假鼻疽伯克霍尔德菌致双髋慢性化脓性关节炎1例并文献回顾

58岁的老年男性患者,因"反复双髋疼痛20 d"入院。于当地医院多次行"双髋切开引流术"后转诊某院,于该院行分泌物、关节液培养结果示假鼻疽伯克霍尔德菌,先后采取抗菌药物治疗、换药、置管冲洗引流术等保守治疗均失败,复查双髋X线片示双髋关节已严重破坏,行双侧髋关节切除旷置与二期全髋关节置换术,同时予以敏感抗菌药物治疗。术后随访2年,关节功能恢复,未见感染复发。因此,在临床慢性化脓性关节炎治疗中,首先需要积极行细菌培养鉴定,选用敏感抗菌药物,其次需要严格把握手术适应证,针对骨与关节感染,应及时彻底清创灌洗引流,关节严重破坏或功能丧失者可行一二期关节置换。

Bilateral hip chronic suppurative arthritis caused by Burkholderia pseu-domallei: a case report and literature review

A 58-year-old male patient was admitted to hospital because of repeated double hip pain for 20 days. After repeated "double hip incision and drainage" in the local hospital, patient was transferred to another hospital. The results of secretion and joint fluid culture showed Burkholderia pseudomallei(B. pseudomallei). Patient experienced the failure of conservative treatment, such as antimicrobial treatment, dressing change, as well as catheter lavage and drainage. Double hip X-ray re-examination showed that double hip joint was severely damaged, exclusion treatment of bilateral hip resection and phase Ⅱ total hip arthroplasty were performed, sensitive antimicrobial agents were given at the same time. After 2 years of post-operative follow-up, joint function recovered and no infection recurred. Therefore, in the clinical treatment of chronic suppurative arthritis, first of all, it requires active bacterial culture and identification as well as selection of sensitive antimicrobial agents, secondly, it is necessary to strictly abide by indications of surgery, in view of bone and joint infection, debridement, lavage and drainage should be performed thoroughly in time, phase I and Ⅱ arthroplasty can be performed as long as severe joint damage or loss of function occur.