Abstract
ObjectiveTuberculous sacroiliitis with abscess accounts for approximately 50 % of all sacroiliac joint tuberculosis cases. Tuberculous abscesses spread into the sacroiliac joint capsule, subcutaneous tissue, and the skin, and finally becomes a skin sinus. As there are no previous reports about sacroiliac joint tuberculosis with a chronic sinus, we evaluated its clinical characteristics and management by negative pressure wound therapy.MethodsA retrospective analysis of 12 patients with sacroiliac joint tuberculosis with chronic sinuses treated between January 2005 and January 2010 was conducted. Patients were treated with negative pressure wound therapy (NPWT). Treatment was divided into three phases: control phase, standard dressing changes daily for 4 weeks; interphase washout period, dressing changes every 3 days for 1 week; and intervention phase, no dressing changes until minimal sinus tract drainage (<5 ml per 24 h). Outcomes including the sinus healing time and the drainage volume were evaluated.ResultsThe mean follow-up was 37.1 months. Sinus healing was observed at an average of 25.25 ± 7.23 (range, 20–42) days after initial treatment. The mean volume of drainage did not change during the control phase, but decreased from 29.17 ± 16.63 to 0.25 ± 0.87 ml in the intervention phase. The mean daily reduction of wound volume, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in the intervention phase was greater than in the control phase (P < 0.05). Anti-tubercular therapy was administered an average of 14.00 ± 2.95 (range, 12–18) months. ESR and CRP returned to normal within 3 months after the sinus closure. Bony fusion was observed in 5 (41.7 %) patients, and fibrous ankylosis in the other patients at last follow-up. All patients healed uneventfully.ConclusionsEarly diagnosis of sacroiliac joint tuberculosis with a chronic sinus can be difficult. NPWT provides better healing of sacroiliac joint tuberculosis with a chronic sinus than standard dressing changes.
Highlights
Tuberculosis is a global problem, with an estimated 8.6 million new cases and 1.3 million related deaths in 2012
The records of 12 patients with sacroiliac joint tuberculosis and a chronic sinus tract treated at our institution between January 2005 and January 2010 were retrospectively reviewed
Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), wound volume, and drainage were compared between the control period and the intervention period in order to evaluate the effects of negative pressure wound therapy (NPWT)
Summary
Tuberculosis is a global problem, with an estimated 8.6 million new cases and 1.3 million related deaths in 2012. About 12 % of newly diagnosed cases are in China, making China the second largest tuberculosis country [32]. Skeletal tuberculosis accounts for 3 to 5 % of all tuberculosis cases. Sacroiliac joint tuberculosis accounts for approximately 10 % of skeletal tuberculosis cases [5, 13, 28]. The formation of paraspinal tuberculous abscesses is seen. Luo et al Journal of Orthopaedic Surgery and Research (2015) 10:120. The aim of this study was to evaluate the clinical characteristics and efficacy of NPWT in the management of sacroiliac joint tuberculosis with a chronic sinus tract
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