关节镜下前交叉韧带重建患者术后膝关节感染的临床研究

Clinical diagnosis and treatment of postoperative knee joint infections in patients undergoing anterior cruciate ligament reconstruction under arthroscopy

目的探讨关节镜下前交叉韧带（ACL）重建术后膝关节感染的诊断和治疗经验。方法回顾性分析2011年2月-2015年6月于医院接受ACL重建术的850例患者的临床资料,统计发生术后膝关节感染患者的病原菌类型构成,对感染者进行关节镜清理及置管灌注冲洗治疗,比较患者治疗前后的白细胞计数（WBC）、红细胞沉降率（ESR）、C-反应蛋白（CRP）及纤维蛋白原（FIB）水平,根据Lysholm评分、膝关节活动度,Lachman试验和前抽屉试验结果评价治疗效果;采用SPSS19.0软件进行统计分析。结果 850例患者中共有9例发生感染,感染率为1.1%;共分离出病原菌9株,其中表皮葡萄球菌6株,金黄色葡萄球菌2株及琼氏不动杆菌1株;治疗后,患者WBC、ESR、CRP和FIB较治疗前明显下降（P〈0.01）;治疗后,患者Lysholm评分（92.5±3.1）分、膝关节活动度125°~135°,Lachman试验和前抽屉试验均阴性。结论关节镜下ACL重建术后膝关节感染发生率较低,但需引起重视并积极治疗,早期进行关节镜清理及置管灌注冲洗治疗能获得良好的预后。

OBJECTIVE To explore the experience of diagnosis and treatment of postoperative knee joint infections in patients undergoing anterior cruciate ligament（ACL）reconstruction under arthroscopy.METHODS The medical records of 850 patients who underwent ACL reconstruction in the hospital from Feb 2011 to Jun 2015 were retrospectively analyzed,the constituent ratios of the pathogens causing the postoperative knee joint infections were statistically analyzed,the arthroscopes were cleaned and catheters were infused and irrigated for the patients with infections.The white blood cell（WBC）counts,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,and fibrinogen（FIB）levels of the patients were observed and compared before and after the treatment,the curative effects were evaluated on the basis of the Lysholm score,range of motion,and results of Lachman test and anterior drawer test,and the statistical analysis was performed with the use of SPSS19.0software.RESULTS The infections occurred in 9of 850 patients,with the infection rate 1.1%.A total of 9strains of pathogens were isolated,including 6strains of Staphylococcus epidermidis,2strains of Staphylococcus aureus,and 1strain of Acinetobacter junii.The WBC counts,ESR,CRP and FIB levels were remarkably reduced after the treatment（P〈0.01）.The Lysholm score of the patients was（92.5±3.1）points after the treatment,the range of motion 125°-135°,and both the Lachman test and anterior drawer test showed negative.CONCLUSION Although the incidence rate of the postoperative knee joint infections is relatively low after the ACL reconstruction under arthroscopy,it needs to be attached great importance to.The early cleaning of arthroscopes and irrigation of catheters can achieve favorable prognosis.