关节镜下前交叉韧带重建术后感染的临床特征与治疗方法分析

Clinical Characteristics and Treatment Strategies of Infection after Arthroscopic Anterior Cruciate Ligament Reconstruction

摘要: 目的：通过回顾性研究总结本院关节镜下前交叉韧带重建术(anterior cruciate ligament reconstruction, ACLR)后感染患者的临床特征、病原学特点及治疗方式，探讨不同发热时间与不同处理方式的患者之间的临床差异，为ACLR术后感染的早期识别和临床治疗提供参考。材料与方法：回顾性纳入2019年1月至2025年12月于安徽医科大学第一附属医院骨科运动创伤与关节镜外科行ACLR，术后发生感染并再次入院治疗的33例患者。收集患者一般资料、检验检查结果、围手术期处理方式、术后发热时间、病原学结果及治疗方案。采用描述性统计分析感染患者的临床特征，按术后发热时间、治疗方式进行亚组分析，比较各组间的临床特征差异。结果：2019.01~2025.12年本院共完成ACLR 2491例，其中术后感染33例，感染率约为1.32%。33例感染患者中，再次手术清创9例(27.3%)，培养阳性6例(18.2%)，葡萄球菌是最常见的病原体。早期发热组身高、体重及BMI均高于晚期发热组(均P < 0.05)，晚期发热组再次手术清创比例显著高于早期发热组(P < 0.001)。再次手术组均为晚期发热，且其体重和BMI均低于非再次手术组(均P < 0.05)。按术后治疗方式进行多组比较显示，不同治疗组在发热时间、体重及BMI方面的差异有统计学意义(均P < 0.05)。结论：本研究显示，本中心ACLR术后感染发生率为1.32%。感染患者多为术后2周内发热，晚期发热患者接受再次手术清创的比例则明显升高。葡萄球菌为主要致病菌，培养阴性并不能排除感染，临床上应结合症状体征、炎症指标、关节液检查及术中所见进行综合判断。发热时间可能是提示病情进展及术后治疗方法的重要临床线索。由于本研究为回顾性研究且样本量有限，相关结论仍需多中心、大样本研究进一步验证。

Abstract: Objective: To summarize the clinical characteristics, microbiological features, and treatment strategies of patients with infection after arthroscopic anterior cruciate ligament reconstruction (ACLR) in our institution, and to investigate the clinical differences among patients with different fever onset times and treatment strategies, so as to provide evidence for the early identification and clinical management of post-ACLR infection. Methods: A retrospective study was conducted on 33 patients who underwent ACLR in the Department of Sports Medicine and Arthroscopic Surgery, The First Affiliated Hospital of Anhui Medical University, between January 2019 and December 2025 and were subsequently readmitted for postoperative infection. General clinical data, laboratory and imaging findings, perioperative management, postoperative fever onset time, microbiological results, and treatment strategies were collected. Descriptive statistical analysis was performed to summarize the clinical characteristics of infected patients. Subgroup analyses were conducted according to postoperative fever onset time and treatment strategies to compare clinical differences among groups. Results: From January 2019 to December 2025, a total of 2,491 ACLR procedures were performed in our institution, among which 33 patients developed postoperative infection, yielding an infection rate of 1.32%. Among the 33 infected patients, 9 (27.3%) underwent repeat arthroscopic debridement and 6 (18.2%) had positive culture results. Staphylococcus species were the most commonly isolated pathogens. Patients in the early-fever group had significantly greater height, body weight, and body mass index (BMI) than those in the late-fever group (all P < 0.05), whereas the proportion of repeat arthroscopic debridement was significantly higher in the late-fever group than in the early-fever group (P < 0.001). All patients in the repeat-surgery group presented with late fever, and their body weight and BMI were significantly lower than those in the non-repeat-surgery group (both P < 0.05). Multigroup comparison based on postoperative treatment strategies showed significant differences among groups in fever onset time, body weight, and BMI (all P < 0.05). Conclusion: The incidence of infection after ACLR in our center was 1.32%. Most infected patients developed fever within 2 weeks after surgery, whereas patients with late-onset fever were more likely to require arthroscopic debridement. Staphylococcus species were the predominant pathogens. Negative culture results could not exclude infection, and clinical diagnosis should be based on a comprehensive assessment of symptoms and signs, inflammatory markers, synovial fluid examination, and intraoperative findings. Fever onset time may serve as an important clinical clue indicating disease progression and guiding postoperative treatment strategies. Given the retrospective design and limited sample size of this study, further multicenter studies with larger sample sizes are warranted.