Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria.
Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria.
J Shoulder Elbow Surg. 2017 Nov;26(11):1915-1921. doi: 10.1016/j.jse.2017.04.001. Epub 2017 Jun 7.
Management of bacterial shoulder infections includes antibiotic therapy and surgical joint decompression. Arthroscopy and open arthrotomy are recommended treatment options. Whether 1 of the 2 surgical options is superior remains unclear. The present study aimed (1) to compare the reinfection rates after arthroscopy and open arthrotomy and (2) to identify risk factors of reinfection after surgical intervention.
The data of 59 consecutive patients were available for final analysis. All patients received arthroscopy or open arthrotomy at our institution between 2001 and 2015. The reinfection rates between the 2 distinct interventions were compared. We also evaluated the influence of potential confounders, such as age, sex, comorbidities, microbiological findings, duration of symptoms, osteoarthritis, Gächter score, and preoperative inflammatory parameters, on the recurrence of infections and compared the functional outcome between the 2 surgery groups.
From 59 included patients, 38 (64.4%) underwent open arthrotomy, and 21 (35.6%) were treated arthroscopically. Reinfection was documented in 18 patients (30.5%). The reinfection rate was significantly higher in arthroscopically treated patients (11 [52.4%]) than in patients who underwent open arthrotomy (7 [18.4%]; P = .007). An infection with Staphylococcus aureus negatively influenced the treatment success (P = .034).
According to our data, open arthrotomy is the more effective treatment method in septic arthritis of the shoulder, with lower reinfection rates and a comparable functional outcome. Furthermore, we could identify Staphylococcus aureus as an independent risk factor for the recurrence of infections.
细菌性肩感染的治疗包括抗生素治疗和手术关节减压。关节镜检查和开放性关节切开术是推荐的治疗选择。两种手术选择中哪一种更优尚不清楚。本研究旨在：（1）比较关节镜检查和开放性关节切开术后的再感染率；（2）确定手术干预后再感染的危险因素。
59 例连续患者的数据可用于最终分析。所有患者于 2001 年至 2015 年在我院接受关节镜或开放性关节切开术。比较两种不同干预措施之间的再感染率。我们还评估了年龄、性别、合并症、微生物学发现、症状持续时间、骨关节炎、Gächter 评分和术前炎症参数等潜在混杂因素对感染复发的影响，并比较了两种手术组的功能结局。
从 59 例纳入患者中，38 例（64.4%）行开放性关节切开术，21 例（35.6%）行关节镜治疗。18 例患者（30.5%）记录到再感染。关节镜治疗的患者（11 例[52.4%]）再感染率明显高于开放性关节切开术的患者（7 例[18.4%]；P = .007）。金黄色葡萄球菌感染对治疗效果有负面影响（P = .034）。
根据我们的数据，开放性关节切开术是治疗肩脓毒性关节炎更有效的方法，再感染率较低，功能结局相当。此外，我们可以确定金黄色葡萄球菌是感染复发的独立危险因素。
