前交叉韧带重建术后感染的早期诊断与治疗

Early diagnosis and treatment of infection after anterior cruciate ligament reconstruction surgery

摘要:

目的 为前交叉韧带重建术后感染的早期诊断和治疗提供依据，以做到早期诊断和治疗，最大限度地保护前交叉韧带的完整性。方法 回顾性分析2016年1月－2021年12月该科室收治的40例前交叉韧带重建术后感染患者（感染组）的临床资料。其中，20例患者使用关节镜下清理术联合载抗生素硫酸钙颗粒关节腔内植入（硫酸钙组），20例患者使用关节镜下清理术联合置管冲洗引流术（置管冲洗组），选取同一时间段正常前交叉韧带重建术后患者40例作为对照组，检测两组患者术后不同时间炎症指标变化；比较感染后，两组（硫酸钙组和置管冲洗组）患者的临床表现和术后1、2和3周炎症指标变化情况，以及术后1、2、3和6周膝关节活动度（ROM）、膝关节Lysholm评分和视觉模拟评分（VAS）。结果 感染组术后3或4 d，C反应蛋白（CRP）、红细胞沉降率（ESR）、降钙素原和白细胞介素-6（IL-6）均高于对照组，两组比较，差异均有统计学意义（P < 0.05），术后10～12 d，感染组CRP、ESR、降钙素原和IL-6明显高于正常情况，对照组CRP、ESR、降钙素原和IL-6均恢复正常，两组比较，差异均有统计学意义（P < 0.05）；硫酸钙组和置管冲洗组术后炎症指标均下降，但硫酸钙组术后1、2和3周CRP明显低于置管冲洗组，差异均有统计学意义（P < 0.05）；术后2和3周，硫酸钙组ESR和IL-6明显低于置管冲洗组，差异均有统计学意义（P < 0.05）。硫酸钙组和置管冲洗组膝关节ROM较术前明显增大，膝关节Lysholm评分较术前明显升高，膝关节VAS较术前明显降低，且硫酸钙组术后1、2、3和6周上述指标明显优于置管冲洗组，差异均有统计学意义（P < 0.05）。结论 行前交叉韧带重建术的患者，术后ESR、CRP、降钙素原和IL-6持续维持较高水平，关节腔内穿刺，白细胞计数大于10 000×10⁶/L，同时合并膝关节疼痛明显加重，可明确诊断为术后感染。对于前交叉韧带重建术后感染的患者，早期行关节镜下清理联合载抗生素硫酸钙颗粒关节腔内植入，有较好的临床效果。值得临床推广应用。

Abstract:

Objective To provide the basis for early diagnosis and treatment of infection after anterior cruciate ligament reconstruction surgery, to achieve early diagnosis and treatment, and protect the integrity of the reconstructed anterior cruciate ligament to the maximum extent.Methods Clinical data of 40 patients (infection group) with infection after anterior cruciate ligament reconstruction surgery admitted to this department from January 2016 to December 2021 were collected. Among of them, 20 patients were treated with arthroscopic detoxination combined with intracarticular implantation of antibiotic loaded calcium sulfate particles (calcium sulfate group), and 20 patients were treated with arthroscopic debridement combined with catheter irrigation drainage (catheter irrigation group). 40 normal patients who underwent anterior cruciate ligament reconstruction surgery during the same time period were selected as the control group, and the changes of inflammation indexes at different time were detected in the two groups. The clinical manifestations and inflammatory indexes of the two groups (calcium sulfate group and catheter irrigation group) were detected after infection. The changes of inflammatory indicators 1, 2 and 3 weeks after the second operation, knee joint motion (ROM), knee joint Lysholm score and visual analogue score (VAS) at 1, 2, 3 and 6 weeks after the second operation were compared between the two groups.Results C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin and interleukin-6 (IL-6) in infection group were higher than those in control group at 3 to 4 days after surgery, and the differences between the two groups were statistically significant (P < 0.05). At 10 to 12 days after surgery, CRP, ESR, procalcitonin and IL-6 in infection group were significantly higher than normal. In control group, CRP, ESR, procalcitonin and IL-6 all returned to normal, and there was statistical significance between the two groups (P < 0.05). Postoperative inflammatory indexes were decreased in calcium sulfate group and catheter irrigation group, but CRP in calcium sulfate group at 1, 2 and 3 weeks after surgery was significantly lower than that in catheter irrigation group, the differences were statistically significant (P < 0.05). ESR and IL-6 in 2 and 3 weeks after operation were significantly lower than those in catheter irrigation group, with statistical significance (P < 0.05). Knee ROM and knee Lysholm score were significantly higher, and knee VAS was lower in calcium sulfate group and catheter irrigation group than those before surgery, and the calcium sulfate group was significantly better than the catheter irrigation group at 1, 2, 3 and 6 weeks after surgery, with statistical significance (P < 0.05).Conclusion In patients after anterior curciate ligamnet reconstruction surgery, ESR, CRP, procalcitonin and IL-6 levels continue to be high after surgery, and the number of white blood cells in joint puncture is more than 10 000×10⁶/L, while the knee pain is significantly aggravated, which can be clearly diagnosed as postoperative infection. Early arthroscopic clean-up combined with antibiotic loaded calcium sulfate granule implantation in patients with infection after anterior cruciate ligament reconstruction surgery has a good clinical effect. It is worthy of clinical application.