Travers V, Norotte G, Roger B, Apoil A
Service de Chirurgie Orthopédique, Hôpital Saint-Antoine, Paris.
Rev Rhum Mal Osteoartic. 1988 Jul-Sep;55(9):655-60.
In reference to 79 cases of primary acute pyogenic arthritis involving large joints of the extremities, the authors analyze respectively the results of medical and surgical treatments. After tapping, the medical treatment combining antibiotics and cast immobilisation, has enabled recovery in more than one out of two cases with "restitutio ad integrum" of the joint. In the absence of rapid improvement, an arthrotomy, performed in 23 instances, has enabled, with irrigation and drainage of the joint, to control in a large number of cases, the infectious process. At the stage of purulent synovitis, a synovectomy was performed in 14 instances, at the price of a frequent decrease of the subsequent mobility. At the osteoarthritis stage, resection or arthrodesis were necessary (10 times) in order to obtain drying of the lesions. All things considered, 50 out of 79 joints recovered completely. We will stress the frequency of iatrogenic etiological factors (16 cases) and the immediate mortality (13 deaths). Finally, at the knee, arthroscopy (12 cases) enables to properly visualize the lesions and an effective irrigation-drainage, while decreasing immediate mortality and subsequent stiffening of the joint.
针对79例累及四肢大关节的原发性急性化脓性关节炎患者，作者分别分析了药物治疗和手术治疗的结果。穿刺后，采用抗生素联合石膏固定的药物治疗，使超过半数的患者关节“完全恢复”。若病情未迅速改善，23例患者接受了关节切开术，通过关节冲洗和引流，在大量病例中控制了感染进程。在化脓性滑膜炎阶段，14例患者接受了滑膜切除术，代价是术后关节活动度常常降低。在骨关节炎阶段，为使病变干燥，有必要进行切除术或关节融合术（10例）。综合考虑，79个关节中有50个完全恢复。我们将强调医源性病因的发生率（16例）和直接死亡率（13例死亡）。最后，在膝关节，关节镜检查（12例）能够清晰观察病变并进行有效的冲洗引流，同时降低直接死亡率和后续关节僵硬的发生率。
