胸锁关节感染1例

<正>患者,女,52岁,2017年4月18日因右胸锁关节周围出现疼痛,于当地医院就诊,以梅花针刺破右胸锁关节周围皮肤后进行拔罐治疗,之后局部出现红肿热痛及渗出伴随发热症状,最高温度可达38. 5℃,对症治疗后发热症状缓解,但局部红肿热痛症状未见消除。查体:右胸锁关节处可见3 cm×2 cm大小的发红区域,局部皮温高,肿胀明显,周     

切降性胸锁关节成形术治疗胸锁关节脱位

目的：探讨切除性胸锁关节成形术治疗胸锁关节脱位的临床应用可行性。方法：采用切除性胸锁关节成形术和修复或重建肋锁韧带治疗5例胸锁关节脱位的病例,并对结果进行平均1．8年随访、评价。结果：全部病例均随访平均1．8年,所有病人均获优秀效果,无感染、疼痛、畸形。结论：我们认为切除性胸锁关节成形术,保留或重建肋锁韧带是治疗胸锁关节脱位疗效可靠的方法。     

胸锁钩钢板治疗胸锁关节脱位的临床观察

目的:观察应用胸锁钩钢板治疗胸锁关节脱位患者的临床治疗效果。方法:2010年6月至2012年6月对7例胸锁关节脱位患者行胸锁钩钢板复位固定术治疗,其中男5例,女2例;年龄38～54岁,平均42.3岁;病程1～4周。术前患者均有外伤史,患侧胸锁关节肿胀、疼痛明显,患侧肩关节活动明显受限。术前X线片及CT证实为胸锁关节脱位,根据Rockwood评分法对术后疗效进行评价。结果:本组7例胸锁关节脱位患者按Rockwood评分法进行评价,优6例,良1例。术后未出现内固定松动、断裂,未出现再次脱位,肩关节功能良好,胸锁关节无疼痛,外观无畸形,患肢活动自如无疼痛。结论:胸锁钩钢板治疗胸锁关节脱位,手术操作简单,固定可靠,疗效肯定,值得临床推广。     

胸锁关节骨性关节炎的关节镜治疗研究

目的探索关节镜下胸锁关节成形术治疗胸锁关节骨性关节炎的治疗效果。方法 7例胸锁关节骨关节炎患者行关节镜下胸锁关节成形术。男3例, 女4例;年龄34～62岁, 平均43岁。术前和随访评估采用Constant评分和Rockwood胸锁关节评分系统。术后随访1～10个月, 平均3.7个月。结果 7例患者均于术后2周内恢复术前功能或完全活动。末次随访时, 6例无疼痛, 1例活动后轻度紧张感。Constant评分中位数从69.6分(62 ～ 80分)提高到94.3分(88～96分);Rockwood评分中位数从5.7分(3～8分)提高到14.3分(12～15分)(最多15分)。临床疗效7例全部为优(13～15分)。无并发症, 关节稳定性未见异常。结论关节镜下胸锁关节成形术是治疗胸锁关节骨关节炎的一种新的安全有效的治疗方法。     

化脓性肩锁关节炎一例报告及文献复习

报告1例由金黄色葡萄球菌引起的化脓性肩锁关节炎。患者无明显诱因出现右肩部肿痛、活动受限, 通过病史、体格检查、影像学检查和局部组织细菌培养确诊为金黄色葡萄球菌感染, 经手术及抗感染后治愈。通过文献复习, 检索并分析了57篇文献的95例化脓性肩锁关节炎, 金黄色葡萄球菌感染26例(27%), 其中明确耐甲氧西林金黄色葡萄球菌3例、甲氧西林敏感的金黄色葡萄球菌2例、耐甲氧西林表皮葡萄菌1例);链球菌13例(14%);特殊病原体6例(6%), 包括副流感嗜血杆菌2例、念珠菌1例、人苍白杆菌1例、鸟分枝杆菌1例、多杀性巴氏杆菌1例;未明确报告具体感染病原体50例(53%)。化脓性肩锁关节炎具有早期诊断困难、病情进展迅速、破坏性强的特点, MRI和超声对诊断有较高的特异性和敏感性, 且超声可辅助获取关节液送检。尽早明确病原菌是该病的治疗关键, 在未明确病原菌前需谨慎使用抗生素, 确诊后应及时抗感染治疗, 必要时手术清创, 大多数患者在积极、规范治疗后可获得满意而确切的治疗效果。     

