Luan Zhiyong,Gao Fengqi,Yao Dalu,et al.Mini-invasive treatment of pyogenic hip arthritis in children under ultrasonic guidance[J].Journal of Clinical Pediatric Surgery,2021,20(05):469-473.[doi:10.12260/lcxewkzz.2021.05.014]
超声引导下微创治疗儿童化脓性髋关节炎10例
- Title:
- Mini-invasive treatment of pyogenic hip arthritis in children under ultrasonic guidance
- Keywords:
- Ultrasonography; Osteoarthritis; Hip/ET; Paracentesis/MT; Osteoarthritis; Hip/RH; Treatment Outcome; Chind
- 分类号:
- R445;684.3
- 摘要:
- 目的 初步评估采用超声引导结合微创技术穿刺引流治疗儿童化脓性关节炎的临床效果。方法 2015年12月至2018年12月长春市儿童医院共收治儿童化脓性髋关节炎10例，其中男6例，女4例，年龄1~8岁，均为单侧发病，左侧7例，右侧3例。治疗方法包括静脉给予足量敏感性抗生素，采用全麻超声引导下穿刺置管进行持续冲洗引流，约7 d后拔管。随访6~12个月，疗效评价指标包括体温、血常规、血沉、C反应蛋白以及连续3次关节液细菌培养结果。结果 10例均超声引导下穿刺置管成功，操作过程中均无不良反应，导管留置时间5~7 d，临床症状缓解率100%。所有患者疼痛消失，关节活动度、体温、血常规、血沉及C反应蛋白恢复正常，连续3次关节液细菌培养阴性，随访6~12个月，1例髋关节活动受限，1例出现股骨头影像学改变，其余8例髋关节恢复良好，临床治愈率达90%。结论 超声引导下穿刺引流冲洗治疗儿童化脓性关节炎疗效显著，与传统开放切开引流方法相比更加安全、简便、损伤小，且无菌程度更高。
- Abstract:
- Objective To apply ultrasound-guided puncture drainage lavage plus mini-invasive surgery for pediatric suppurative arthritis so as to improve the clinical curative rate and safety. Methods From December 2015 to December 2018,a total of 10 children with unilateral pyogenic arthritis of the hip were admitted.There were 6 boys and 4 girls with an age range of (1-8) years.The involved side was left (n=7) and right (n=3).The treatments included intravenous dosing of sufficient sensitive antibiotics,general anesthesia,ultrasound-guided catheterization,continuous lavage & drainage and extubation at around 1 week.The evaluation items included body temperature,blood routine,erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),three times of joint fluid bacterial culture and symptoms. Results The success rate of ultrasound-guided puncture drainage for lavatory catheter placement was 100%.There was no intraoperative onset of adverse reactions.The catheter retention time was 5-7 days and the clinical symptom relief rate 100%.All pains disappeared,joint activity,body temperature,blood routine,ESR and C-reactive protein normalized.The bacterial culture of joint fluid remained negative thrice in a row.During a follow-up period of (6-12) months,there were limited hip joint activity (n=1),imaging changes of femoral head (n=1) and an excellent recovery of hip joint (n=8).And the clinical curative rate was 90%. Conclusion Ultrasound-guided puncture drainage lavatory treatment of children with suppurative arthritis has a significant effect.Compared with traditional open incision drainage,it is safe,simple,less traumatic and more sterile.
参考文献/References:
1 Gafur OA,Copley LA,Hollmig ST,et al.The impact of the current epidemiology of pediatric musculoskeletal infection on evaluation and treatment guidelines[J].J Pediatr Orthop,2008,28(7):777-785.DOI:10.1097/BPO.0b013e318186eb4b.
2 Staheli LT,潘少川,杨建平,等.实用小儿骨科学[M].第2版.北京:人民卫生出版社,2007:358. Staheli LT,Pan SC,Yang JP,et al.Practical Pediatric Orthopedics[M].2nd Edition.Beijing:People’s Health Publishing House,2007:358.
3 Lavi E,Gileles-Hillel A,Simanovsky N,et al.Pyogenic sacroiliitis in children:don’t forget the very young[J].Eur J Pediatr,2019,178(4):575-579.DOI:10.1007/s00431-019-03333-8.
4 Moros ML,Rodrigo C,Villacampa A,et al.Septic shock in pregnancy due to pyogenic sacroiliitis:a case report[J].J Med Case Rep,2009,3:6505.DOI:10.1186/1752-1947-3-6505.
5 金斌,孙军.6月龄以下婴儿化脓性髋关节炎诊疗分析[J].临床小儿外科杂志,2015,14(4):316-318.DOI:10.3969/j.issn.1671-6353.2015.04.019. Jin B,Sun J.Diagnosis and treatment of suppurative hip arthritis in infants aged under 6 months[J].J Clin Ped Sur,2015,14(4):316-318.DOI:10.3969/j.issn.1671-6353.2015.04.019.
6 Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].AM J Sports Med,1982,10(3):150-154.DOI:101177/036354658201000306.
7 曹豫江,李明.关节镜灌洗术治疗儿童急性化脓性髋关节炎的临床分析[J].第三军医大学学报,2013,35(7):691-692. Cao YJ,Li M.Clinical analysis of arthroscopic lavage in the treatment of children with acute suppurative hip arthritis[J].Journal of Third Military Medical University,2013,35(7):691-692.
8 P??kk?nen M,Peltola H.Treatment of acute septic arthritis[J].Pediatr Infect Dis J,2013,32(6):684-685.DOI:10.1097/INF.0b013e31828e1721.
