背景:术后手术部位感染(SSI)的管理对骨科医生来说是一个巨大的挑战,并且由于长的治疗周期和相关的不适经历而显著影响患者及其家人。
方法:一名68岁女性,没有任何合并症病史,糖尿病,高血压,过敏,或者肺结核,因跌倒后右膝疼痛入院。X线和CT扫描显示右髌骨骨折闭合。患者接受了切开复位和内固定的张力带接线和圆形线。术前评估显示营养状况正常。术前30分钟给予预防性五水头孢唑林钠,术后维持24小时以防止感染。术后3天患者出院。然而,伤口表现出感染的迹象:发红,肿胀,还有分泌物的存在.门诊使用敷料和口服抗生素,但未能控制感染,导致再次住院。实施手术清创术和连续关节冲洗以解决感染。进行分泌物培养以鉴定致病菌。根据药敏试验,使用左氧氟沙星和利福平。然而,患者随后出现严重的膝关节肿胀和碘刺激反应。抗过敏治疗和生理盐水敷料用于缓解肿胀,疼痛,和皮肤刺激。MRI结果提示关节水肿和可能的感染需要进一步的手术清创,患者拒绝接受额外的手术并要求出院.出院后使用左氧氟沙星和利福平控制感染一个月,定期进行康复锻炼。幸运的是,成功控制了感染,膝关节功能得到满意恢复。
结论:髌骨骨折手术后的SSI会导致生活质量下降,严重的经济负担,和心理困扰。因此,有效的治疗方法对于管理术后SSIs非常重要。
结论:充分的手术清创对于去除闭合性髌骨骨折术后金黄色葡萄球菌引起的早期SSI感染组织至关重要。持续关节冲洗和敏感抗生素有助于控制感染,积极的康复训练可促进膝关节功能恢复。
BACKGROUND: Management of postoperative surgical site infection (SSI) is a huge challenge to orthopedic surgeons, and significantly impacts patients and their families due to long treatment cycles and associated discomfort experiences.
METHODS: A 68-year-old woman without a medical history of any comorbidities, diabetes, hypertension, allergies, or tuberculosis, was admitted to our hospital complaining of right knee pain following a fall. X-ray and CT scans revealed a closed right patella fracture. The patient underwent open reduction and internal fixation with tension band wiring and circle wire. Preoperative assessment showed normal nutritional status. Prophylactic cefazolin sodium pentahydrate was administered 30 min preoperatively and maintained for 24 h post-
operation to prevent infection. The patient was discharged 3 days after the
operation. However, the wound exhibited signs of infection: redness, swelling, and the presence of secretions. Outpatient dressings and oral antibiotics were prescribed but failed to control the infection, leading to rehospitalization. Surgical debridement and continuous articular irrigation were implemented to address the infection. Secretion cultures were taken to identify the causative bacteria. Levofloxacin and Rifampicin were used according to drug sensitivity tests. However, the patient experienced severe knee swelling and an iodine irritative reaction subsequently. Anti-allergic treatment and normal saline dressings were applied to alleviate swelling, pain, and skin irritation. MRI results indicated arthroedema and possible infection necessitating further surgical debridement, the patient rejected additional surgery and requested discharge. Levofloxacin and Rifampicin were used for a month to control the infection after discharge, accompanied by regular rehabilitation exercises. Fortunately, the infection was successfully managed, and knee function was satisfactorily restored.
CONCLUSIONS: SSI after patella fracture surgery can lead to a worse quality of life, serious economic burden, and psychological distress. Therefore, effective treatment methods for managing postoperative SSIs are very important.
CONCLUSIONS: Sufficient surgical debridement is vital to remove infection tissue of early SSI caused by Staphylococcus aureus with a closed patella fracture surgery. Continuous articular irrigation and sensitive antibiotics help control infection, and active rehabilitation training improves knee function recovery.