胸锁关节解剖锁定钢板联合韧带重建治疗胸锁关节前脱位

目的观察胸锁关节解剖锁定钢板联合韧带重建治疗胸锁关节前脱位的疗效。方法选取2015年1月至2018年1月西南医科大学附属医院骨科10例胸锁关节前脱位患者,行胸锁关节解剖锁定钢板联合韧带重建治疗。其中男7例、女3例,年龄(42.20±8.08)岁。所有患者在伤后2周内接受手术治疗,以Rockwood评分评价患者术前及术后肩关节功能。术后随访9～15个月,平均(12.05±1.19)个月。结果术后X线摄片示复位满意。术前、术后3d、1个月、6个月及末次随访时患者Rockwood评分分别为(5.30±1.16)分、(8.20±0.79)分、(10.30±1.06)分、(13.40±1.26)分和(13.50±1.18)分。与术前比较,术后3dRockwood评分明显改善(P0.05);术后1个月评分较术后3d有所改善(P0.05);术后6个月较术后1个月明显改善(P0.05);末次随访时与术后6个月的评分无差异(P0.05)。末次随访时患者肩功能评分优8例、良2例,优良率为100%。未见血管神经损伤、内固定松动及断裂、胸锁关节疼痛及包块等并发症发生。结论胸锁关节解剖锁定钢板联合韧带重建治疗胸锁关节前脱位可达到固定牢靠、并发症少、关节功能恢复好的效果,可作为处理胸锁关节前脱位的新方法。     

锁骨钩钢板治疗不稳定性胸锁关节脱位

目的 探讨锁骨钩钢板切开复位治疗不稳定性胸锁关节脱位的临床意义及疗效. 方法 2005年4月至2007年10月,采用切开复位锁骨钩钢板内固定治疗19例不稳定性胸锁关节脱位患者,根据Grade分型:Ⅱ型2例,Ⅲ型17例.全部采用患侧切开复位锁骨钩钢板内固定术加关节成形术并修补肋锁韧带、胸锁韧带. 结果术后均尤再脱位,钢板尤断裂、松动、脱钩等现象.所有患者均获随访,时间6～24个月,平均8个月;愈合时间3～6周,平均4周.按照Rockwood胸锁关节评分标准:优16例,良2例,可1例,优良率为94.7%.术后患者均恢复解剖结构及外观,功能满意.结论 锁骨钩钢板内固定治疗小稳定性胸锁关节脱位具有操作简便安全、创伤小、固定可靠等优点,并有较好的维持复位和促进恢复作用,术后患者功能及外观恢复满意.     

重度胸锁关节脱位的内固定治疗

胸锁关节脱位较少见，临床上多见前脱位。传统的治疗方法多为保守治疗，因其复位容易但固定难多失败；而对于手术治疗及术式的选择，也常是临床医生感到棘手的问题。自2001年7月以来，采用切开复位胸骨缝合钢丝“8”字固定治疗胸锁关节脱位12例，经随访观察，效果满意。     

Surgical management of sternoclavicular joint septic arthritis

IntroductionInfections of the sternoclavicular joint (SCJ) account for less than 1% of all joint infections. There are no standardized diagnostic and therapeutic algorithms defined in literature. This study intended to report the risk factors, the bacterial spectrum, the extent and localization and the clinical outcome of SCJ infections.Patients and methodsWe retrospectively reviewed the medical charts of 13 patients (8 men, five women, mean age 37.6 years) with SCJ infections between Januray 1st 2008 and October 30th 2015 for clinical parameters and radiological studies. All patients were interviewed during their follow-up along with clinical examination and assessing the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH).ResultsNine patients presented with local chest pain and swelling; in 4 patients, the prevalent symptom was pain without local signs of inflammation. Full blood count revealed a mean leukocytosis of 15 × 10⁹ L and a mean CRP of 21.0 mg/dl. Approximately 61.5% reported known diabetes mellitus. 10 patients presented an involvement of surrounding structures. All patients received a preoperativ CT scan. Each patient was treated via SCJ resection without intraoperative complications. Primary wound closure was possible in all cases. The mean follow-up was 95 days. Wound culture revealed Staphylococcus aureus in all patients. Pathological examination affirmed acute osteomyelitis in 7 patients. Four patients required the intensive care of which 2 patients died from septic shock. Recurrent infection was encountered in 3 patients who underwent revision surgery. Mean DASH Score was 18.7.ConclusionCT should be routinely obtained to recognize the possible extends to the surrounding structures. SCJ resection can result in satisfactory clinical results and should be considered in cases of extended infections including the surrounding structures. Empiric antibiotic coverage should contain cephalosporin or extended-spectrum penicillin. Inappropriate or less-invasive surgical procedures may cause recurrencent infections, especially in cases of osteomyelitis.     

