根据盖赫特分类法的化脓性膝关节炎感染根除率：一项系统评价
The eradication rate of infection in septic knee arthritis according to the Gächter Classification: a systematic review.
作者信息
De Franco Cristiano, Artiaco Stefano, de Matteo Vincenzo, Bistolfi Alessandro, Balato Giovanni, Vallefuoco Salvatore, Massè Alessandro, Rosa Donato
机构信息
Department of Public Health, Orthopedic Unit, "Federico II" University, Naples (Italy).
Hospital Città Della Salute e Della Scienza, Department of Orthopaedics, Traumatology, and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Turin (Italy).
出版信息
Orthop Rev (Pavia). 2022 Apr 25;14(2):33754. doi: 10.52965/001c.33754. eCollection 2022.
INTRODUCTION
Knee septic arthritis rapidly damages the knee joint. Gächter described a classification of joint infections based on arthroscopic findings: an arthroscopic staging of the common disease has prognostic and therapeutic consequences. The aim of this systematic review was to analyze the application of the Gächter classification system to knee septic arthritis, evaluating prognostic and therapeutic implications of this classification.
MATERIALS AND METHODS
A comprehensive electronic search of the literature was performed. The following search terms were used: (Arthroscopy* OR Arthrotom* OR Aspiration) AND Knee AND Septic AND Arthritis. The study reported the Gächter classification in septic knee arthritis and the eradication rate according to the type. The primary endpoint is the eradication rate of septic knee arthritis according to the Gächter sort. Secondary endpoints are surgical procedures according to Gächter classification and the rate of re-operations.
RESULTS
Seven studies were included. The overall eradication rate of knee septic arthritis ranged from 90% to 100%: 95%-100% Gächter I; 97%-100% Gächter II; 67%-100% Gächter III; 50%-100% Gächter IV. Surgical treatments for knee septic arthritis included arthroscopic irrigation alone, articular irrigation, and debridement in knee arthroscopy or knee arthrotomy according to Gächter stage. However, 28% required re-operations for persistent infection: secondary procedures included further irrigation and debridement with the arthroscopic or arthrotomic approach.
CONCLUSION
Gächter classification showed a crucial prognostic role in predicting the outcome of surgical treatment of septic knee arthritis. Regardless of the procedure performed, a prompt operation and an accurate debridement of the synovial membrane are the most critical factors for eradicating infection and good clinical outcomes.
LEVEL OF EVIDENCE
Level II, prognostic study.
引言
膝关节化脓性关节炎会迅速损害膝关节。盖赫特根据关节镜检查结果描述了一种关节感染分类方法：对这种常见疾病进行关节镜分期具有预后和治疗意义。本系统评价的目的是分析盖赫特分类系统在膝关节化脓性关节炎中的应用，评估该分类的预后和治疗意义。
材料与方法
对文献进行全面的电子检索。使用了以下检索词：（关节镜检查或关节切开术或抽吸术）与膝关节与化脓性与关节炎。该研究报告了化脓性膝关节炎中的盖赫特分类以及根据类型的根除率。主要终点是根据盖赫特分类的化脓性膝关节炎的根除率。次要终点是根据盖赫特分类的手术程序和再次手术率。
结果
纳入了七项研究。膝关节化脓性关节炎的总体根除率为90%至100%：盖赫特I型为95%-100%；盖赫特II型为97%-100%；盖赫特III型为67%-100%；盖赫特IV型为50%-100%。膝关节化脓性关节炎的手术治疗包括单纯关节镜冲洗、关节冲洗以及根据盖赫特分期在膝关节镜检查或膝关节切开术中进行清创。然而，28%的患者因持续感染需要再次手术：二次手术包括采用关节镜或关节切开术进一步冲洗和清创。
结论
盖赫特分类在预测化脓性膝关节炎手术治疗结果方面显示出关键的预后作用。无论采用何种手术程序，及时手术和准确清创滑膜是根除感染和取得良好临床结果的最关键因素。
证据级别
II级，预后研究。
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