胸锁关节感染的外科治疗进展  

Proceedings in surgical treatment of sternoclavicular joint infection

作　　者：谢冬[1] 费苛[1] 陈昶[1] 王海峰[1] 姜格宁[1] 

机构地区：[1]同济大学附属上海市肺科医院胸外科,200433

出　　处：《中华胸心血管外科杂志》2016年第8期506-508,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市浦江人才计划（15PJD034）

摘　　要：胸锁关节（SCJ）感染是少见的颈胸交界处骨关节感染，抗感染治疗效果有限，常需外科手术介入。SCJ常见基础病因包括静脉吸毒、深静脉插管留置等。SCJ最常见的致病菌为金黄色葡萄球菌、铜绿假单胞菌。根治性切除联合肌瓣重建以及有效的抗感染治疗是最有效的治疗措施，是否行肌瓣重建视感染程度、切除范围及残余软组织而定。多数患者手术切除后，远期肩关节功能良好。Septic arthritis of the sternoclavicular joint （SCJ） is a rare condition and accounts for 0. 5 % - 1.0% of septic arthritis. SCJ infections often require surgical intervention. Diabetes mellitus, rheumatoid arthritis, intravenous drug use, in- traarticular injection and immunosuppressive disorders are predisposing factors. Staphylococcus aureus and Pseudomonas aerugi- nosa are the most common bacteriologies. Early diagnosis of SCJ infection requires a high index of suspicion and a confirmatory CT or MRt scan. The characteristic imaging features include intramedullary and soft tissue gas, scquestra, soft tissue swelling and destruction or widening of joint space. Management strategies have ranged from conservative antibiotic therapy to en-bloc resection of the sternoclavicular joint with or without ipsilateral pectoralis major muscle transposition. The shoulder function in most patients were well preserved.

关 键 词：骨关节感染 颈胸交界处 外科治疗 金黄色葡萄球菌 抗感染治疗 铜绿假单胞菌 肌瓣重建 深静脉插管 

分 类 号：R687.4[医药卫生—骨科学]