膝关节感染性关节炎的关节镜治疗

Arthroscopic treatment for septic arthritis of the knee

背景：膝关节感染性关节炎的治疗由于所需时间长、易复发和术后功能恢复差等特点,一直是关节外科临床上的棘手问题,相关的病例报道很多,但对手术技术细节的全面探讨并不多见。目的：探讨关节镜下清理、冲洗、置管,术后持续大流量灌洗治疗膝关节感染性关节炎的疗效及技术细节。方法：回顾性分析2004年1月至2014年8月,采用关节镜下清理及术后持续灌洗的方法治疗的膝关节感染性关节炎患者14例。男9例,女5例;年龄28-81岁,平均（48.07±14.56）岁。比较患者术前、术后1周及末次随访时膝关节的伸屈活动度、VAS评分及Lysholm评分。结果：14例患者平均随访（24.18±12.60）个月（3-45个月）。膝关节术前、术后1周和末次随访时的平均伸直度分别为5.71°±5.29°、3.57°±3.49°和1.14°±1.50°;平均屈曲度分别为85.77°±33.32°、95.01°±25.12°和116.79°±11.43°;VAS评分分别为（8.64±0.97）分、（5.43±1.80）分和（1.14±1.19）分。术前和末次随访时的Lysholm评分分别为（51.93±10.86）分和（89.07±4.99）分。至末次随访时,无1例复发。t检验结果：术后1周和末次随访时的VAS评分均较术前有明显下降（P〈0.05）,末次随访时的Lysholm评分与术前比较明显增加（P〈0.05）。术后1周的伸屈度与术前比较,无明显统计学差异（P〉0.05）,但末次随访时的伸屈度数与术前比较,均有显著统计学差异（P〈0.05）。结论：关节镜下清理、冲洗、置管,术后持续灌洗治疗膝关节感染性关节炎可以显著改善患膝的症状及功能,是一种创伤小、恢复快的有效方法。

Background： Treatment of septic arthritis of the knee has been a troublesome problem in joint surgery due to its prolonged time needed for treatment, recurrent characteristics and poor functional recovery. Though there are many reports about it,few comprehensive discussion on the technical details of the operation is seen.Objective： To investigate the role of arthroscopic debridement and intubation together with postoperative irrigation for septic arthritis of the knee and also to discuss the technical details during and after operation.Methods： A retrospective analysis was done in 14 patients with septic arthritis treated under arthroscope between January2004 and August 2014. There were 9 males and 5 females with an average age of（48.07±14.56） years（range,28-81）. The range of motion of the knee, VAS score and Lysholm score before treatment, one week after treatment and at the last followup were compared.Results： The average follow-up period was（24.18±12.60） months（range, 3-45 months）.The average extension degree was5.71°±5.29°, 3.57°±3.49° and 1.14°±1.50°before treatment, one-week after treatment and at the last follow-up, respectively.At the above-mentioned time points, the average flexion degree was 85.77°±33.32°, 95.01°±25.12°and 116.79°±11.43°, and the the average VAS scores were 8.64±0.97, 5.43±1.80 and 1.14±1.19. The Lysholm score was 51.93±10.86 before treatment and 89.07±4.99 at the last follow-up. No recurrence was found till the last follow-up. The VAS score at one-week after treatment and the last follow-up were significantly lower than preoperative one（P〈0.05）. The Lysholm score at the last follow-up was significantly higher than preoperative one（P〈0.05）. There was no statistical difference between the range of motion at one-week after treatment and before treatment（P〉0.05）, but significant difference was found between the range of motion before treatment and at the last follow-up（P〈0.05）.Conclusions： Arthroscopic debridement and intubation together with postoperative irrigation for septic arthritis of the knee is an effective method with less invasion and rapid recovery.