关节镜下灌洗联合手术切开清创治疗关节镜下肩袖修补术后感染

目的探讨关节镜下灌洗联合手术切开清创治疗关节镜下肩袖修补术后感染的临床疗效。方法回顾性分析2016年1月至2019年6月采用关节镜下灌洗联合手术切开清创治疗4例关节镜下肩袖修补术后感染患者资料,男3例,女1例;年龄55岁(范围,51~61岁)。4例患者均于术后1个月内出现手术部位不同程度的红肿、疼痛等症状,同时伴有发热、脓肿、窦道形成。入院后完善血液学及放射学检查,使用抗生素治疗,并根据微生物培养结果调整使用抗生素。同时采用关节镜下灌洗联合手术切开清创进行治疗。术后继续使用抗生素抗感染治疗。术后复查血常规、红细胞沉降率、C反应蛋白,X线片等,评估感染症状是否缓解及预后情况。术前及随访时均采用视觉模拟评分(visual analogue scale,VAS)和美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分评估疼痛及肩关节功能。结果4例患者手术均顺利完成,其中1例进行负压吸引1周后再关闭伤口。微生物培养结果显示,4例患者中,2例结核分枝杆菌(+)、1例铜绿假单胞菌(+)、1例金黄色葡萄球菌(+)。经治疗后患者肩部窦道均顺利愈合,患肩红肿、疼痛等症状消失。4例患者随访时间分别为3、4、32、33个月。末次随访时均未出现感染复发,肩关节活动度及评分均较清创术前好转,其中2例术后出现肩关节感染症状1个月的早期清创患者VAS及ASES评分分别由术前的5分及40分、6分及23分,分别提升至1分及80分、1分及73分;另2例术后出现肩关节感染症状病程超过6个月的患者VAS评分及ASES评分分别由术前的6分及28分、6分及32分,分别改善至1分及62分、2分及65分。4例患者均对治疗结果表示满意。结论肩关节感染病程不超过1个月时,采用关节镜灌洗联合手术切开清创的方法治疗关节镜下肩袖修补术后感染可取得较好临床疗效。

Arthroscopic irrigation combined with open debridement in the treatment of shoulder infection after arthroscopic rotator cuff repair

Objective To investigate the clinical efficacy of arthroscopic irrigation combined with surgical debridement in the treatment of shoulder infection after arthroscopic rotator cuff repair.Methods Data of 4 post-operative infected patients(male 3 cases,female 1 case;55 years(51-61 years)]after arthroscopic rotator cuff repair who underwent arthroscopic irrigation combined with surgical debridement from January 2016 to June 2019 were retrospectively analyzed.Less than 1 month after surgery,swelling,pain in the surgical area occurred and all patients had fever,abscess and sinus.Hematology and radiology were conducted immediately after admission.Antibiotic treatment was applied,and adjusted according to the culture results timely.All patients underwent arthroscopic irrigation combined with surgical debridement.Antibiotics continued accordingly after the operation.Blood routine,erythrocyte sedimentation rate,C-reactive protein,X-ray,etc.were rechecked regularly to evaluate the symptomatic relief of the infection and prognosis.Visual analogue scale(VAS)and American Shoulder and Elbow Surgeons(ASES)score were used to evaluate shoulder function during the pre-operative and post-operative follow-up period.Results The surgery was successfully completed in all 4 patients.One was treated with VSD for vacuum suction and the wound was closed one week later.The results of microbial culture showed that 2 cases were Mycobacterium tuberculosis positive,1 case Pseudomonas aeruginosa positive,and 1 case was Staphylococcus aureus positive.After treatment,the shoulder sinuses of all patients were healed,without swelling,pain,etc.The follow-up time was 3,4,32,and 33 months,respectively.There was no recurrence of infection until the latest follow-up.The joint mobility and scores were better than the situation of preoperative.The VAS score and ASES score of 2 patients with early debridement(<1 month duration of infected symptoms)were respectively improved significantly from 5 and 40,6 and 23 before operation to 1 and 80,1 and 73 respectively at the latest follow up.The VAS score and ASES score of other 2 patients(>6 months duration of infected symptoms)were respectively improved from 6 and 28,6 and 32 to 1 and 62,2 and 65 respectively.All patients were satisfied with the results.Conclusion Early arthroscopic irrigation combined with surgical debridement is an effective method to treat the post-operative infections after arthroscopic rotator cuff repair.