Frenkel Rutenberg Tal, Velkes Steven, Sidon Eliezer, Paz Lior, Peylan Jacques, Shemesh Shai, Iordache Sorin Daniel
Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Plast Surg Hand Surg. 2020 Feb;54(1):14-18. doi: 10.1080/2000656X.2019.1657434. Epub 2019 Aug 27.
Pyogenic flexor tenosynovitis (PFT) of the hand is a common infection which is clinically diagnosed using Kanavel's signs. Delay in diagnosis and treatment may lead to devastating outcomes, including reduced range of motion (ROM), deformities, tendon impairment or even amputation. While the gold standard for treatment is irrigation and debridement of the flexor sheath, little is known about the outcomes of conservative treatment with intravenous (IV) antibiotics. Patients treated conservatively for PFT between 2000 and 2013 were included. Demographic information, co-morbidities and clinical features at presentation such as Kanavel's signs and inflammatory markers levels were gathered. Treatment course, length of stay (LOS), functional outcomes and complications were collected. Fifty-four (54) patients presented with PFT in the study period. Forty-six (46) patients, ages 19-84 years old, who were treated conservatively were included. Average time from symptoms onset to presentation was 4.6 ± 7.1 days. Fourteen (14) patients failed to improve with course of oral antibiotics prior to presentation. The average number of Kanavel's signs was 3 ± 0.7. Inflammatory markers were elevated in 82.2% of patients. The mean LOS was 4.7 ± 2 days. Forty-four (44) patients continued follow-up for 55 ± 45 months. Final flexion ROM was full or minimally limited in 69% of patients. Three patients were eventually operated. Complication rate for the entire cohort was 4.3% and no fingers were lost. This retrospective case series indicate that inpatient empirical IV antibiotic therapy can be considered for patients presenting with uncomplicated PFT, provided it is practiced under a hand specialist's surveillance.
手部化脓性屈指肌腱腱鞘炎（PFT）是一种常见感染，临床上通过卡纳韦尔征进行诊断。诊断和治疗的延迟可能导致严重后果，包括活动范围（ROM）减小、畸形、肌腱损伤甚至截肢。虽然治疗的金标准是屈肌鞘冲洗和清创，但对于静脉注射（IV）抗生素保守治疗的效果知之甚少。纳入了2000年至2013年间接受PFT保守治疗的患者。收集了人口统计学信息、合并症以及就诊时的临床特征，如卡纳韦尔征和炎症标志物水平。记录了治疗过程、住院时间（LOS）、功能结局和并发症。在研究期间，有54例患者出现PFT。其中46例年龄在19至84岁之间的患者接受了保守治疗。从症状出现到就诊的平均时间为4.6±7.1天。14例患者在就诊前口服抗生素治疗无效。卡纳韦尔征的平均数量为3±0.7。82.2%的患者炎症标志物升高。平均住院时间为4.7±2天。44例患者继续随访55±45个月。69%的患者最终屈曲ROM完全或仅有轻微受限。3例患者最终接受了手术。整个队列的并发症发生率为4.3%，无手指缺失。这个回顾性病例系列表明，对于表现为非复杂性PFT的患者，可以考虑住院经验性静脉抗生素治疗，但前提是在手部专科医生的监督下进行。
