Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany.
Arch Orthop Trauma Surg. 2021 Nov;141(11):1835-1843. doi: 10.1007/s00402-020-03563-8. Epub 2020 Aug 14.
Infected pubic symphysitis (IPS) is a rare bacterial infection of the pubic symphysis that causes subpubic pain, disability and ultimately permanent immobility. Due to difficult diagnosis, patients present with long-standing complaints and consult several doctors. To date, no validated treatment protocol exists and most patients are treated conservatively with antibiotics. This study was aimed to assess the results after careful surgical debridement and pathogen-specific antibiotic treatment in IPS.
A chart review of eight patients with proven IPS was performed. Five of eight patients filled in a specific own-developed questionnaire and could be examined clinically and radiologically at a mean of 13 months (range: 6-30 months) postoperatively.
There were six males and two females with an average age of 69 years (range: 55-80 years). The mean duration of symptoms before surgical treatment was 10.5 months (range: 1-30 months). There were no complications due to the surgical debridement. There was no recurrence of infection at the pubic symphysis during the follow-up period. The most common pathogen was Pseudomonas aeruginosa in three patients. Mean preoperative pain, measured on the visual analogue scale (VAS, range: 0-10) for the four analysed categories in the five follow-up patients was 7.2, 30 days postoperatively 2.7 and 13 months postoperatively 0.4. There was a steady increase in the quality of life (QoL) 30 days postoperatively and at the 13 months follow-up when compared to preoperative values.
Surgical debridement is the keystone for treatment of IPS and should be combined with local and systemic antibiotic therapy.
感染性耻骨联合炎（IPS）是一种罕见的耻骨联合细菌性感染，可导致耻骨下疼痛、残疾，最终导致永久性活动受限。由于诊断困难，患者出现长期的投诉并咨询了多位医生。迄今为止，尚无经过验证的治疗方案，大多数患者接受抗生素的保守治疗。本研究旨在评估精心的外科清创术和针对病原体的抗生素治疗在 IPS 中的效果。
对 8 例经证实的 IPS 患者进行了图表回顾。8 例患者中有 5 例填写了专门开发的特定问卷，并在术后平均 13 个月（范围：6-30 个月）进行了临床和放射学检查。
有 6 名男性和 2 名女性，平均年龄为 69 岁（范围：55-80 岁）。在接受手术治疗之前，症状的平均持续时间为 10.5 个月（范围：1-30 个月）。外科清创术没有并发症。在随访期间，耻骨联合没有感染复发。在 3 例患者中最常见的病原体是铜绿假单胞菌。在 5 例随访患者的 4 个分析类别中，术前疼痛的平均视觉模拟量表（VAS，范围：0-10）为 7.2，术后 30 天为 2.7，术后 13 个月为 0.4。与术前相比，术后 30 天和 13 个月时生活质量（QoL）呈稳步上升。
外科清创术是 IPS 治疗的关键，应与局部和全身抗生素治疗相结合。
