Kim Sung-Jae, Choi Yun-Rak, Lee Wonyong, Jung Woo-Seok, Chun Yong-Min
Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, CPO Box 8044, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
Arch Orthop Trauma Surg. 2018 Sep;138(9):1257-1263. doi: 10.1007/s00402-018-2959-0. Epub 2018 May 18.
The purpose of this study was to compare clinical outcomes and development of post-infectious arthritis of the shoulder joint after single (Group S) or repeated (Group R) arthroscopic debridement surgeries. We hypothesized that (1) repeated surgeries might be attributable to initial subchondral involvement resulting from septic arthritis and (2) the repeated surgery group would exhibit a higher incidence of post-infectious arthritic changes and inferior clinical outcomes due to prolonged resolution of the infection.
This study included 42 patients (single surgery, n = 29; repeated surgery, n = 13) who underwent arthroscopic debridement for septic arthritis and had a minimum of 2 years of postoperative follow-up data. All patients underwent preoperative magnetic resonance imaging (MRI) with gadolinium enhancement to evaluate subchondral bone involvement suspicious for osteomyelitis secondary to septic arthritis and extension of infection around the glenohumeral joint. Functional and radiological outcomes were assessed.
Group S experienced a shorter duration (25.4 days) of infection than Group R (39.7 days) (p = 0.002). Increased signal intensity in the subchondral bone on preoperative MRI was identified in 9 patients (31%) in Group S and 5 patients (38%) in Group R. Post-infectious arthritic changes developed in 6 (21%) and 5 (38%) in Groups S and R, respectively. However, there were no significant differences between groups. At the final follow-up, there were no significant differences in functional assessments.
Despite a prolonged period of infection in the repeated surgery group, there was no significant difference in development of post-infectious arthritic changes or clinical outcomes in patients requiring single or repeated surgeries.
Retrospective comparative study, III.
本研究旨在比较单次（S组）或重复（R组）关节镜清创术后肩关节感染后关节炎的临床结局和发展情况。我们假设：（1）重复手术可能归因于脓毒性关节炎导致的初始软骨下受累；（2）由于感染的持续时间延长，重复手术组感染后关节炎变化的发生率会更高，临床结局更差。
本研究纳入了42例因脓毒性关节炎接受关节镜清创术且术后至少有2年随访数据的患者（单次手术，n = 29；重复手术，n = 13）。所有患者术前行钆增强磁共振成像（MRI），以评估疑似脓毒性关节炎继发骨髓炎的软骨下骨受累情况以及盂肱关节周围感染的扩散情况。评估功能和影像学结局。
S组的感染持续时间（25.4天）短于R组（39.7天）（p = 0.002）。术前MRI显示S组9例患者（31%）和R组5例患者（38%）软骨下骨信号强度增加。S组和R组分别有6例（21%）和5例（38%）出现感染后关节炎变化。然而，两组之间无显著差异。在末次随访时，功能评估无显著差异。
尽管重复手术组的感染时间延长，但在需要单次或重复手术的患者中，感染后关节炎变化的发展或临床结局并无显著差异。
回顾性比较研究，III级。
