Lipatov Konstantin, Asatryan Arthur, Melkonyan George, Kazantcev Aleksandr, Solov'eva Ekaterina, Gorbacheva Irina, Voinov Mikhail
Institute of Clinical Medicine named a!er N.V. Sklifosovsky, Sechenov First Moscow State Medical University , Moscow, Russia.
Department of Healthcare, State Budgetary Institution, S.S. Yudin of Moscow City Clinical Hospital Moscow, Russia.
Acta Orthop Traumatol Turc. 2025 Mar 17;59(1):27-32. doi: 10.5152/j.aott.2025.23006.
Septic arthritis of the hand often leads to sti!ness or even complete loss of joint function. Septic arthritis with osteomyelitis is especially severe. In this case, most experts recognize the need to perform arthrodesis. This study is devoted to another way of solving this problem.
The results of treatment of 240 patients (255 joints) treated for septic arthritis of the hand were retrospectively analyzed. In most cases, septic arthritis with osteomyelitis was noted-145 (56.9%). All patients were operated on. After resection of osteochondral structures, in most cases, the developed method named distraction (gap) arthroplasty was used. Mid-term results were assessed within 7 months (interquartile range [IQR]: 4-9). Finger function was assessed using the total active motion (TAM) system.
With the development of osteomyelitis, the delay in treatment was longer than in patients without osteomyelitis: 13 days (IQR: 4-22). Tendon destruction, which prevents the restoration of joint function, was observed in 12 (4.7%) cases. After rehabilitation, the maximum median TAM was in patients after arthritis with osteomyelitis of the metacarpophalangeal (MCP) joint-68.1% (IQR: 50.1-86.2), 65.3% (IQR: 49.4-75.4), 60.8% (IQR: 58.7-72.4), and 63.8% (IQR: 51.7-71.9) after arthritis with osteomyelitis of the proximal interphalangeal (PIP) joint, distal interphalangeal (DIP) joint, and thumb interphalangeal (IP) joint, respectively.
Septic arthritis of the hand is a severe disease that is often accompanied by the development of osteomyelitis, the spread of a purulent process to the paraarticular soft tissues, and sometimes the destruction of the tendons. It often leads to the need for arthrodesis or amputation of the finger. As an alternative to this, a treatment method named "distraction (gap) arthroplasty" after resection of the a!ected structures of the joint can be considered.
Level IV, Therapeutic Study.
手部化脓性关节炎常导致关节僵硬甚至完全丧失关节功能。伴有骨髓炎的化脓性关节炎尤为严重。在这种情况下，大多数专家认为需要进行关节融合术。本研究致力于解决这一问题的另一种方法。
回顾性分析240例（255个关节）手部化脓性关节炎患者的治疗结果。在大多数情况下，发现伴有骨髓炎的化脓性关节炎——145例（56.9%）。所有患者均接受了手术。在切除骨软骨结构后，大多数情况下采用了名为撑开（间隙）关节成形术的成熟方法。在7个月内评估中期结果（四分位间距[IQR]：4 - 9）。使用总主动活动度（TAM）系统评估手指功能。
随着骨髓炎的发展，治疗延迟时间比无骨髓炎的患者更长：13天（IQR：4 - 22）。在12例（4.7%）病例中观察到肌腱破坏，这阻碍了关节功能的恢复。康复后，掌指（MCP）关节骨髓炎后关节炎患者的最大中位TAM为68.1%（IQR：50.1 - 86.2），近端指间（PIP）关节、远端指间（DIP）关节和拇指指间（IP）关节骨髓炎后关节炎患者分别为65.3%（IQR：49.4 - 75.4）、60.8%（IQR：58.7 - 72.4）和63.8%（IQR：51.7 - 71.9）。
手部化脓性关节炎是一种严重疾病，常伴有骨髓炎的发展、脓性过程扩散至关节周围软组织，有时还伴有肌腱破坏。它常常导致需要进行关节融合术或手指截肢。作为替代方法，可以考虑在切除关节受累结构后采用名为“撑开（间隙）关节成形术”的治疗方法。
四级，治疗性研究。
