconstruction, with only one patient cultured positively（0.98%）. All cases were treated with debridement, continuous or interrupted irrigation, and intravenous antibiotics. The grafts were retained in 4 of 5 patients. Conclusion The treatment protocols of postoperative ACL infection are： early intervention and retaining the graft if possible, routine debridement followed by continuous irrigation, full range sensitive antibiotics, immobilization and postponed exercise.