胸锁关节感染的手术治疗

Surgical Management of Sternoclavicular Joint Infections.

作者信息

Kachala Stefan S, D'Souza Desmond M, Teixeira-Johnson Lucileia, Murthy Sudish C, Raja Siva, Blackstone Eugene H, Raymond Daniel P

机构信息

Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.

Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio.

出版信息

Ann Thorac Surg. 2016 Jun;101(6):2155-60. doi: 10.1016/j.athoracsur.2016.01.054. Epub 2016 Apr 12.

DOI:10.1016/j.athoracsur.2016.01.054

PMID:27083249

Abstract

BACKGROUND

Infections of the sternoclavicular joint (SCJ) respond poorly to nonoperative management and typically require resection. We examined presenting characteristics and outcomes after surgical management of SCJ infections, reviewing a 20-year single-institution experience.

METHODS

From January 1992 to December 2012, 40 patients (age, 57 ± 12 years; 70% male) underwent resection of an infected SCJ. Sternal infections after cardiac surgery were excluded. Clinical features, microbiology, recurrence, survival, and functional impairment were assessed. Infection was documented by the surgeon, and supported by tissue culture. Clinical presentation and treatment course were obtained by review of medical records. The functional assessment was determined by phone interviews using the validated QuickDASH outcome measure. Mortality data were gathered from the medical record.

RESULTS

Pain was the presenting symptom in 93% of patients. Staphylococcal species were isolated in 73% of tissue specimens. Fifteen patients (37%) underwent primary closure and 25 patients (63%) underwent closure by secondary intention with application of negative-pressure wound therapy. There were four recurrences (10%), one after primary closure and three in the secondary intention group. No deaths occurred within 30 days of operation, and 5-year survival was 67%. Functional assessment using the QuickDASH outcome measure revealed minimal loss in upper extremity function after the procedure (preoperative score, 10 ± 3; postoperative score, 19 ± 6.8; n = 11). There was no difference in functional outcome comparing primary closure versus secondary intention (19 ± 4.4 versus 20 ± 8.2; p = 0.64).

CONCLUSIONS

Septic arthritis of the SCJ is routinely managed surgically at many centers. We report that primary closure with a muscle flap can achieve similar outcomes to secondary intention in selected patients. Furthermore, patients experienced minimal functional impairment at long-term follow-up.

摘要

背景

胸锁关节（SCJ）感染对非手术治疗反应不佳，通常需要进行切除术。我们回顾了一家机构20年的经验，研究了SCJ感染手术治疗后的表现特征和结果。

方法

1992年1月至2012年12月，40例患者（年龄57±12岁；70%为男性）接受了感染性SCJ切除术。排除心脏手术后的胸骨感染。评估临床特征、微生物学、复发情况、生存率和功能损害。感染由外科医生记录，并得到组织培养的支持。通过查阅病历获得临床表现和治疗过程。使用经过验证的QuickDASH结果测量方法通过电话访谈确定功能评估。从病历中收集死亡率数据。

结果

93%的患者以疼痛为首发症状。73%的组织标本中分离出葡萄球菌属。15例患者（37%）进行了一期缝合，25例患者（63%）采用负压伤口治疗二期愈合。有4例复发（10%），1例在一期缝合后复发，3例在二期愈合组复发。术后30天内无死亡病例，5年生存率为67%。使用QuickDASH结果测量方法进行的功能评估显示，术后上肢功能损失最小（术前评分10±3；术后评分19±6.8；n = 11）。一期缝合与二期愈合的功能结果无差异（19±4.4对20±8.2；p = 0.64）。