9 P??kk?nen M,KallioMJ,Lankinen P,et al.Preceding trauma in childhood hematogenous bone and joint infections[J].J Pediatr Orthop B,2014,23(2):196-199.DOI:10.1097/BPB.0000000000000006.
10 Johnson MW.Acute knee effusions:a systematic approach to diagnosis[J].Am Fam Physician,2000,61(8):2391-2400.
11 Wheeler AM,Heizer HR,Todd JK.Influence of culture results on management and outcome of pediatric osteomyelitis and/or septic arthritis[J].J Pediatric Infect Dis Soc,2012,1 (2):152-156.DOI:10.1093/jpids/pis035.
12 P??kk?nen M,Kallio MJ,Kallio PE,et al.Significance of negative cultures in the treatment of acute hematogenous bone and joint infections in children[J].J Pediatric Infect Dis Soc,2013,2(2):119-125.DOI:10.1093/jpids/pis108.
13 Morrey BF,Marth M,Milmer O,et al.Septic arthritis in children[J].Orthop Clin North Am,1975,6(4):923-934.DOI:10.1136/bmj.c4407.
14 John EG,Andrew W,Scott JL,et al.Primary and delayed closure after open irrigation ang debridement of septic arthritis in children[J].Pediatric Orthop,2005,14(2):101-105.DOI:10.1097/01202412-200503000-00008.
15 王庆锋,温鹏.关节镜微创技术在儿童早期急性化脓性髋关节炎中的临床应用[J].宁夏医学杂志,2016,38(2):120-121.DOI:10.13621/j.1001-5949.2016.02.0120. Wang QF,Wen P.Clinical application of arthroscopic mini-invasive technique in children with early acute suppurative hip arthritis[J].Ningxia Medical Journal,2016,38(2):120-121.DOI:10.13621/j.1001-5949.2016.02.0120.
16 Ferroni A,Al Khoury H,Dana C,et al.Prospective survey of acute osteoarticular infections in a French paediatric orthopedic surgery unit[J].Clin Microbiol Infect,2013,19(9):822-828.DOI:10.1111/clm.12031.
17 Sahin U,Unlu M,Akkaya A,et al.The value of small-bore catheter thoracostomy in the treatment of malignant pleural effusions[J].Respiration,2001,68(5):501-505.DOI:10.1159/000050558.
18 宋宝健,王强.持续冲洗结合负压封闭引流治疗儿童急性化脓性关节炎[J].临床骨科杂志,2016,19(5):578-579,582.DOI:10.3969/j.issn.1008-0287.2016.05.026. Song BJ,Wang Q.Continuous Douche plus vacuum sealing drainage (VSD) in the treatment of pediatric acute suppurative osteomyelitis[J].Journal of Clinical Orthopaedics,2016,19(5):578-579,582.DOI:10.3969/j.issn.1008-0287.2016.05.026.
19 Dodwell ER.Osteomyelitis and septic arthritis in children:Current concepts[J].Curr Opin Pediatr,2013,25(1):59-63.DOI:10.1097/MOP.0b013e32835c2b42.
20 P??kk?nen M,Kallio MJ,Kallio PE,et al.C-reactive protein versus erythrocyte sedimentation rate, white blood cell count and alkaline phosphatase in diagnosing bacteraemia in bone and joint infections[J].J Paediatr Child Health,2013,49(3):189-192.DOI:10.1111/jpc.12122.
相似文献/References:
[1]俞钢 朱小春 葛午平 林炎坤 金龙 劳伟华 史浩 肖尚杰 洪淳 周佳亮 傅晓静. 胎儿外科相关疾病的产前诊断及干预[J].临床小儿外科杂志,2011,10(02):111.
The antenatal diagnosis, tassessment, and therapy of fetal surgical anomalies[J].Journal of Clinical Pediatric Surgery,2011,10(05):111.
[2]刘金桥 何静波 陈文娟 陈叶 杨芳 尹海燕.高频超声及彩色多普勒对小儿睾丸肿瘤的诊断价值[J].临床小儿外科杂志,2011,10(02):130.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):130.
[3]李萌,于增文,李索林,等.超声多普勒血管显像在内结扎法腹腔镜脾切除术中的应用[J].临床小儿外科杂志,2008,7(03):4.
[4]解承兰,张兰,傅廷亮,等.胎儿腹部病变的产前诊断及围产期处理[J].临床小儿外科杂志,2007,6(02):5.
[5]刘辉,林琼,傅忠,等.超声诊断先天性肥厚性幽门狭窄20例[J].临床小儿外科杂志,2007,6(02):20.
[6]罗远建,金科,甘青,等.儿童神经母细胞瘤的影像学表现[J].临床小儿外科杂志,2007,6(02):22.
[7]李长春 王珊 章均 欧阳军 孔祥如 杨超 赵珍珍 吕麟亚. B超引导下芯针穿刺活检术诊断儿童实体肿瘤的临床分析[J].临床小儿外科杂志,2011,10(04):247.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):247.
[8]周路遥 何秋明 朱莉玲 张遇乐 贺雪华 符柳江 夏慧敏. 术前超声评估可疑阑尾炎123例分析[J].临床小儿外科杂志,2011,10(04):270.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):270.
[9]陈文娟 段星星 李皓 张雪华 胡原 张号绒. 高频超声对疑似发育性髋关节异常患儿髋关节发育的评估价值[J].临床小儿外科杂志,2011,10(05):345.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):345.
[10]张豪 钱蔷英 阮双岁. 424例儿童阴囊内疾病的超声诊断分析[J].临床小儿外科杂志,2011,10(05):357.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):357.
备注/Memo
收稿日期:2020-04-27。
基金项目:吉林省卫生与健康技术创新项目（编号：2020J083）
作者简介:栾志勇,Email:284288854@qq.com