Mirzayan R, Itamura J M, Vangsness C T, Holtom P D, Sherman R, Patzakis M J
Department of Orthopaedic Surgery, University of Southern California School of Medicine, Los Angeles 90033, USA.
J Bone Joint Surg Am. 2000 Aug;82(8):1115-21. doi: 10.2106/00004623-200008000-00008.
Deep infection of the shoulder following rotator cuff repair is uncommon. There are few reports in the literature regarding the management of such infections.
We retrospectively reviewed the charts of thirteen patients and recorded the demographic data, clinical and laboratory findings, risk factors, bacteriological findings, and results of surgical management.
The average age of the patients was 63.7 years. The interval between the rotator cuff repair and the referral because of infection averaged 9.7 months. An average of 2.4 procedures were performed prior to referral because of infection, and an average of 2.1 procedures were performed at our institution. All patients had pain on presentation, and most had a restricted range of motion. Most patients were afebrile and did not have an elevated white blood-cell count but did have an elevated erythrocyte sedimentation rate. The most common organisms were Staphylococcus epidermidis, Staphylococcus aureus, and Propionibacterium species. At an average of 3.1 years, all patients were free of infection. Using the Simple Shoulder Test, eight patients stated that the shoulder was comfortable with the arm at rest by the side, they could sleep comfortably, and they were able to perform activities below shoulder level. However, most patients had poor overhead function.
Extensive soft-tissue loss or destruction is associated with a worse prognosis. Extensive débridement, often combined with a muscle transfer, and administration of the appropriate antibiotics controlled the infection, although most patients were left with a substantial deficit in overhead function of the shoulder.
肩袖修复术后肩部深部感染并不常见。文献中关于此类感染的治疗报道较少。
我们回顾性分析了13例患者的病历，记录了人口统计学数据、临床和实验室检查结果、危险因素、细菌学检查结果以及手术治疗结果。
患者的平均年龄为63.7岁。肩袖修复至因感染转诊的平均间隔时间为9.7个月。因感染转诊前平均进行了2.4次手术，在我们机构平均进行了2.1次手术。所有患者就诊时均有疼痛，大多数患者活动范围受限。大多数患者无发热，白细胞计数未升高，但红细胞沉降率升高。最常见的病原体是表皮葡萄球菌、金黄色葡萄球菌和丙酸杆菌属。平均3.1年后，所有患者均无感染。使用简单肩部测试，8例患者表示肩部在手臂休息于身体一侧时感觉舒适，能够舒适入睡，并且能够进行肩部水平以下的活动。然而，大多数患者的上肢过顶功能较差。
广泛的软组织丢失或破坏与较差的预后相关。广泛清创，通常联合肌肉转移，并使用适当的抗生素控制了感染，尽管大多数患者的肩部上肢过顶功能仍有明显缺陷。
