化膿性肩関節炎の治療経験

Septic Arthritis of the Shoulder

　目的：外科的治療を行った化膿性肩関節炎5症例について検討し報告する．対象：男性4例，女性1例，平均年齢58.2歳，平均経過観察期間は1年11カ月であった．結果：基礎疾患を4例に認め，2例に注射歴があった．治療開始期間は平均17.8日，初回手術は切開排膿・デブリードマン・ドレナージを2例，切開排膿・デブリードマン・持続灌流を3例に行った．MRIは3例に施行し，病巣を上腕骨頭内に認めるもの3例，骨幹部に認めるもの2例，関節窩に認めるもの1例であった．考察：発症早期からの外科的治療が有用で，MRIでの感染範囲の評価が重傷度の判定に有用である．

　Septic arthritis of the shoulder is uncommon in adults. The purpose of this report is to describe our experience with 5 cases treated surgically. There were 4 males and one female, and their ages ranged from 26 to 71 years old (mean 58.2). Their follow-up periods ranged from 13 to 34 months (mean 23 months). All but one patient had at least one serious associated disease. Two patient had received intra-articular injections of the shoulder. MRSA was detected in two patients, MSSA in one patient, pneumococcus in one patient, and anaerobes in one patient. The intervals between the onset of symptoms the initial medical examination ranged from 7 days to 37 days (mean 17.8 days). The initial operation was open arthrotomy in 3 patients and continuous irrigation in 2 patients. Additional operations were performed in two patients. The JOA scores at the final follow-up examination ranged from 31 to 100 (mean 80.2). As Gelberman, the risk factors for septic arthritis of the shoulder were a delay in the start of treatment, elderly person, compromised host, serious underlying disease, and virulent organism. We found that infection by drug-resistant bacteria and complication by osteomyelitis were also risk factors.