Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Campus Box 8238, St. Louis, MO 63110, USA.
J Bone Joint Surg Am. 2010 Mar;92 Suppl 1 Pt 1:107-13. doi: 10.2106/JBJS.I.01315.
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.
开放性灌洗和清创术是治疗腕关节化脓性关节炎的标准方法。尽管已有孤立的关节镜灌洗和清创术的报道，但据我们所知，尚未对关节镜和开放性技术进行比较。本研究的目的是比较两种治疗方法。
在一家单机构中，对 11 年间最初接受开放性或关节镜灌洗和清创术治疗的腕关节化脓性关节炎患者进行回顾性比较。比较两组的临床表现、实验室和微生物学发现、住院过程、并发症和结果。
1997 年至 2007 年间，共发现 36 例累及 40 个腕关节的化脓性关节炎患者。19 个腕关节（17 例患者）最初接受开放性灌洗和清创术治疗，21 个腕关节（19 例患者）最初接受关节镜治疗。开放性治疗组中有 11 个腕关节需要重复灌洗和清创术，关节镜组中有 8 个腕关节需要重复手术。如果需要重复灌洗和清创术，除了两例外，均以开放性方式进行。当比较包括系列中的所有患者时，两组之间需要进行的灌洗和清创术次数或住院时间均无差异。然而，当将比较仅限于孤立性腕关节化脓性关节炎患者时，发现开放性治疗组中只有 7 个腕关节中的 1 个，而关节镜组中 8 个腕关节均通过单次灌洗和清创术成功治疗（p = 0.001）。接受关节镜灌洗和清创术治疗孤立性腕关节化脓性关节炎的患者无一例需要再次手术。接受关节镜灌洗和清创术治疗孤立性腕关节化脓性关节炎的患者平均住院 6 天，而接受开放性方法治疗的患者平均住院 16 天（p = 0.04）。本系列中 90 天围手术期死亡率很高（开放性治疗组为 18%[3 例]，关节镜治疗组为 21%[4 例]）。
关节镜灌洗和清创术是治疗孤立性腕关节化脓性关节炎的有效方法；这些患者的手术次数和住院时间均少于接受开放性治疗的患者。然而，这些益处并未在有多处感染的患者中见到。
