Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Life Sciences, McMaster University, Hamilton, Ontario, Canada.
Arthroscopy. 2018 Feb;34(2):625-646.e1. doi: 10.1016/j.arthro.2017.07.038. Epub 2017 Oct 31.
To investigate arthroscopic management of native shoulder joint septic arthritis-specifically, indications, patient outcomes, and complications.
PubMed, MEDLINE, and Embase were used to search the literature, and data abstraction was performed independently and in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist guided reporting and data abstraction. The quality of all included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) criteria. The results are presented in a narrative summary fashion using descriptive statistics including means, proportions, ranges, κ values, and intraclass correlation coefficient values.
Overall, 27 studies (19 case reports and 8 case series) were identified, including 115 patients (121 shoulders). The mean follow-up period was 29.1 months (range, 1-199 months). The indications for shoulder arthroscopy owing to infection included pain; limited range of motion; swelling, erythema, and tenderness; fever; elevated leukocyte count, erythrocyte sedimentation rate, and/or C-reactive protein level; synovial aspirate findings; and/or imaging findings. Overall, 46 patients (40%) achieved infection eradication and functional improvement after a single arthroscopic procedure. However, 43 patients (37%) had ongoing symptoms or complications, including 32 (30%) who required revision arthroscopic procedures, 7 (6%) who underwent open arthrotomy for septic arthritis management, 2 (2%) in whom avascular necrosis of the humeral head developed, 1 (1%) in whom adhesive capsulitis developed, and 1 (1%) in whom an irregular profile of the humeral epiphysis developed on plain radiographs.
Arthroscopic management of native shoulder septic arthritis can yield alleviation of pain and a return to full range of motion, daily activities, and sports. However, there is a high reoperation rate, which may correlate with poor patient prognostic factors. This systematic review did not show the superiority of either arthroscopic surgery or open arthrotomy for the management of shoulder septic arthritis.
Level IV, systematic review of Level IV studies.
研究关节镜下治疗原发性肩关节化脓性关节炎的方法，具体包括适应证、患者结局和并发症。
使用 PubMed、MEDLINE 和 Embase 进行文献检索，独立并重复进行数据提取。采用系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）检查表进行报告和数据提取。使用非随机研究方法学指数（MINORS）标准评估所有纳入研究的质量。结果以描述性统计的形式呈现，包括均值、比例、范围、κ 值和组内相关系数值。
共纳入 27 项研究（19 篇病例报告和 8 篇病例系列研究），包括 115 例患者（121 个肩关节）。平均随访时间为 29.1 个月（范围，1-199 个月）。因感染而行肩关节镜检查的适应证包括疼痛、活动范围受限、肿胀、红斑和触痛、发热、白细胞计数、红细胞沉降率和/或 C 反应蛋白水平升高、关节液抽吸发现和/或影像学发现。总体而言，46 例（40%）患者在单次关节镜手术后感染得到清除，功能得到改善。然而，仍有 43 例（37%）患者存在持续症状或并发症，包括 32 例（30%）需要再次行关节镜手术，7 例（6%）需行开放性关节切开术治疗化脓性关节炎，2 例（2%）发生肱骨头缺血性坏死，1 例（1%）发生粘连性肩关节囊炎，1 例（1%）平片显示肱骨头骨骺不规则。
关节镜下治疗原发性肩关节化脓性关节炎可缓解疼痛，恢复全范围活动度，恢复日常活动和运动功能。然而，再手术率较高，这可能与患者预后不良的因素有关。本系统评价并未显示关节镜手术或开放性关节切开术在治疗肩关节化脓性关节炎方面具有优势。
IV 级，IV 级研究的系统评价。
