Sammer Douglas M, Shin Alexander Y
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110, USA.
J Bone Joint Surg Am. 2009 Jun;91(6):1387-93. doi: 10.2106/JBJS.H.00630.
Open irrigation and débridement is the standard of treatment for septic arthritis of the wrist. Although isolated cases of arthroscopic irrigation and débridement have been reported, a comparison of arthroscopic and open techniques has not been performed, to our knowledge. The purpose of this study was to compare the two methods of management.
A retrospective comparison of patients with septic arthritis of the wrist initially treated, over an eleven-year period, with open or arthroscopic irrigation and débridement was undertaken at a single institution. The clinical presentation, laboratory and microbiological findings, hospital course, complications, and outcomes were compared between the two groups.
Between 1997 and 2007, thirty-six patients with septic arthritis involving a total of forty wrists were identified. Nineteen wrists (seventeen patients) were initially treated with open irrigation and débridement, and twenty-one wrists (nineteen patients) were initially treated arthroscopically. Eleven wrists in the open-treatment cohort required repeat irrigation and débridement, and eight wrists in the arthroscopy cohort required a repeat procedure. If a repeat irrigation and débridement was required, it was performed in an open fashion in all but two cases. When the comparison included all of the patients in the series, no difference between the two cohorts was found with regard to the number of irrigation and débridement procedures required or the length of the hospital stay. However, when the comparison was limited to the patients with isolated septic arthritis of the wrist, it was found that only one of seven wrists in the open-treatment cohort but all eight wrists in the arthroscopy cohort had been successfully managed with a single irrigation and débridement procedure (p = 0.001). No patient in whom isolated septic arthritis of the wrist had been treated with arthroscopic irrigation and débridement required a second operation. The patients in whom isolated septic arthritis of the wrist was treated with the open method stayed in the hospital for an average of sixteen days compared with a six-day stay for those in whom isolated septic arthritis of the wrist was treated with the arthroscopic method (p = 0.04). The ninety-day perioperative mortality rate in the series was substantial (18% [three patients] in the open-treatment cohort and 21% [four patients] in the arthroscopy cohort).
Arthroscopic irrigation and débridement is an effective treatment for patients with isolated septic arthritis of the wrist; these patients had fewer operations and a shorter hospital stay than did patients who had received open treatment. However, these benefits were not seen in patients with multiple sites of infection.
Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
开放性冲洗清创术是腕关节化脓性关节炎的标准治疗方法。据我们所知，虽然已有关节镜下冲洗清创术的个别病例报道，但尚未对关节镜技术与开放技术进行比较。本研究的目的是比较这两种治疗方法。
在单一机构对11年间最初接受开放性或关节镜下冲洗清创术治疗的腕关节化脓性关节炎患者进行回顾性比较。比较两组患者的临床表现、实验室及微生物学检查结果、住院过程、并发症及治疗结果。
1997年至2007年间，共确定36例腕关节化脓性关节炎患者，累及40个腕关节。19个腕关节（17例患者）最初接受开放性冲洗清创术治疗，21个腕关节（19例患者）最初接受关节镜下治疗。开放性治疗组有11个腕关节需要重复冲洗清创术，关节镜组有8个腕关节需要重复手术。如果需要重复冲洗清创术，除2例以外均采用开放方式进行。当比较该系列中的所有患者时，两组在所需冲洗清创术的次数或住院时间方面未发现差异。然而，当比较仅限于孤立性腕关节化脓性关节炎患者时，发现开放性治疗组7个腕关节中只有1个通过单次冲洗清创术成功治疗，而关节镜组的8个腕关节均通过单次冲洗清创术成功治疗（p = 0.001）。接受关节镜下冲洗清创术治疗的孤立性腕关节化脓性关节炎患者均无需二次手术。采用开放方法治疗的孤立性腕关节化脓性关节炎患者平均住院16天，而采用关节镜方法治疗的患者平均住院6天（p = 0.04）。该系列的90天围手术期死亡率较高（开放性治疗组为18%[3例患者]，关节镜组为21%[4例患者]）。
关节镜下冲洗清创术是孤立性腕关节化脓性关节炎患者的有效治疗方法；与接受开放治疗的患者相比，这些患者手术次数更少，住院时间更短。然而，在有多个感染部位的患者中未观察到这些益处。
治疗性III级。有关证据水平的完整描述，请参见作者须知。
