化脓性胸锁关节炎的手术治疗  

Surgical management of sternoclavicular septic arthritis

作　　者：陈加雄[1] 吕辉照[1] 赵枫[1] 曹杰[1] CHEN Jiaxiong;LYU Huizhao;ZHAO Feng;CAO Jie(Second Department of Orthpaedics,180th Hospital of Chinese PLA,Quanzhou 362000,China)

机构地区：[1]解放军第180医院骨二科,福建泉州362000

出　　处：《骨科》2018年第2期118-122,共5页ORTHOPAEDICS

摘　　要：目的探讨化脓性胸锁关节炎的手术治疗效果。方法我院自2010年2月至2015年4月共收治化脓性胸锁关节炎病人12例,年龄为31~83岁,平均55.2岁;均为男性。其中5例病人CT或MRI扫描显示脓肿包绕胸锁关节但没有骨侵袭,采用单纯清创、引流术;其余7例病人CT或MRI检查显示骨破坏或有骨髓炎的影像学征像,采用扩大清创引流+胸锁关节部分切除术。手术前后采用Constant评分对肩关节功能进行评估,术前肩关节Constant评分为69~94分,平均76.5分。结果病人手术时间为67~320 min,平均124.5 min;出血量为200~1 200 ml,平均450.0 ml;输血量为0~600 ml,平均158.3 ml。所有病人获得24~36个月的随访,切口均Ⅰ期愈合,无再感染征象,无肩关节活动障碍。末次随访时,肩关节Constant评分为67~93分(平均78.0分),与术前比较,差异无统计学意义(Z=0.0001,P>0.05)。结论化脓性胸锁关节炎是少见、特殊的胸部骨关节感染,及早诊断、治疗非常重要,多数病人经正规抗感染和手术治疗后,远期肩关节功能预后良好。Objective To evaluate the effectiveness of surgical management for sternoclavicular septic arthritis.Methods From February 2010 to April 2015,there were 12 patients with sternoclavicular septic arthritis treated in PLA 180th Hospital.The average age was 55.2 years(range:31 to 83 years).All patients were male.Five patients showed abscess surrounding sternoclavicular joint but no bone invasion occurred in CT/MRI scans,and were given the simple debridement and drainage.The rest 7 patients showed bone invasion or osteomyelitis in CT/MRI scans,and were given an extended intervention with partial resection of the sternoclavicular joint.The Constant Score were used to evaluate the shoulder function before and after operation.The preoperative Constant score was 76.5(range:69 to 94).Results The average operation time was 124.5 min(range:67 to 320 min).The average blood loss was 450.0 ml(range:200 to1 200 ml).The average transfusion volume was 158.3 ml(range:0 to 600 ml).All patients were followed up for 29 months(range:24 to 36 months).All patients had well-healed without re-infection.There was no significant difference in the Constant Score preoperation(78.0 scores)and postoperation(76.5 scores)at the time of the last follow-up(Z=0.0001,P=1.000).Conclusion Sternoclavicular septic arthritis is a rare disease.It is important to diagnose and manage as soon as possible.The function of shoulder is good with antibiotics and surgical management

关 键 词：感染 胸锁关节 关节炎 清创术 

分 类 号：R687.4[医药卫生—骨科学]