不同冲洗时间对关节镜治疗老年化脓性膝关节炎的疗效分析

Analysis on the arthroscopy efficacy with different irrigation times for the treatment of suppurative knee arthritis in elder patients

目的 :探讨不同冲洗时间对于关节镜治疗老年化脓性膝关节炎的疗效。方法 :选取2012年10月至2014年10月收治的23例老年化脓性膝关节炎病例作为研究对象,采用关节镜下清理、置管及术后灌洗方法治疗,根据不同冲洗时间将患者分为冲洗1周组(10例)及冲洗2周组(13例),通过比较术后皮温恢复时间、C-反应蛋白(CRP)、血沉、关节活动度以及膝关节功能等评价两组治疗效果。结果 :23例均获随访,平均随访时间(13.3±2.3)个月,无一例复发。术后两组患者CRP均在2周时恢复正常;冲洗2周组血沉在术后2周恢复正常,1周组术后2周血沉仍高,在术后3周恢复正常,两组差异有统计学意义。术后膝关节皮温恢复正常时间1周组为10~20 d,平均(15.5±1.9)d;2周组8~17 d,平均(13.4±1.2)d,两组差异有统计学意义。术后1、3、6个月,患者膝关节活动度均较术前明显好转(P<0.05);术后1个月,2周组膝关节活动度较1周组明显好转(P<0.05);术后3、6个月,两组膝关节活动度差异无统计学意义。术后1、3、6个月,患者膝关节Lysholm评分均较术前明显好转(P<0.05);术后1个月,2周组膝关节Lysholm评分较1周组高(P<0.05);术后3、6个月,两周组膝关节Lysholm差异无统计学意义。所有患者术后3个月膝关节功能均已稳定,根据Lysholm评分,术后6个月1周组优3例,良6例,可1例;2周组优5例,良7例,可1例;两组差异无统计学意义。结论:采用关节镜技术治疗老年膝关节化脓性关节炎创伤小,清创彻底,有利于炎症的消除和膝关节功能的恢复,术后推荐冲洗2周,有利于患者膝关节功能早期康复。

Objective：To evaluate the curative effect of arthroscopy-assisted irrigation with different times for the treatment of suppurative knee arthritis in elder patients.Methods：From October 2012 to October 2014,23 old patients with suppurative knee arthritis were treated with arthroscopic debridement and continuous irrigation.All the patients were randomly divided into two groups：one-week irrigation group（10 cases） and two-week irrigation group（13 cases）.The ESR,CRP,recovery time of knee skin temperature Joint rang of motion and knee function were observed to evaluate the therapeutic effects.Results：All the patients were followed up,and the mean duration was（13.3±2.3） months.No recurrence was observed.The CRP in both groups returned to normal level 2 weeks after operation.The ESR in two-week irrigation group returned to normal level2 weeks after operation,while in one-week irrigation group it was still at a high level,and returned to normal level 3 weeks after operation;there was a statistical significance between these two groups（P〈0.05）.The recovery time of knee skin temperature after operation in two-week irrigation group was（13.4±1.2） d on average（ranged,8 to 17d）,which was less than（15.5±1.9） d on average（ranged,10 to 20 d） in one-week irrigation group（P〈0.05）.The knee joint mobility of all patients l,3,6months after operation was significantly improved compared with those before surgery（P〈0.05）.The knee joint mobility of patients in two-week irrigation group was better than that in one-week irrigation group at the first month after operation（P〈0.05）;but there were no significant differences between these two groups 3,6 months after operation.The Lysholm score of all patients 1,3,6months after operation was significantly improved compared with those before surgery（P〈0.05）.The Lysholm score of patients in two-week irrigation group was better than in one-week irrigation group at the first month after operation（P〈0.05）;but there were no significant differences between these two groups 3,6 months after operation.All the patients had stable knee functions3 months after operation.According to the Lysholm scale,3 patients got an excellent result,6 good and 1 poor in one-week irrigation group 6 months after operation;5 patients got an excellent result,7 good and 1 poor in two-week irrigation group;there was no significant differences between these two groups.Conclusion：Treatment of suppurative knee arthritis using arthroscopy has such advantages as minimal invasion and complete debridement,which is helpful to attenuate inflammation and regain knee function.It is suggested that the irrigation should be prolonged for two weeks postoperatively.