关节镜联合万古霉素硫酸钙治疗膝关节感染

Arthroscopic debridement combined with implantation of vancomycin-calcium sulfate for septic knee arthritis

[目的]评价关节镜联合载药硫酸钙治疗膝关节感染的临床效果。[方法]回顾性分析2017年1月~2019年2月膝关节感染患者9例,均有侵袭性操作史,均采用关节镜清创灌洗联合万古霉素硫酸钙关节内置入治疗。总结临床与辅助检查结果。[结果]9例患者均顺利完成手术。术后9例患者患膝肿痛逐渐消退,至末次随访时未发现感染复发病例。随时间推移,9例患者的VAS评分显著减少(P<0.05),而Lysholm评分和Judet评分显著增加(P<0.05)。辅助检查方面,细菌培养阳性9例,其中,金黄色葡萄球菌4例,表皮葡萄球菌5例,均对万古霉素敏感。病理检查显示滑膜组织增生,内可见多量中性粒细胞浸润。术后1周WBC、ESR和CPR均较术前显著下降(P<0.05),术后1个月WBC、ESR和CPR较术后1周进一步下降(P<0.05),接近正常值水平。9例患者术后即刻X线片检查可见关节腔内植入万古霉素硫酸钙颗粒影,术后1个月时X线片检查见载药颗粒影完全消失。至末次随访时,9例患者均未见膝关节明显退行性改变征象。[结论]运用关节镜清创联合万古霉素硫酸钙植入关节腔,可有效治疗膝关节感染,保留其功能。

[Objective]To evaluate clinical outcomes of arthroscopic debridement combined with intraarticular implantation of vancomycin-calcium sulfate for septic knee arthritis.[Methods]A retrospective study was done in 9 patients who underwent surgical treatment for septic knee arthritis secondary to invasive therapy of the affected knee from January 2017 to February 2019 in our hospital.All the 9 patients received arthroscopic debridement and irrigation,combined with intraarticular implantation of vancomycin-calcium sulfate.The clinical outcomes and results of assistant examinations were summarized.[Results]All the 9 patients had operation performed successfully,got pain and knee swelling subsided gradually postoperatively,and had no recurrence of infection to the latest follow up.The VAS score significantly decreased,whereas the Lysholm score and ROM significantly increased over time(P<0.05).With respect to assistant examinations,9 patients had positive bacterial culture results,involving Staphylococcus aureus in 4 cases and Staphylococcus epidermidis in 5 cases,which all were sensitive to vancomycin.Pathologic examination revealed severe synovial proliferation accompanied with heavy infiltration of neutrophilic leukocytes.The WBC,ESR and CRP significantly decreased at 1 week after operation compared with those before operation(P<0.05),and further decreased at 1 month postoperatively to near the normal levels(P<0.05).X-ray examinations showed shadows of calcium sulfate granules immediately after operation,which were completely resolved and disappeared at 1 month after operation.At the latest follow up,no remarkable degenerative changes of the knee were noticed on images in anyone of the 9 patients.[Conclusion]This arthroscopic debridement combined with intraarticular implantation of vancomycin-calcium sulfate is effective to control intraarticular infection,and preserve the joint function.