Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Effectiveness of Drain Insertion and Irrigation in the Treatment of Septic Arthritis of the Knee under Local Anesthesia

국소 마취하 배액관 삽입 및 세척을 통한 화농성 슬관절염의 치료의 효용성

  • Yi, Jin Woong (Department of Orthopedic Surgery, Konyang University College of Medicine) ;
  • Oh, Byung Hak (Department of Orthopedic Surgery, Konyang University College of Medicine) ;
  • Heo, Youn Moo (Department of Orthopedic Surgery, Konyang University College of Medicine) ;
  • Jang, Min Gu (Department of Orthopedic Surgery, Konyang University College of Medicine) ;
  • Min, Young Ki (Department of Orthopedic Surgery, Konyang University College of Medicine) ;
  • Seo, Kyung Deok (Department of Orthopedic Surgery, Konyang University College of Medicine)
  • 이진웅 (건양대학교 의과대학 정형외과학교실) ;
  • 오병학 (건양대학교 의과대학 정형외과학교실) ;
  • 허윤무 (건양대학교 의과대학 정형외과학교실) ;
  • 장민구 (건양대학교 의과대학 정형외과학교실) ;
  • 민영기 (건양대학교 의과대학 정형외과학교실) ;
  • 서경덕 (건양대학교 의과대학 정형외과학교실)
  • Received : 2020.08.19
  • Accepted : 2020.11.04
  • Published : 2021.08.30
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Abstract

Purpose: Septic arthritis of the knee is an orthopedic emergency that requires early diagnosis and surgical treatment. This study examined the effectiveness of drain insertion and irrigation in the treatment of septic arthritis of the knee under local anesthesia. Materials and Methods: A retrospective study was conducted on nine cases (eight patients) diagnosed with septic arthritis of the knee from September 2017 to February 2020 and treated with drain insertion and irrigation under local anesthesia. After penetrating through the superolateral portal to the superomedial portal and inserting the drain, daily irrigation of approximately 3 L of normal saline was done. The following were investigated: age, sex, underlying disease, cause, degree of osteoarthritis, time from diagnosis to surgery, duration of hospitalization, duration of normalization of C-reactive protein, and smear and culture. Results: The initial white blood cell count of joint fluid was 71,472±51,667/mm3 (32,400-203,904/mm3), and polymorphic leukocytes were 91.1%±2.6% (86%-95%). The average time from diagnosis to surgery was 8.3±1.3 hours (6-10 hours), and the irrigation period was 8.2±3.2 days (4-15 days). The average length of hospitalization was 20.8±8.7 days (9-37 days). There was no reoperation or recurrence. Smear and culture tests were not identified. Conclusion: In the treatment of septic arthritis of the knee, the insertion of a drain tube and irrigation under local anesthesia is a relatively fast and simple method to reduce pain by repetitive draining of purulent joint fluid and can be used as an alternative treatment for patients with a risk of general or spinal anesthesia.

목적: 화농성 슬관절염은 조기 진단과 신속한 수술적 치료가 필요한 정형외과적 응급 질환이다. 본 연구는 국소 마취하에 배액관 삽입 및 세척을 통한 화농성 슬관절염 치료의 효용성에 대해서 알아보고자 하였다. 대상 및 방법: 2017년 9월부터 2020년 2월까지 화농성 슬관절염을 진단받고 국소 마취하에 배액관 삽입과 세척을 통해 치료를 시행 받은 총 9예(8명)의 환자를 대상으로 후향적 연구를 하였다. 상외측 삽입구에서 상내측으로 관통하는 방식으로 배액관을 넣은 후 약 3 L의 생리식염수를 이용하여 매일 세척하였다. 나이, 성별, 기저질환, 화농성 슬관절염의 원인, 골관절염의 정도, 진단 후 수술까지 소요된 시간, 재원기간, C-반응성 단백이 정상화되는 기간, 배양 균주 등을 확인하였다. 결과: 진단 당시 혈액검사에서 혈청 백혈구 수치는 평균 9,211±2,912개/mm3 (6,100-16,300개/mm3), C-반응성 단백은 평균 12.1±11.2 mg/dl (3.9-35.4 mg/dl)였으며, 초기 관절 천자액 검사상 평균 백혈구 수치는 71,472±51,667개/mm3 (32,400-203,904개/mm3), 평균 다형 백혈구 분율은 평균 91.1%±2.6% (86%-95%)였다. 진단 후 수술까지 소요된 시간은 평균 8.3±1.3 시간(6-10시간)이었고, 평균 세척 기간은 8.2±3.2일(4-15일), 평균 재원 기간은 20.8±8.7일(9-37일)였다. 도말 및 배양 검사로 원인균은 동정되지 않았다. 결론: 화농성 슬관절염의 치료에서 국소 마취를 통한 삽입관 삽입과 세척술은 비교적 빠르고 간단한 방법으로 조기에 관절 내 삼출물을 제거하여 통증을 줄이고 반복적으로 세척할 수 있어 전신 또는 척수 마취의 위험성이 높은 환자에게 치료의 대안으로 활용될 수 있다.

Keywords

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