Diefenbeck M, Abitzsch D, Hofmann G O
Septische Knochen- und Weichteilchirurgie, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland.
Unfallchirurg. 2012 Jun;115(6):489-95. doi: 10.1007/s00113-012-2188-x.
Acute septic arthritis is a surgical emergency because rapid septic destruction of articular cartilage can lead to impairment or even loss of joint function. Diagnosis consists of patient history, clinical examination, laboratory results, (sonography- guided) joint aspiration and radiography. Emergency therapy is based on arthroscopic or open joint debridement and lavage combined with systemic antibiotic therapy. No data are available for the recommendation of local antibiotics but antiseptic solutions are not recommended because of cartilage damage. New trends in diagnostics are positron emission tomography/computed tomography (PET/CT), urine sticks for analysis of joint fluid and molecular pathology. Chronic joint empyema is more diagnostically demanding and is difficult to treat. In cases of necrotic and infected articular cartilage, joint resection has to be performed for quiescence of infection. Options following successful treatment of empyema are arthroplasty, arthrodesis or permanent resection.
急性化脓性关节炎是一种外科急症，因为关节软骨的快速化脓性破坏可导致关节功能受损甚至丧失。诊断包括患者病史、临床检查、实验室检查结果、（超声引导下的）关节穿刺及影像学检查。急诊治疗基于关节镜或开放性关节清创及灌洗并联合全身抗生素治疗。目前尚无推荐局部使用抗生素的数据，但由于会造成软骨损伤，不推荐使用抗菌溶液。诊断的新趋势是正电子发射断层扫描/计算机断层扫描（PET/CT）、用于关节液分析的尿试纸及分子病理学。慢性关节积脓的诊断要求更高且治疗困难。对于坏死和感染的关节软骨病例，必须进行关节切除以控制感染。脓胸成功治疗后的选择包括关节成形术、关节融合术或永久性切除术。
