腕关节感染:当前概念综述

infection of the wrist joint: A current concepts review.

作者信息

Singh Mohit, Jeyaraman Madhan, Jeyaraman Naveen, Jayakumar Tarun, Iyengar Karthikeyan P, Jain Vijay Kumar

机构信息

Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India.

Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600056, Tamil Nadu, India.

出版信息

J Clin Orthop Trauma. 2023 Sep 28;44:102257. doi: 10.1016/j.jcot.2023.102257. eCollection 2023 Sep.

Abstract

BACKGROUND

Osteoarticular Tuberculosis (TB) of wrist joint is a rare, often misdiagnosed form of site affected by infection that can lead to severe disability and morbidity. This review aims to summarize the current literature on the diagnosis and management of infection of the wrist joint.

MATERIALS AND METHODS

A comprehensive search strategy using the PEO (Population, Exposure, Outcome) framework was conducted on PubMed, Google Scholar, and Web of Science databases from 1967 to 2022, excluding single case reports and correspondence articles. The keywords used for the search included ' 'osteoarticular' and 'wrist'. Clinical presentation, demographic details, complementary investigations undertaken, trends, and complications of different management interventions were recorded to generate this review.

RESULTS

Osteoarticular Tuberculosis (TB) of the wrist joint accounts for fewer than 1% of all skeletal TB cases across a spectrum of age ranges. Magnetic Resonance Imaging (MRI) represents an excellent modality to reveal the extent of the disease at an early stage of the condition. Synovial fluid analysis has been recommended for microbiological diagnosis. Treatment options include anti-tubercular therapy (ATT), incision and drainage, debridement, synovectomy, and arthrodesis.

CONCLUSION

Early diagnosis and treatment of wrist tuberculosis is crucial for achieving good functional outcomes in patients with this uncommon condition. Polymerase Chain Reaction (PCR) and GeneXpert technology for the detection of (MTB) have improved diagnostic accuracy in detecting MTB DNA and rifampicin resistance. Anti-Tubercular Therapy (ATT) regime remains a foundation pillar in the overall management of these patients with focused surgical interventions leading to improved clinical outcomes.

摘要

背景

腕关节骨关节结核是一种罕见的、常被误诊的感染性疾病,可导致严重的残疾和发病。本综述旨在总结目前关于腕关节感染诊断和治疗的文献。

材料与方法

采用PEO(人群、暴露因素、结局)框架,在1967年至2022年期间对PubMed、谷歌学术和科学网数据库进行全面检索,排除单病例报告和通信文章。检索所用关键词包括“骨关节”和“腕关节”。记录临床表现、人口统计学细节、进行的辅助检查、不同治疗干预的趋势和并发症,以撰写本综述。

结果

腕关节骨关节结核在各年龄段的所有骨骼结核病例中占比不到1%。磁共振成像(MRI)是在疾病早期揭示病变范围的极佳方式。推荐进行滑液分析以进行微生物学诊断。治疗选择包括抗结核治疗(ATT)、切开引流、清创、滑膜切除术和关节融合术。

结论

对于这种罕见疾病的患者,早期诊断和治疗腕关节结核对于取得良好的功能结局至关重要。用于检测结核分枝杆菌(MTB)的聚合酶链反应(PCR)和GeneXpert技术提高了检测MTB DNA和利福平耐药性的诊断准确性。抗结核治疗(ATT)方案仍然是这些患者整体治疗的基础支柱,针对性的手术干预可改善临床结局。

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