Harada Kaoru, McConnell Ian, DeRycke Eric C, Holleck Jürgen L, Gupta Shaili
From the Department of Internal Medicine, Yale University School of Medicine, New Haven, and the Department of Medicine, Section of Infectious Diseases, Veterans Affairs Healthcare Systems of Connecticut, West Haven.
South Med J. 2019 Apr;112(4):238-243. doi: 10.14423/SMJ.0000000000000958.
To determine whether there are differences in the outcomes of native joint septic arthritis (SA) in adults, based on medical versus surgical management.
A 10-year retrospective single-center study was conducted of patients admitted to a tertiary care hospital between January 1, 2006 and December 31, 2015 with a diagnosis of SA to compare outcomes based on the management approach taken: medical (bedside closed-needle joint aspiration) versus surgical (arthrotomy/arthroscopy). Evaluated outcomes included joint recovery, time to recovery, length of stay, disposition to home versus rehabilitation unit, recurrence of SA in the same joint, and mortality.
Of 118 confirmed cases of SA, 48 were in prosthetic joints and 70 were in native joints, and 61 met our inclusion criteria. Forty-one (67%) patients received surgery, and 20 (33%) received closed-needle aspiration. There was no statistically significant difference in long-term outcomes between the two groups at 12 months. Patients managed medically were more likely to experience full recovery at 3 months and were less likely to need short-term rehabilitation.
Medical management with closed-needle aspiration may be an adequate approach to the treatment of native joint infections.
基于内科治疗与外科治疗，确定成人原发性关节化脓性关节炎（SA）的治疗结果是否存在差异。
对2006年1月1日至2015年12月31日期间入住一家三级护理医院且诊断为SA的患者进行了一项为期10年的回顾性单中心研究，以比较基于治疗方法的结果：内科治疗（床边闭合针吸关节穿刺术）与外科治疗（关节切开术/关节镜检查）。评估的结果包括关节恢复情况、恢复时间、住院时间、回家与康复机构的去向、同一关节SA的复发情况以及死亡率。
在118例确诊的SA病例中，48例为人工关节，70例为原发性关节，61例符合纳入标准。41例（67%）患者接受了手术，20例（33%）接受了闭合针吸穿刺术。两组在12个月时的长期结果无统计学显著差异。接受内科治疗的患者在3个月时更有可能完全康复，且不太可能需要短期康复治疗。
闭合针吸穿刺术的内科治疗可能是治疗原发性关节感染的一种适当方法。
