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[急性关节感染——诊断与治疗]

[Acute joint infection--diagnosis and treatment].

作者信息

Jerosch J

机构信息

Klinik für Orthopädie und Orthopädische Chirurgie, Johanna-Etienne-Krankenhaus, Neuss.

出版信息

Orthopade. 2004 Nov;33(11):1309-18; quiz 1319-20. doi: 10.1007/s00132-004-0728-y.

Abstract

The acute joint infection is a rare condition; the delayed diagnosis may lead to significant joint destruction. Diagnostic tools are the c-reactive protein and joint aspiration. Today arthroscopic treatment options are suitable tools for the treatment of such conditions. Arthroscopic lavage and debridement with additional systemic antibiotic treatment proofed to be very effective in an infected joint. If there are continuous signs of infection even with antibiotic treatment, rearthroscopy within few days is indicated. The number of rearthroscopies is related to the initial stage of the infection. With a shaver thorough debridement of all necrotic tissue as well as resection of adhesions is performed without complete resection of the intact and noninfected synovial membrane. The use of intraarticular resorbable antibiotic fleece is possible, but not generally recommended. Suction irrigation systems are only rarely indicated. If there is bony involvement, open arthrotomy still is the golden standard.

摘要

急性关节感染是一种罕见病症;延迟诊断可能导致严重的关节破坏。诊断工具是C反应蛋白和关节穿刺。如今,关节镜治疗方案是治疗此类病症的合适工具。关节镜下灌洗和清创术联合全身抗生素治疗已被证明对感染关节非常有效。即使使用抗生素治疗仍有持续感染迹象时,应在数天内再次进行关节镜检查。再次关节镜检查的次数与感染的初始阶段有关。使用刨削器彻底清除所有坏死组织以及切除粘连组织,但不完整切除完整且未感染的滑膜。可使用关节内可吸收抗生素棉毡,但一般不推荐。很少需要使用吸引冲洗系统。如果有骨质受累,切开手术仍是金标准。

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