关节镜下清创治疗人工膝关节置换术后早期感染的临床分析

目的 :对比分析关节镜和常规开放清创治疗人工膝关节置换术后早期感染的临床疗效。方法 :回顾性研究2009年10月至2016年9月3家医院收治的膝关节置换术后早期感染的患者11例11膝,术前穿刺抽取关节液行细菌培养及药物敏感试验,分为2组,其中关节镜组5例,关节镜下行清创术;常规组6例,行常规开放清创术。术后两组敏感抗生素持续闭式灌注2~3周,待冲洗液变清后3~5 d拔管,术中记录手术时间、出血量、切口长度。于术后第1、3、7天利用疼痛标尺评分记录患者伤肢疼痛情况,根据美国特种外科医院(the Hospital for Special Surgery,HSS)膝关节评分评价术后疗效。结果:11例经治疗后局部及全身症状体征消失,血液及关节液检查结果均正常。术后随访6~18个月,关节镜组1例、常规组2例术后3个月感染复发,经再次关节镜清创手术后感染得以控制。随访终末根据HSS膝关节评分进行疗效评定,关节镜组优3例,良2例,中0例,差0例;常规组优3例,良1例,中1例,差1例。结论:对人工膝关节置换术后早期感染中没有明显骨质感染、破坏,关节周围皮肤没有窦道形成,假体无松动且能找到敏感抗生素的患者,应用关节镜手术后持续灌洗、敏感抗生素应用可以获得较好的疗效,是一种创伤小、疗效较好的方法。

Clinical analysis on arthroscopic debridement for the treatment of early infection after total knee replacement

Objective: To compare the clinical effects of arthroscopic debridement versus open debridement on controlling and treatment of infection after total knee replacement.Methods: From October 2009 to September 2016 in three hospitals,11 patients with 11 joints which were infected after total knee replacement were randomly divided into two groups:5 cases in arthroscopy group and 6 cases in routine group. Patients in arthroscopy group were treated with arthroscopic debridement to remove the necrotic tissues,then closed-type irrigation with sensitive antibiotics by using two sebific ducts were performed continuously for 2 or 3 weeks until the flushing fluid became clear for 3 or 5 days;other 6 patients in routine group were treated with open surgical debridement and the following procedures in keeping with those in the arthroscopy group. Operation time,blood loss and incision length were recorded during the operation,and pain scores were recorded on the 1st,3rd and 7th day after the operation. The curative effects were evaluated according to the Hospital for Special Surgery score system.Results: The local and general symptoms of the 11 patients disappeared,and the test outcomes of biochemistry,blood and synovial fluid were normal. All patients were followed up,and the duration ranged from 6 to 18 months. Infection recurrences were observed in 1 case of arthroscopy group and 2 cases of routine group 3 months later after operation,and all these patients who underwent the second time operation with arthroscopic debridement were cured. According to the Hospital for Special Surgery score system,3 cases obtained excellent result,2 good,no poor and bad cases in arthroscopy group;3 cases obtained excellent result,1 good,1 poor and 1 bad in routine group.Conclusion: If the sensitive antibiotics can be found for the infected joints without obvious destruction of bone and no prosthesis loosening,it has a better therapeutic effect by using arthroscopic debridement combined with continuous drainage and irrigation. The method has a better curative effect with smaller trauma.