Alessi D M, Sercarz J A, Calcaterra T C
Division of Head and Neck Surgery, UCLA Medical Center 90024.
Arch Otolaryngol Head Neck Surg. 1988 Sep;114(9):1000-2. doi: 10.1001/archotol.1988.01860210066017.
Osteomyelitis of the clavicle is a rare entity and can occur as a complication of head and neck surgery. Ten consecutive cases of the clavicular osteomyelitis were reviewed at the University of California Medical Center, Los Angeles, over the past seven years. Six cases were associated with prior surgical procedures, and five cases presented as chronic wound drainage. One case was related to a pharyngocutaneous fistula following a supraglottic laryngectomy. Four patients presented with acute symptoms resulting from hematogenous spread, and two of the four patients had Staphylococcus aureus on blood cultures. Long-term intravenous antibiotic therapy (six to eight weeks) was used to successfully treat cases of hematogenously spread osteomyelitis. Wide surgical débridement was the mainstay of treatment in the chronic conditions, with antibiotic therapy having a secondary role. Myocutaneous flaps were required in two patients who had had surgery and antecedent radiotherapy. To conclude, the surgeon should be aware that osteomyelitis of the clavicle can occur as a complication of head and neck procedures. In addition, the treatment of the chronic form of clavicular osteomyelitis is surgical débridement and possible flap reconstruction.
锁骨骨髓炎是一种罕见疾病，可作为头颈外科手术的并发症出现。在过去七年中，加利福尼亚大学洛杉矶分校医学中心对连续10例锁骨骨髓炎病例进行了回顾。6例与先前的外科手术有关，5例表现为慢性伤口引流。1例与声门上喉切除术后咽皮肤瘘有关。4例患者因血行播散出现急性症状，其中2例血培养出金黄色葡萄球菌。长期静脉抗生素治疗（6至8周）成功治疗了血行播散性骨髓炎病例。广泛的手术清创是慢性病例治疗的主要方法，抗生素治疗起辅助作用。2例接受过手术和前期放疗的患者需要肌皮瓣。总之，外科医生应意识到锁骨骨髓炎可作为头颈手术的并发症出现。此外，慢性锁骨骨髓炎的治疗方法是手术清创以及可能的皮瓣重建。
