Regauer M, Neu J
Chirurgische Klinik und Poliklinik, Campus Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstraße 20, 80336, München, Deutschland.
Unfallchirurg. 2012 Sep;115(9):844-6. doi: 10.1007/s00113-012-2172-5.
A 28-year-old patient showed clear signs of knee joint infection 8 days after arthroscopic reconstruction of the anterior cruciate ligament. The treating physicians recommended further observation although they stated that a knee joint infection could not be reliably excluded. One week later arthroscopic revision was performed and intraoperative smear tests showed infection by Pseudomonas aeruginosa. Therefore, another 6 days later the obviously infected transplant had to be removed. In the long run painful and limited range of motion of the affected knee joint persisted. The patient complained about medical malpractice concerning management of the complication. The expert opinion stated that due to the fateful course of infection the tendon graft could not be retrieved after the eighth day post surgery anyway. Thus, only flawed delay of treatment was criticized. The arbitration board argued, however, that scientific data concerning the fate of infected tendon grafts do not support the expert opinion and that immediate arthroscopy and antibiotic treatment at least had the potential to influence the course of infection in a positive manner. Evidence clearly shows that survival of an infected tendon graft depends on early diagnosis and emergency treatment rather than just on fate. Due to the fact that, although having in mind the possibility of a knee joint infection, the necessary therapy was delayed for 8 days, the arbitration board considered the described medical malpractice a severe treatment error, leading to reversal of evidence in favour of the patient.
一名28岁患者在关节镜下前交叉韧带重建术后8天出现明显的膝关节感染迹象。主治医生建议进一步观察，尽管他们表示不能完全排除膝关节感染。一周后进行了关节镜翻修手术，术中涂片检查显示感染铜绿假单胞菌。因此，又过了6天，明显感染的移植物不得不被移除。从长远来看，患侧膝关节持续存在疼痛和活动范围受限的问题。患者抱怨在并发症处理方面存在医疗过失。专家意见认为，由于感染的灾难性发展过程，无论如何在术后第8天之后都无法挽回肌腱移植物。因此，仅批评了有缺陷的治疗延误。然而，仲裁委员会认为，关于感染肌腱移植物转归的科学数据并不支持专家意见，而且立即进行关节镜检查和抗生素治疗至少有可能对感染进程产生积极影响。有证据清楚地表明，感染肌腱移植物的存活取决于早期诊断和紧急治疗，而不仅仅是命运。由于尽管考虑到膝关节感染的可能性，但必要的治疗仍延迟了8天，仲裁委员会认为所述医疗过失是严重的治疗错误，导致证据倒向患者一方。
