老年患者术后膝关节感染的临床治疗研究

Clinical treatment of postoperative knee joint infections in elderly patients

目的探讨分析负压封闭引流术联合关节腔灌洗对老年患者骨折术后膝关节感染的临床疗效,以降低感染率。方法回顾性分析2008年5月-2013年6月收治的骨折术后膝关节感染患者62例,采用随机数法将其随机分为两组,其中31例为治疗组,给予负压封闭引流术联合关节腔灌洗,剩余31例为对照组,采用常规静脉抗感染治疗,比较两组患者治疗效果及不良反应发生率;应用SPSS17.0软件进行数据分析。结果治疗组患者治疗总有效率为87.10%,明显高于对照组的67.74%,差异有统计学意义(P<0.05),两组患者关节液培养,治疗组培养出病原菌40株,对照组培养出病原菌42株,两组均以金黄色葡萄球菌最多,分别占57.5%和61.8%,两组病原菌构成比较差异无统计学意义;两组在不良反应发生率比较差异也无统计学意义。结论改良负压封闭引流术联合关节腔灌洗对骨折术后膝关节感染治疗相对一般静脉抗感染效果较好,但需要帮助患者克服再次切开患处的心理障碍,并选择合适灌洗液。

OBJECTIVE To explore the clinical efficacy of vacuum sealing drainage combined with intra-articular lavage in treatment of postoperative knee joint infections in elderly patients with fractures so as to reduce the incidence of infections.METHODS A total of 62fracture patients with postoperative knee joint infections who were treated from May 2008to Jun 2013were retrospectively reviewed,the patients were randomly divided into two groups by using randomized number method,the treatment group with 31cases was treated with the vacuum sealing drainage combined with intra-articular lavage,while the control group with 31cases was given the conventional intravenous anti-infective therapy,the therapeutic effect and the incidence of adverse reactions were observed and compared between the two groups,and the statistical analysis was performed with the use of SPSS17.0software.RESULTS The total effective rate of treatment was 87.10%in the treatment group,significantly higher than 67.74%in the control group,and there was significant difference（P〈0.05）.Through the culture of synovial fluid specimens obtained from the two groups of patients,a total of 40strains of pathogens have been cultured from the treatment group,42strains from the control group;the Staphylococcus aureus was the predominant species of the isolated pathogens,accounting for 57.5%in the treatment group,61.8%in the control group,the difference in the constituent ratio of the pathogen between the two groups was not significant;there was no significant difference in the incidence of adverse reactions between the two groups.CONCLUSION As compared with the convention intravenous anti-infective therapy,the modified vacuum sealing drainage combined with intra-articular lavage can achieve clinical effect on treatment of postoperative knee joint infections in the fracture patients,however,it is necessary to help the patients overcome the psychological barrier of cutting the affected site once again and choose appropriate lavage fluid.