Zimmermann B, Mikolich D J, Lally E V
Brown University School of Medicine, Providence, RI, USA.
Semin Arthritis Rheum. 1996 Dec;26(3):592-604. doi: 10.1016/s0049-0172(96)80010-2.
Two cases of septic sacroiliac (SI) joint arthritis are presented to illustrate the difficulty of diagnosing and treating this uncommon osteoarticular infection. The patients presented are a 68-year-old woman with septic sacroiliitis caused by Streptococcus agalactiae and a 20-year-old man with Salmonella infantis infection involving the SI joint. The recent literature is reviewed and compared with previously published series. Of the 177 cases we reviewed, 47 (27%) occurred in pediatric patients. The mean age was 20 years. Only six patients (3%) were older than 60 years of age. Magnetic resonance imaging (MRI) is most useful for defining extent of infection, osteomyelitis, and abscess formation in the SI joint. Computed tomography (CT) is valuable for defining the extent of bone involvement and for guidance of percutaneous needle arthrocentesis. Other imaging modalities are useful primarily in the initial evaluation of patients with a nonspecific presentation. Four to six weeks of intravenous (i.v.) antibiotic therapy is recommended. Indications for surgical intervention include abscess formation, osteomyelitis, sequestrum of necrotic bone, and failure to respond to i.v. antibiotic therapy.
本文介绍了两例化脓性骶髂关节炎病例，以说明诊断和治疗这种罕见的骨关节炎感染的困难。所呈现的患者分别是一名68岁因无乳链球菌引起化脓性骶髂关节炎的女性，以及一名20岁因婴儿沙门氏菌感染累及骶髂关节的男性。对近期文献进行了回顾，并与先前发表的系列研究进行了比较。在我们回顾的177例病例中，47例（27%）发生在儿科患者中。平均年龄为20岁。只有6例患者（3%）年龄超过60岁。磁共振成像（MRI）对于确定骶髂关节感染范围、骨髓炎和脓肿形成最为有用。计算机断层扫描（CT）对于确定骨受累范围和引导经皮针关节穿刺很有价值。其他成像方式主要在对表现不特异的患者进行初始评估时有用。建议进行4至6周的静脉抗生素治疗。手术干预的指征包括脓肿形成、骨髓炎、坏死骨死骨、以及对静脉抗生素治疗无反应。