Surgical treatment of sternoclavicular joint infections in cirrhotic patients

BACKGROUND: Cirrhotic patients with sternoclavicular joint (SCJ) infection pose a unique challenge for which there are no management guidelines. We reviewed our experience with this unusual infection in this high-risk patient population. METHODS: We performed a retrospective analysis of all patients with cirrhosis (n = 5) treated surgically for SCJ infection from January 1998 to July 2006. RESULTS: All infections were locally advanced with bone necrosis, complex abscess formation, or mediastinal involvement. En bloc SCJ resection was performed in 3 patients. A more conservative approach of incision and drainage with debridement was performed in 2 patients. Sepsis and/or pulmonary compromise occurred in all patients postoperatively and the surgical mortality rate was 40%. All deaths occurred after en bloc SCJ resection. CONCLUSIONS: Sternoclavicular joint infections in cirrhotic patients tend to be extensive in nature and pose a high surgical risk. Adequate surgical drainage and debridement may be better tolerated than a radical en block resection.     

Surgical management of sternoclavicular septic arthritis

Introduction  

Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition and has many diagnostic and therapeutic standards. The purpose of this study was to evaluate our experience with surgical and diagnostic management to provide a surgical pathway to help surgeons treat this disease.     

Spontaneous atraumatic dislocation of sternoclavicular joint in Reiter's syndrome

Reactive arthritis or Reiter's syndrome characteristically affects the joint of the lower limb in an asymmetrical pattern.Usually it does not affect the axial skeleton or upper limbs.Although cases of ...     

闭合性胸锁关节脱位合并金黄色葡萄球菌感染1例

正患者,男,60岁,重物压砸致上胸部疼痛2周,呼吸困难3 d入院。患者2周前搬抬重物时不慎被砸中上胸部,当即出现上胸部疼痛,右肩活动时疼痛加重。在当地医院就诊予以对症治疗(具体过程不详),患者症状无明显缓解。3 d前出现呼吸困难,于我院急诊科行CT检查示右侧包裹性胸腔积液,右胸锁关节脱位。以右胸锁关节脱位,右侧包裹性胸腔积液收入院。     

Sternoclavicular joint septic arthritis and mediastinitis. A case report and review of the literature

Septic arthritis of the sternoclavicular joint is rare. Its causes have been reported to include immuno-compromizing diseases, intravenous drug abuse, fractures of the clavicle or catheterization of the subclavian vein. We report a case of septic arthritis of the SCJ in a diabetic patient following periarticular injection of steroids in the ipsilateral shoulder, as this route of infection has not been documented, to our knowledge, in the literature to date. We review the literature regarding epidemiology and methods of surgical treatment that have been proposed, and present our own surgical experience. Bacterial infection should always be suspected in cases of SCJ arthritis. If surgery is required, it is important to remember that bony procedures leave vascular structures exposed, making their cover by myoplasty mandatory.     

锁骨钩钢板在胸锁关节脱位治疗中的应用

目的:探讨应用锁骨钩钢板治疗胸锁关节脱位的方法及疗效。方法:2010年1月至2014年3月,采用锁骨钩钢板固定治疗胸锁关节脱位患者6例,其中男5例,女1例;年龄26～48岁,平均34岁;病程3～20 d.患者均为外伤后患侧胸锁关节肿胀、疼痛,患侧肩关节活动明显受限,经X线片及CT诊断为胸锁关节前脱位,根据Rockwood评分法对术后疗效进行评价。结果:所有患者术后切口愈合良好,外观美观;X线片显示胸锁关节脱位复位良好,钢板位置良好。6例患者均获随访,时间4～18个月,平均12个月。根据Rockwood评分法进行疗效评定:优4 例,良 1 例,可 1 例,未见内固定失效及再脱位,无血管、神经及胸膜等副损伤。结论:锁骨钩钢板能在复位固定胸锁关节的同时保留胸锁关节微动功能,且不损伤胸锁关节软骨面。手术安全性高,固定效果好,患者术后可进行早期康复锻炼。