Lawrenz Joshua M, Mesko Nathan W, Higuera Carlos A, Molloy Robert M, Simpfendorfer Claus, Babic Maja
Cleveland Clinic Foundation, 9500 Euclid Ave.Cleveland, OH 44195, USA.
J Bone Jt Infect. 2017 Mar 20;2(3):127-135. doi: 10.7150/jbji.16429. eCollection 2017.
Prosthetic joint infection is an unfortunate though well-recognized complication of total joint arthroplasty. An iliacus and/or iliopsoas muscle abscess is a rarely documented presentation of hip prosthetic joint infection. It is thought an unrecognized retroperitoneal nidus of infection can be a source of continual seeding of the prosthetic hip joint, prolonging attempts to eradicate infection despite aggressive debridement and explant attempts. The current study presents five cases demonstrating this clinical scenario, and discusses various treatment challenges. In each case we report the patient's clinical history, pertinent imaging, management and outcome. Diagnosis of the iliacus muscle abscess was made using computed tomography imaging. In brief, the mean number of total drainage procedures (open and percutaneous) per patient was 4.2, and outcomes consisted of one patient with a hip girdlestone, two patients with delayed revisions, and two patients with retained prosthesis. All patients ended with functional pain and on oral antibiotic suppression with an average follow up of 18 months. This article highlights an iliacus muscle abscess as an unrecognized source of infection to a prosthetic hip. It demonstrates resilience to standard treatment protocols for prosthetic hip infection, and is associated with poor patient outcomes. Aggressive surgical debridement appears to remain critical to treatment success, and early retroperitoneal debridement of the abscess should be considered.
人工关节感染是全关节置换术一种虽已广为人知但仍令人遗憾的并发症。髂肌和/或髂腰肌脓肿是髋关节人工关节感染中鲜有文献记载的一种表现形式。据认为，未被识别的腹膜后感染病灶可能是人工髋关节持续感染的源头，尽管进行了积极的清创和假体取出尝试，但仍会延长根除感染的时间。本研究报告了5例呈现这种临床情况的病例，并讨论了各种治疗挑战。在每个病例中，我们报告了患者的临床病史、相关影像学检查、治疗方法及结果。髂肌脓肿的诊断采用计算机断层扫描成像。简而言之，每位患者的总引流程序（开放引流和经皮引流）平均次数为4.2次，结果包括1例患者进行了髋关节关节融合术，2例患者进行了延期翻修手术，2例患者保留了假体。所有患者最终均出现功能性疼痛，并采用口服抗生素抑制治疗，平均随访18个月。本文强调了髂肌脓肿是人工髋关节未被识别的感染源。它显示出对人工髋关节感染标准治疗方案的抵抗力，并与患者预后不良相关。积极的外科清创似乎仍然是治疗成功的关键，应考虑早期对脓肿进行腹膜后清创。
