Song Hai-Bo, Chen Jie, Liux Liu Hong, Zhou Zhao-Hui, Wang Jian-Feng, Gu Hao-Jie
The TCM Hospital of Haining, Haining 314400, Zhejiang, China;
Zhongguo Gu Shang. 2017 Apr 25;30(4):318-321. doi: 10.3969/j.issn.1003-0034.2017.04.007.
To compare the clinical effects of arthroscopic debridement versus open debridement on controlling and treatment of infection after total knee replacement.
From October 2009 to September 2016 in three hospitals, 11 patients with 11 joints which were infected after total knee replacement were randomly divided into two groups:5 cases in arthroscopy group and 6 cases in routine group. Patients in arthroscopy group were treated with arthroscopic debridement to remove the necrotic tissues, then closed-type irrigation with sensitive antibiotics by using two sebific ducts were performed continuously for 2 or 3 weeks until the flushing fluid became clear for 3 or 5 days;other 6 patients in routine group were treated with open surgical debridement and the following procedures in keeping with those in the arthroscopy group. Operation time, blood loss and incision length were recorded during the operation, and pain scores were recorded on the 1st, 3rd and 7th day after the operation. The curative effects were evaluated according to the Hospital for Special Surgery score system.
The local and general symptoms of the 11 patients disappeared, and the test outcomes of biochemistry, blood and synovial fluid were normal. All patients were followed up, and the duration ranged from 6 to 18 months. Infection recurrences were observed in 1 case of arthroscopy group and 2 cases of routine group 3 months later after operation, and all these patients who underwent the second time operation with arthroscopic debridement were cured. According to the Hospital for Special Surgery score system, 3 cases obtained excellent result, 2 good, no poor and bad cases in arthroscopy group;3 cases obtained excellent result, 1 good, 1 poor and 1 bad in routine group.
If the sensitive antibiotics can be found for the infected joints without obvious destruction of bone and no prosthesis loosening, it has a better therapeutic effect by using arthroscopic debridement combined with continuous drainage and irrigation. The method has a better curative effect with smaller trauma.
比较关节镜下清创术与切开清创术对全膝关节置换术后感染的控制及治疗效果。
2009年10月至2016年9月在3家医院，将11例全膝关节置换术后关节感染患者的11个关节随机分为两组：关节镜组5例，常规组6例。关节镜组患者采用关节镜下清创术清除坏死组织，然后用两条引流管持续闭式灌洗敏感抗生素2或3周，直至冲洗液连续3或5天变清；常规组另外6例患者采用切开手术清创，后续操作与关节镜组一致。术中记录手术时间、失血量和切口长度，术后第1、3和7天记录疼痛评分。根据特殊外科医院评分系统评估疗效。
11例患者的局部和全身症状消失，生化、血液及关节液检查结果正常。所有患者均获随访，随访时间6至18个月。术后3个月，关节镜组有1例、常规组有2例出现感染复发，所有这些接受二次关节镜下清创术的患者均治愈。根据特殊外科医院评分系统，关节镜组3例结果为优，2例为良，无差和劣的病例；常规组3例结果为优，1例为良，1例为差，1例为劣。
对于感染关节能找到敏感抗生素、无明显骨质破坏且无假体松动的情况，采用关节镜下清创联合持续引流灌洗具有较好的治疗效果。该方法创伤较小，疗效较好。
