title: The efficacy of negative pressure wound therapy in treating sacroiliac joint tuberculosis with a chronic sinus tract: a case series.
abstract: OBJECTIVE
  Tuberculous 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Early 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.
authors.affiliation: Department of Orthopedics, General Hospital of Chinese People's Liberation Army (301 Hospital), No. 28 Fuxing Road, Beijing, 100853, China. xiaoboluo213@yeah.net.|Department of Orthopedics, The 309th Hospital of Chinese People's Liberation Army, Beijing, 100091, China. xiaoboluo213@yeah.net.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Luo
authors.affiliation: Department of Orthopedics, General Hospital of Chinese People's Liberation Army (301 Hospital), No. 28 Fuxing Road, Beijing, 100853, China. xiangyutang28@yeah.net.|Chinese People's Liberation Army 264 Hospital, Beijing, China. xiangyutang28@yeah.net.
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Orthopedics, The 309th Hospital of Chinese People's Liberation Army, Beijing, 100091, China. yuanzhengma39@yeah.net.
authors.forename: Yuanzheng
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Orthopedics, General Hospital of Chinese People's Liberation Army (301 Hospital), No. 28 Fuxing Road, Beijing, 100853, China. yonggangzhang23@yeah.net.
authors.forename: Yonggang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Chinese People's Liberation Army 264 Hospital, Beijing, China. shuzhifang26@yeah.net.
authors.forename: Shuzhi
authors.initials: S
authors.lastname: Fang
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012189:Retrospective Studies; D012446:Sacroiliac Joint / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000175:diagnosis* / Q000601:surgery*; D055815:Young Adult