CAJ | 학술논문

目的探讨前交叉韧带(ACL)重建术后感染的诊断分型与分期治疗的有效性. 方法 2002年10月至2010年12月共收治11例ACL重建术后感染患者,男8例,女3例；平均年龄为28.8岁(18 ～45岁).感染确诊时间为术后1～ 64周,平均7.7周.结合国内外文献,我们根据全身症状、局部是否有红肿渗出及是否累及关节腔等特点将感染分为3型:Ⅰ型,急性感染性滑膜炎型(5例)；Ⅱ型,关节外型(3例)；Ⅲ型,感染性关节炎型[3例,其中关节穿刺培养阳性者为ⅢA型(2例),阴性者为ⅢB型(1例)].根据分型和病程不同,早期应用广谱抗生素治疗,必要时行早期清创和关节内置管冲洗,病程长并有窦道形成者采用开放手术清创,取出移植肌腱和内固定物. 结果 11例患者术后获2.5 ～8.0年(平均5.2年)随访.11例患者感染均获痊愈,但3例(Ⅰ型1例,ⅢA型2例)遗留关节伸直受限.11例患者未次随访时膝关节Lysholm评分为76 ～93分,平均82分.KT-1000检查评估20°前句松弛度对比健侧＜2 mm者2例,对比健侧为3 mm者6例,＞3mm者3例. 结论对于ACL重建术后感染,根据临床表现应早期进行诊断分型,根据我们的诊断分型实施分期治疗可取得良好疗效.
목적 탐토전교차인대(ACL)중건술후감염적진단분형여분기치료적유효성. 방법 2002년10월지2010년12월공수치11례ACL중건술후감염환자,남8례,녀3례；평균년령위28.8세(18 ～45세).감염학진시간위술후1～ 64주,평균7.7주.결합국내외문헌,아문근거전신증상、국부시부유홍종삼출급시부루급관절강등특점장감염분위3형:Ⅰ형,급성감염성활막염형(5례)；Ⅱ형,관절외형(3례)；Ⅲ형,감염성관절염형[3례,기중관절천자배양양성자위ⅢA형(2례),음성자위ⅢB형(1례)].근거분형화병정불동,조기응용엄보항생소치료,필요시행조기청창화관절내치관충세,병정장병유두도형성자채용개방수술청창,취출이식기건화내고정물. 결과 11례환자술후획2.5 ～8.0년(평균5.2년)수방.11례환자감염균획전유,단3례(Ⅰ형1례,ⅢA형2례)유류관절신직수한.11례환자미차수방시슬관절Lysholm평분위76 ～93분,평균82분.KT-1000검사평고20°전구송이도대비건측＜2 mm자2례,대비건측위3 mm자6례,＞3mm자3례. 결론 대우ACL중건술후감염,근거림상표현응조기진행진단분형,근거아문적진단분형실시분기치료가취득량호료효.
Objective To discuss the self-developed diagnostic classification and stage-adapted treatment of infection after anterior cruciate ligament (ACL) reconstruction.Methods Eleven cases of infection after arthroscopic ACL reconstruction were treated in our department from October 2002 to December 2010.They were 8 men and 3 women,28.8 years of age on average (from 18 to 45 years).Infection was definitely diagnosed in 1 to 64 weeks (average,7.7 weeks).On the basis of literature review,we developed a diagnostic classification system which divides infections into 3 types according to clinical manifestations and used it to establish the diagnoses of infection.We had 5 cases of type Ⅰ (acute infectious synovitis),3 cases of type Ⅱ (extra-articular infection) and 3 cases of type Ⅲ (septic arthritis) of which 2 were type ⅢA with positive culture results and one was type Ⅲ B with negative culture result.Staged-adapted treatment algorithms were adopted based on the clinical classification of the patients,including early administration of intravenous antibiotics,arthroscopic debridement and irrigation with graft retention,as well as radical open debridement with graft and hardware removal.Results Follow-ups of 5.2 years on average (from 2.5 to 8.0 years)showed that all the 11 cases of infection were cured,but 3 cases had limited extension (one case of type Ⅰ and 2 cases of type ⅢA).The Lysholm scores at the last follow-up ranged from 76 to 93 points (average,82 points).In anterior laxity of the knee joint,the KT-1000 examinations showed 2 cases had side to side difference ＜2 mm,6 cases had side to side difference of 3 mm and 3 cases had side to side difference ＞ 3 mm.Conclusions Infection after arthroscopic ACL reconstruction can be classified according to its early clinical manifestations.Our classification system may lead to better stage-adapted treatment of the infection.