清创+灌洗引流治疗前交叉韧带重建术后感染的效果观察

Clinical Effect of Debridement and Lavage-drainage in the Treatment of Infection after Anterior Cruciate Ligament Reconstruction

目的:探讨关节镜下清创+灌洗引流结合胫骨近端切口清创+VSD灌洗引流治疗自体腘绳肌腱重建前交叉韧带术后感染的早中期临床效果。方法:回顾性分析2013年9月-2018年8月笔者所在科关节镜下自体腘绳肌腱重建前交叉韧带术后感染病例共17例,予行关节镜下清创+持续灌洗引流术结合胫骨近端切口清创+持续VSD灌洗引流术,进行随访,比较诊断感染时及治愈时血白细胞、血沉及CRP,采用Lyshlom膝关节评分系统、前抽屉试验、Lachman试验、膝关节活动度、KT-1000检查结果、X线及MRI检查对疗效进行评价。结果:诊断感染时的血白细胞、血沉及CRP分别高于治愈时的血白细胞、血沉及CRP,差异有统计学意义(t=7.23、18.83、12.74,P<0.01);末次随访的Lyshlom膝关节评分82~95分,平均(91.88±3.87)分;前抽屉试验及Lachman试验除取出内植入物1例阳性外,其余均阴性;膝关节活动度:过伸5°~10°,平均(4.71±2.14)°,屈曲125°~135°,平均(128.82±3.32)°;KT-1000检查结果1.1~10.3 mm,若除外取出内植入物1例,则平均为(1.65±0.75)mm;X线及MRI提示无明显关节退变且韧带成熟度良好。结论:关节镜下清创+灌洗引流结合胫骨近端切口清创+VSD灌洗引流治疗关节镜下自体腘绳肌腱重建前交叉韧带术后感染,辅以抗生素治疗和功能锻炼,可取得良好早中期临床效果。

Objective:To investigate the early and mid-term clinical effect of arthroscopic debridement and continuous lavage-drainage combined with proximal tibial incision debridement and continuous VSD lavage-drainage in the treatment of infection after arthroscopic anterior cruciate ligament reconstruction with autologous hamstring tendon.Method:A retrospective analysis of 17 cases of infection after arthroscopic anterior cruciate ligament reconstruction with autologous hamstring tendon from September 2013 to August 2018 in our department,they were treated with arthroscopic debridement and continuous lavage-drainage combined with proximal tibial incision debridement and continuous VSD lavage-drainage.All cases were followed up to compare white blood cells,erythrocyte sedimentation and CRP at the time of diagnosis and cure of infection,and the clinical effect were evaluated by Lyshlom knee score system,anterior drawer test,Lachman test,knee joint mobility,KT-1000 test results,X-ray and MRI examination.Result:White blood cells,erythrocyte sedimentation and CRP at the time of diagnosis of infection were higher than those at the time of cure of infection respectively,the differences were statistically significant(t=7.23,18.83,12.74,P<0.01).At the last follow-up,Lyshlom knee score was 82 to 95 points with an average of(91.88±3.87)points;anterior drawer test and Lachman test were negative except for one positive case in which the internal implant was removed;Knee joint motion of 5°to 10°of overextension with an average(4.71±2.14)°,125°to 135°of flexion with an average of(128.82±3.32)°;KT-1000 test result was 1.1 to 10.3 mm,the average was(1.65±0.75)mm except for the only 1 case in which the internal implant was removed;X-ray and MRI showed no significant joint degeneration and good ligament maturity.Conclusion:Arthroscopic debridement and lavage-drainage combined with proximal tibial incision debridement and VSD lavage-drainage in the treatment of infection after arthroscopic anterior cruciate ligament reconstruction with autologous hamstring tendon,supplied with antibiotic treatment and function exercise,can achieve good early and mid-term clinical effect.