关节镜在全膝关节置换后早期急性感染治疗中的应用

Arthroscopic application in early acute infection after total knee arthroplasty

选择2003-09/2006-12解放军第二军医大学第二附属医院骨科接诊的全膝关节置换后3周内出现膝关节急性感染、膝关节正侧位X射线片未见明显骨质破坏和假体松动10例患者(11膝)进行关节镜下清创。术后持续大剂量生理盐水灌注冲洗1周,静脉给予万古霉素6周。所有患者均获随访,随访时间平均为29.9个月。8例患者关节镜清创后局部及全身症状消失、血沉以及C-反应蛋白处于正常范围,末次随访平均关节活动度为115°,平均HSS评分为82.1。2例患者接受二期翻修手术,1例患者二次翻修手术失败后接受膝关节融合手术。结果提示关节镜清创配合术后大剂量灌注冲洗和静脉抗生素是治疗全膝关节置换后早期急性感染的有效方法之一。

Ten patients （11 knees） who developed acute infection symptoms within 3 weeks after total knee arthroplasty with no evidence of bone destruction or prosthesis loosening by radiographic evaluation were selected between September 2003 and December 2006. Arthroscopic debridement was performed accompanying with irrigation by large-dose normal saline for 1 week and intravenous vancomycin for 6 weeks. All patients were followed up, with the mean follow-up interval of 29.9 months. In 8 patients, local and whole symptoms disappeared after arthroscopic debridement, blood sedimentation and C-reactive protein restored to normal range. Average joint range of movement was 115° and average HSS score was 82.1 at the time of final follow-up. Two patients received secondary stage revision. Knee arthrodesis was performed in 1 patient who received revision. The results of the study show that arthroscopic debridement in combination with large-dose irrigation and intravenous antibiotics is an effective alternative for early acute infection after total knee arthroplasty.