前交叉韧带重建术后早期感染的治疗

Treatment of Early Septic Arthritis after ACL Reconstruction

目的：探讨前交叉韧带重建术后早期感染的治疗方法及疗效。方法：2008年1月至2013年1月。对前交叉韧带重建术后15例早期感染患者进行关节穿刺冲洗，必要时行关节镜下关节腔清理术．并于术后根据药敏结果使用静脉注射抗生素治疗2～3周。体温、关节液及血液检查稳定正常3天后．改口服抗生素3～4周。药物治疗的同时进行常规功能康复训练，以关节局部症状、全身症状、关节液检查及Lysholm评分作为评价标准。结果：15例患者中，4例经关节腔穿刺冲洗后炎症得到控制，另有11例患者需进行关节镜下清理术。15例患者移植物功能良好，予保留。15例患者随访时间14-36个月（平均22个月），无发热，无患膝皮温升高，外周血检查未见明显异常，关节稳定性及关节活动功能正常。Lysholm评分为（88．5±6．7）分，复查X线未见明显骨隧道扩大。结论：对前交叉韧带重建术后关节感染患者，应及早进行关节穿刺冲洗、关节镜下关节腔冲洗术，并配合敏感抗生素治疗。能有效控制感染。有利于缓解全身及局部症状，挽救重建移植物，保持关节稳定性及恢复关节功能。

Objective To discuss the treatment and curative effect of early septic arthntls atter anterior cruciate ligament（ACL）reconstruction. Methods From January 2008 to January 2013 ,we treated 15 patients with early septic arthritis after ACL reconstruction by douching through arthrocentesis, and/or arthroscopic debridement. Intravenous antibiotic therapy was applied to patients for 2 ~3 weeks,and shifted to oral antibiotic for another 3 ~4 weeks when body temperature,synovial fluid of patient were normal for 3 days. Simultaneously,rehabilitation training was carried on. Local and systemic symptoms, synovial fluid test and Lysholm scores were used as evaluation criteria. Results Infection was effectively controlled in 4 of 15 patients by arthrocentesis,11 of 15 patients by arthroscopic debridement. 15 ACL reconstructions functioned well and no significant bone tunnel enlargement was found on X-ray image. 15 patients were foUowed up for 14 to 36 months（average 22 months）,during which their Lysholm scores increased（88.5±6.7） ,laboratory inspection,joint stability and range of motion,and knee skin temperature were normal. Conclusions Early douching through arthrocentesis or arthroscopic debridement in cooperation with sensitive antibiotic therapy are recommended when septic arthritis occurred after ACL reconstruction.