自体腘绳肌腱重建前交叉韧带早期感染的处理

Management of early joint infection secondary to anterior cruciate ligament reconstruction with hamstring tendon auto⁃graft

[目的]探讨使用自体腘绳肌肌腱重建前交叉韧带(anterior cruciate ligament, ACL)早期感染的临床诊治方法。[方法] 2017年12月—2022年12月在本院行关节镜下ACL重建术后发生感染的患者共13例,第一时间行膝关节穿刺抽液,并送检细菌、真菌培养及常规细胞检查,并尽快行关节镜下清理,评价临床及检验结果。[结果]13例患者均顺利完成手术,手术时间平均(67.5±14.3)min,灌洗时间平均(9.1±1.8)d。患者均获随访,与术前相比,术后14 d及末次随访,患者VAS评分[(7.6±1.2),(3.5±0.9),(1.1±0.3), P<0.001]显著减少,Lysholm评分[(47.5±9.4),(58.7±12.3),(83.8±11.5), P<0.001]、膝伸-屈ROM[(65.9±13.6)°,(87.8±15.6)°,(121.4±11.7)°, P<0.001]显著增加。其中12例成功保留移植物,1例术中予以去除,二期重建。检验方面,共培养出细菌11株,其中表皮葡萄球菌最多,共5株,其次为金黄色葡萄球菌,共3株。与术前相比,术后14 d及末次随访时,血液检查中WBC计数、中性粒细胞占比(N%)、CRP、ESR均显著降低(P<0.05)。[结论]采用自体腘绳肌重建ACL术后感染的病原菌以表皮葡萄球菌为主,关节镜下清创+置管冲洗引流联合静脉使用抗生素可获得良好的临床疗效。

[Objective]To analyze the clinical diagnosis and treatment of early joint infection secondary to anterior cruciate ligament re⁃construction(ACLR)with hamstring tendon autograft.[Methods]From December 2017 to December 2022,a total of 13 patients with joint in⁃fection after arthroscopic ACLR in our hospital underwent arthroscopic debridement as soon as knee joint aspiration for bacterial and fungal culture and routine cell examination.The clinical outcomes were evaluated.[Results]All the 13 patients had arthroscopic debridement con⁃ducted successfully with the average operation time of(67.5±14.3)min,and the average irrigation time of(9.1±1.8)days after operation.All patients were followed up,and with time from that preoperatively,14 days after surgery and the last follow-up,the VAS score significantly re⁃duced[(7.6±1.2),(3.5±0.9),(1.1±0.3),P<0.001],while the Lysholm score[(47.5±9.4),(58.7±12.3),(83.8±11.5),P<0.001],knee extensionflexion range of motion(ROM)[(65.9±13.6)°,(87.8±15.6)°,(121.4±11.7)°,P<0.001]significanty increased.The graft was successfully re⁃tained in 12 patients,while graft removed in 1 patient who received revision reconstruction in the second stage.Regarding lab test,a total of 11 strains of bacteria were cultured,Staphylococcus epidermidis was the most,with 5 strains,followed by Staphylococcus aureus,with 3 strains.The WBC count,neutrophil ratio(N%),CRP and ESR were significantly decreased 14 days after surgery and at the last follow-up(P<0.05).[Conclusion]Staphylococcus epidermidis is the main pathogen of joint infection secondary to ACLR with hamstring tendon autograft.Arthroscopic debridement combined with catheter irrigation and drainage and intravenous antibiotics do achieve good clinical efficacy.