Grimes J, Carpenter C, Reinker K
Division of Orthopaedics, University of Hawaii, John Burns School of Medicine, Honolulu 96813, USA.
J Pediatr Orthop. 1995 Sep-Oct;15(5):666-71. doi: 10.1097/01241398-199509000-00023.
Toxic shock syndrome (TSS) was initially described by Todd et al. in 1978. TSS as a complication of orthopaedic surgery was reported in 1984. There have been previously a total of nine cases of TSS reported in orthopaedic patients. These patients presented at an average of 13 days postoperatively compared to 2 days for general surgical patients. Patients with external fixators, however, presented an average of 25 days postoperatively. Menstrual TSS and nonmenstrual TSS present similarly; however, the fatality rate is reported as 10 and 50%, respectively. There was a 27% case fatality rate in orthopaedic patients. Because TSS is not a septicemia but a toxemia, the treatment depends on aggressive hemodynamic stabilization rather than antibiotic therapy. The classical presentation of TSS is not often seen in patients with TSS complicating orthopaedic surgery. Wounds rarely have any signs of infection. This presentation may be even more difficult to identify due to the occasionally long latency period between surgery and the development of TSS. It appears that external fixators may be left in place if there are no signs of infection. This requires further study.
中毒性休克综合征（TSS）最初由托德等人于1978年描述。1984年有报道称TSS是骨科手术的一种并发症。此前骨科患者中总共报告了9例TSS。这些患者术后平均13天出现症状，而普通外科患者为2天。然而，使用外固定器的患者术后平均25天出现症状。经期TSS和非经期TSS表现相似；然而，据报道病死率分别为10%和50%。骨科患者的病死率为27%。由于TSS不是败血症而是毒血症，治疗取决于积极的血流动力学稳定，而非抗生素治疗。TSS的典型表现在骨科手术并发TSS的患者中并不常见。伤口很少有任何感染迹象。由于手术与TSS发生之间偶尔存在较长的潜伏期，这种表现可能更难识别。如果没有感染迹象，外固定器似乎可以留在原位。这需要进一步研究。
