Tasnim Sadia, Shirafkan Ali, Okereke Ikenna
School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA.
J Thorac Dis. 2020 Aug;12(8):4418-4426. doi: 10.21037/jtd-20-761.
The sternoclavicular joint (SCJ) is anatomically and clinically significant considering its proximity to important neuro-vascular structures like the subclavian vessels and the phrenic nerve. Infections of this joint masquerade multiple disorders, delay diagnosis and spread to the bone and deep tissues. There is no standardized workup and treatment protocol for sternoclavicular joint infections (SCJI) as defined in literature. Here, we review the existing literature to understand the current knowledge of the diagnosis and treatment of SCJI. We searched English publications in PubMed and included clinical trials, case reports, case series, retrospective cohort studies, literature and systematic reviews after excluding non-infectious etiology of SCJ pathologies. There are many risk factors for SCJI, such as immunocompromised status, intravenous drug use, trauma and arthropathies. But a large percentage of patients with disease have none of these risk factors. SCJIs can present with fever, joint swelling, immobility, and rarely with vocal cord palsy or dysphagia. While causes over 50% of SCJI cases, other pathogens such as and are frequently seen. When diagnosed early, the infection can be medically managed with antibiotics or joint aspirations. Most cases of SCJI, however, are diagnosed after extensive spread to soft tissue and bones requiring resection with or without a muscle flap. Complications of undertreatment can range from simple abscess formation to mediastinitis, even sepsis. SCJIs are rare but serious infections prompting early detection and interventions. Most cases of SCJI treated adequately show complete resolution in months while retaining maximum functionality. Key features of proper healing include aggressive physiotherapy to prevent adhesive shoulder capsulitis and decreased range of motion.
胸锁关节（SCJ）在解剖学和临床上具有重要意义，因为它靠近锁骨下血管和膈神经等重要的神经血管结构。该关节感染会伪装成多种疾病，导致诊断延误，并扩散至骨骼和深部组织。目前文献中尚未定义针对胸锁关节感染（SCJI）的标准化检查和治疗方案。在此，我们回顾现有文献，以了解SCJI诊断和治疗的当前知识。我们在PubMed上搜索了英文出版物，纳入了临床试验、病例报告、病例系列、回顾性队列研究、文献综述和系统评价，排除了SCJ病变的非感染性病因。SCJI有许多危险因素，如免疫功能低下、静脉药物使用、创伤和关节病。但很大一部分患病患者没有这些危险因素。SCJI可能表现为发热、关节肿胀、活动受限，很少出现声带麻痹或吞咽困难。虽然[具体病原体1]导致超过50%的SCJI病例，但其他病原体如[具体病原体2]和[具体病原体3]也很常见。早期诊断时，感染可通过抗生素治疗或关节穿刺进行医学处理。然而，大多数SCJI病例在广泛扩散至软组织和骨骼后才被诊断出来，需要进行带或不带肌瓣的切除手术。治疗不足的并发症范围从简单的脓肿形成到纵隔炎，甚至败血症。SCJI虽然罕见但很严重，需要早期检测和干预。大多数得到充分治疗的SCJI病例在数月内可完全康复，同时保留最大功能。正确愈合的关键特征包括积极的物理治疗，以预防粘连性肩周炎和减少活动范围。
