摘要
目的 探讨前交叉韧带（ACL）重建术后感染的诊断分型与分期治疗的有效性。方法2002年10月至2010年12月共收治11例ACL重建术后感染患者，男8例，女3例；平均年龄为28．8岁（18-45岁）。感染确诊时间为术后1-64周，平均7．7周。结合国内外文献，我们根据全身症状、局部是否有红肿渗出及是否累及关节腔等特点将感染分为3型：Ⅰ型，急性感染性滑膜炎型（5例）；Ⅱ型，关节外型（3例）；Ⅲ型，感染性关节炎型13例，其中关节穿刺培养阳性者为ⅢA型（2例），阴性者为ⅢB型（1例）]。根据分型和病程不同，早期应用广谱抗生素治疗．必要时行早期清创和关节内置管冲洗，病程长并有窦道形成者采用开放手术清创，取出移植肌腱和内固定物。结果11例患者术后获2．5-8．0年（平均5．2年）随访。11例患者感染均获痊愈，但3例（Ⅰ型1例，ⅢA型2例）遗留关节伸直受限。11例患者末次随访时膝关节Lysholm评分为76-93分，平均82分。KT-1000检查评估20。前向松弛度对比健侧〈2mm者2例，对比健侧为3mm者6例，〉3mm者3例。结论对于ACL莺建术后感染，根据临床表现应早期进行诊断分型，根据我们的诊断分型实施分期治疗可取得良好疗效。
Objective To discuss the self-developed diagnostie classification and stage-adapted treatment of infection after anterior cruciate ligament （ACL） reconstruction. Methods Eleven cases of infection after arthroseopic ACL reeonstruction were treated in our department from October 2002 to Decemtter 2010. They were 8 men and 3 women, 28.8 years of age on average （from 18 to 45 years） . Infection was definitely diagnosed in 1 to 64 weeks （average, 7.7 weeks）. On the basis of literature review, we developed a diagnostic classification system which divides infections into 3 types according to clinical manifestations and used it to establish the diagnoses of infection. We had 5 cases of type I （acute infectious synovitis）, 3 cases of type II （extra-artieular infection） and 3 cases of type Ⅲ （septic arthritis） of which 2 were type ⅢA with positive culture results and one was type m B with negative culture result. Staged-adapted treatment algorithms were adopted based on the clinieal classification of the patients, including early administration of intravenous antibiotics, arthroscopic debridement and irrigation with graft retention, as well as radical open debridement with graft anti hardware removal. Results Follow-ups of 5.2 years on average （front 2.5 to 8.0 years） showed that all the 11 cases of infection were cured, but 3 cases had limited extension （one case of type I and 2 cases of type Ⅲ A） . The Lysholm scores at the last follow-up ranged from 76 to 93 points （average, 82 points） . In anterior laxity of the knee joint, the KT-1000 examinations showed 2 cases had side to side dif- ference 〈 2 ram, 6 cases had side to side difference of 3 mm and 3 cases had side to side difference 〉 3 mm. Conclusions Infection after arthroscopic ACL reconstruction can be classified according to its early clinical manifestations. Our classification system may lead to better stage-adapted treatment of the infection.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2012年第11期935-939,共5页
Chinese Journal of Orthopaedic Trauma
关键词
前交叉韧带
感染
关节炎
感染性
诊断
治疗
Anterior cruciate ligament
Infection
Arthritis, infectious
Diagnosis
Therapy
