Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España.
Rev Esp Cir Ortop Traumatol (Engl Ed). 2021 Jan-Feb;65(1):3-8. doi: 10.1016/j.recot.2020.05.007. Epub 2020 Jun 24.
40%-50% of this septic arthritis occurs in the knee, despite rapid medical surgical treatment, 24%-50% will have a poor clinical outcome. It is not clear which debridement technique, by arthrotomy or arthroscopy, is more effective in controlling infection, or whether or not previous osteoarthritis worsens the outcome. The objective of this study on septic arthritis of the osteoarthritic knee was to analyse which surgical debridement technique, arthroscopy or arthrotomy, is more effective, the clinical and radiographic outcomes of the patients, and how many go on to require a TKR after the infection has healed.
A retrospective study was performed in 27 patients with native septic arthritis of the knee. Eighteen were men and the mean age was 64.8 years (30-89years). Fifteen patients were debrided by arthrotomy and 12 by arthroscopy. The effectiveness of debridement in controlling infection, the radiographic progression of the osteoarthritis on the Ahlbäch scale, the need for subsequent replacement, and pain and functional status were analysed using the VAS and WOMAC scales at 52.8±11.2-month follow-up.
The infection was controlled in 93% and 92% of the patients, 13% and 42% required 2 or more surgeries for infection control, 18% and 44.4% showed progression of arthritis in the arthrotomy and arthroscopy groups, respectively. One patient in each group required a knee replacement. The VAS score was superior in the arthrotomy group and there were no differences in WOMAC score.
Debridement by arthrotomy in the emergency department by non-sub-specialist knee surgeons is more effective than arthroscopic debridement in controlling septic arthritis of the knee. Surgical debridement of septic arthritis in knees with previous osteoarthritis enabled control of the infection with no pain despite the progression of the osteoarthritis.
尽管进行了快速的医学和外科治疗，仍有 40%-50%的此类化脓性关节炎发生在膝关节，其中 24%-50%的患者临床预后较差。目前尚不清楚关节切开术或关节镜检查术哪种清创技术更能有效控制感染，或者先前的骨关节炎是否会使预后恶化。本项针对膝关节骨关节炎合并化脓性关节炎的研究旨在分析关节镜或关节切开术这两种外科清创技术中，哪一种更有效，患者的临床和影像学结果如何，以及在感染治愈后有多少患者需要进行 TKR。
对 27 例膝关节原发性化脓性关节炎患者进行回顾性研究。其中 18 例为男性，平均年龄为 64.8 岁（30-89 岁）。15 例患者接受关节切开术清创，12 例患者接受关节镜清创。在 52.8±11.2 个月的随访中，采用 VAS 和 WOMAC 评分评估清创术控制感染的效果、Ahlbäch 分级评估骨关节炎的放射学进展、是否需要后续置换以及疼痛和功能状态。
93%和 92%的患者感染得到控制，分别有 13%和 42%的患者需要 2 次或以上手术才能控制感染，关节切开术组和关节镜组的关节炎进展率分别为 18%和 44.4%。每组各有 1 例患者需要进行膝关节置换。关节切开术组的 VAS 评分更优，而 WOMAC 评分无差异。
非膝关节专科医师在急诊科行关节切开术清创比关节镜清创更能有效控制膝关节化脓性关节炎。对合并先前骨关节炎的膝关节化脓性关节炎进行外科清创术可以控制感染，尽管关节炎在进展，但没有疼痛。
