关节镜清理联合抗菌药物治疗膝关节革兰阳性菌感染的疗效观察

目的:探讨关节镜清理联合抗菌药物治疗膝关节革兰阳性菌感染患者的疗效,为临床合理治疗提供参考依据。方法:选取2017年4月～2019年7月在我院治疗的经细菌学检查确诊为革兰阳性菌感染的膝关节炎症患者128例,随机分为观察组和对照组,各64例,观察组接受关节镜下膝关节清理术联合万古霉素或替考拉宁治疗,对照组接受万古霉素或替考拉宁治疗。分析患者治疗前病原菌分布情况,比较两组临床疗效、不良反应发生情况及复发率,比较两组患者的膝关节症状评分、体征评分。结果:128例革兰阳性菌感染患者中,共检出病原菌128株,金黄色葡萄球菌、表皮葡萄球菌、凝固酶阴性葡萄球菌及肠球菌分别占23.71%、25.77%、24.74%、20.62%。观察组的优良率为95.31%(61/64),高于对照组的81.25%(52/64),两组优良率比较,差异有统计学意义(P0.05)。治疗后观察组的膝关节症状评分、体征评分均低于对照组(P0.05)。观察组的复发率低于对照组(P0.05),而两组不良反应发生率比较差异无统计学意义(P0.05)。结论:采用关节镜清理联合抗菌药物治疗膝关节革兰阳性菌感染患者疗效确切,可改善患者症状积分和体征积分,降低复发率,安全可靠。

Effect of Arthroscopic Debridement Combined with Antibiotics on Gram-positive Bacterial Infection of Knee Joint

ABSTRACT Objective: To investigate the efficacy of arthroscopic debridement combined with antibiotics in the treatment of Gram-positive bacterial infections of knee joint, and to provide reference for rational clinical treatment. Methods: 128 patients with knee joint inflammation who were diagnosed as Gram-positive bacterial infection by bacteriological examination in our hospital from April 2017 to July 2019 were selected, they were randomly divided into observation group and control group, 64 cases in each group. The observation group received arthroscopic knee joint debridement combined with vancomycin or teicoplanin treatment, while the control group received vancomycin or teicoplanin treatment. The distribution of pathogenic bacteria before treatment was analyzed. The clinical efficacy, adverse reactions and recurrence rate of the two groups were compared. The knee symptom score and sign score of the two groups were compared. Results: A total of 128 strains of pathogenic bacteria were detected in 128 patients with Gram-positive bacteria infection, Staphylococcus aureus, Staphylococcus epidermidis, coagulase-negative Staphylococcus and Enterococcus accounted for 23.71%, 25.77%, 24.74% and 20.62% respectively. The excellent and good rate of the observation group was 95.31% (61/64), which was higher than 81.25% (52/64) of the control group. There was significant difference between the two groups (P<0.05). After treatment, the knee joint symptom score and sign score of the observation group were lower than those of the control group (P<0.05). The recurrence rate of the observation group was lower than that of the control group (P<0.05), but there was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Arthroscopic debridement combined with antimicrobial therapy is effective in treating patients with Gram-positive bacterial infection of knee joint. It can improve the symptom score and sign score of patients, reduce the recurrence rate, and is safe and reliable.