Department of Orthopaedic Surgery, Carl Gustav Carus University of Dresden, Dresden, Germany.
Arthroscopy. 2011 Jul;27(7):1014-7. doi: 10.1016/j.arthro.2010.12.008. Epub 2011 May 25.
Subcutaneous emphysema of the upper extremity is rare. Crepitation on physical examination and visible gas on radiographs raise the concern of gas gangrene due to gas-producing bacteria. Rapid establishment of a differential diagnosis is necessary to initiate proper treatment. We present a case of subcutaneous emphysema after elbow arthroscopy caused by a noninfectious genesis. A 59-year-old woman with loose bodies in her left elbow due to mild degenerative joint disease and restricted range of motion was offered an elbow arthroscopy with removal of loose bodies and arthrolysis. Postoperatively, the elbow was actively put alternatively in maximum extension and flexion. On the first postoperative day, rapidly ascending swelling and subcutaneous crepitation starting from the hand to the forearm were noted. There was no clinical evidence of infection. Radiographs showed subcutaneous air. Frequent blood tests and clinical evaluation ruled out a potentially life-threatening bacterial infection, and the signs resolved after 1 week without surgical treatment. Presumably, the intensive postoperative range-of-motion exercises led to a sucking in of air into the wound during each movement. This case illustrates that it is important to differentiate nonbacterial from bacterial causes of soft-tissue gas formation to initiate the appropriate treatment.
上肢皮下气肿很少见。体格检查时出现捻发音，X 线片上可见气体，这会引起产气细菌所致气性坏疽的担忧。为了进行适当的治疗，必须迅速确定鉴别诊断。我们报告了一例由非感染性病因引起的肘关节镜检查后皮下气肿。一位 59 岁的女性因轻度退行性关节病和活动范围受限导致左肘有游离体，接受了关节镜下游离体切除和关节松解术。术后，肘部积极进行最大限度的屈伸活动。术后第一天，从手部到前臂出现迅速上升的肿胀和皮下捻发音。没有感染的临床证据。X 线片显示皮下积气。频繁的血液检查和临床评估排除了潜在的危及生命的细菌感染，并且在没有手术治疗的情况下，1 周后症状消退。推测，术后剧烈的活动范围练习导致每次运动时空气被吸入伤口。本例说明区分软组织气体形成的非细菌性和细菌性原因以启动适当的治疗非常重要。
