海分枝杆菌所致手深部慢性感染特点及其救治  

Characteristics of Deep Chronic Hand Infections Caused by Mycobacterium Marinum and Treatment

作　　者：梁志白 吕辉照 周晓文 艾建国[1] 赵枫[1] Liang Zhibai;Lyu Huizhao;Zhou Xiaowen;Ai Jianguo;Zhao Feng(Department of Orthopaedics,No.910 Hospital of Joint Logistics Support Force of Chinese PLA,Quanzhou 362000,China)

机构地区：[1]中国人民解放军联勤保障部队第910医院骨科,福建泉州362000

出　　处：《骨科》2024年第2期140-144,共5页ORTHOPAEDICS

基　　金：泉州市医疗卫生领域科技计划项目(2023NS017)。

摘　　要：目的 总结由鱼刺伤导致海分枝杆菌感染手深部组织的相关经验,归纳其损伤特点、治疗原则、相关解剖以及诊疗要点。方法 回顾性分析2015年1月至2022年1月收治于我院的13例海洋鱼类所致手外伤病人的临床资料,其中男9例,女4例;年龄为(44.32±5.66)岁(33~56岁)。通过治疗前后美国手外科协会总主动活动度(total action movement,TAM)、疼痛视觉模拟量表(visual analogue scale,VAS)评分、Swanson手功能评定标准和Gartland-Werley腕关节评分标准分析手术疗效并总结相关经验。结果 病人随访时间为(22.92±13.33)个月(6~46个月)。术后3个月依据TAM进行评定,优7例,良6例,优良率达到100%,较术前显著改善(P<0.001);VAS评分[(0.92±0.95)分]较术前[(4.54±0.88)分]明显降低(P<0.001)。Swanson手功能评定,优6例,良7例,优良率为100%,与术前比较患指功能得到明显改善(P<0.001)。3例累及腕部病人Gartland-Werley腕关节评分均为优,症状得到缓解。结论 海分枝杆菌所致手深部感染少见且诊断困难,但如果能及时清创并予相应药物治疗,治疗效果良好。Objective To summarize the experience of deep hand tissue infection by Mycobacterium marinum caused by fish stab wounds,and to summarize the injury characteristics,treatment principles,related anatomy and treatment points.Methods The clinical data of 13 patients with hand trauma caused by marine fish admitted to our hospital from January 2015 to January 2022 were retrospectively analyzed.There were 9 males and 4 females,aged(44.32±5.66)years old(33-56 years old).The American Society for Surgery of the Hand total active movement(TAM),visual analogue scale(VAS)scores,Swanson Hand Function Assessment Criteria and Gartland-Werley Wrist Score Criteria before and after treatment were used to analyze the surgical efficacy and summarize the related experience.Results All 13 patients were followed up from 6 to 46 months,with a mean of(22.92±13.33)months.Based on the TAM,7 cases obtained excellent outcome and 6 cases good outcome,with an excellent and good rate of 100%,which was significantly improved as compared with the preoperative period(P<0.001);the postoperative VAS score(0.92±0.95)was significantly relieved as compared with the preoperative period(4.54±0.88,P<0.001).Swanson Hand Function Assessment Criteria showed excellent results in 6 cases and good results in 7 cases,with an excellent and good rate of 100%.Compared with preoperative results,the finger function was improved significantly postoperation(P<0.001).Three patients with wrist involvement were evaluated for wrist function using the Gartland-Werley Wrist Score Criteria,all of which obtained excellent results and symptoms were relieved.Conclusion Deep hand infections caused by Mycobacterium marinum are rare and difficult to diagnose,but they can be treated well with timely debridement and appropriate medication.

关 键 词：海分枝杆菌 手 深部感染 清创 

分 类 号：R658.2[医药卫生—外科学]