鏡視下デブリドマンによる化膿性肩関節炎の治療経過

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The purpose of this study was to report the clinical courses and results of arthroscopic debridement with continuous irrigation or suction drain in patients with septic arthritis of the shoulder. We studied five patients (two males, three females) with septic arthritis of the shoulder who underwent arthroscopic debridement and were followed up for more than 3 months. The average age was 66.6 years old. We reviewed the course of infection, cultured organism, postoperative management, antibiotic treatment, total number of operations and JOA score. The courses of infection were injection in two cases, CVC catheter infection in one case, peritonitis in one case and no incentive in one case. Cultured organisms were MRSA in 3 cases, MSSA in 1 case and β streptococcus in 1 case. Transitions of culture result were found in all irrigation cases. Continuous irrigation was performed in 3 cases. The total number of operations in all cases was 2.0 times on average (irrigation cases; 2.7 times, suction drain cases; 1.0 time). The first administered antibiotic agent was VCM, VCM+GM, LZD, CEZ and ABPC. Antibiotics were changed an average of 2.2 times during the treatment (irrigation cases; 3.0 times, suction drain cases 1.0 time). The mean duration of antibiotic treatment after final surgery was 46.2 days. Recurrence of the infection did not occur in any case and mean JOA score was 82.9 points at final examinations.Arthroscopic debridement is effective and less invasive to patients with septic arthritis of the shoulder but various post operative managements such as continuous irrigation or suction drain are selected in each institution. In our study, antibiotics were changed several times and multiple operations were carried out in continuous irrigation cases. Arthroscopic debridement with suction drain and optimal antimicrobial treatment is an effective strategy for selected patients with septic arthritis of the shoulder.

鏡視下デブリドマンによる化膿性肩関節炎の治療経過

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