新生儿化脓性关节炎治疗方式的选择  

Treatment strategies for septic arthritis with a neonatal onset

作　　者：徐宏文 黎艺强 周庆和 刘远忠 陈伟东 李敬春 于凌佳 

机构地区：[1]广州市妇女儿童医疗中心,510623

出　　处：《中华小儿外科杂志》2016年第8期582-588,共7页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨新生儿期起病的化脓性关节炎治疗方式的选择。方法回顾性分析我院2004-2015年收治的新生儿期起病的化脓性关节炎患儿52例，其中男37例，女15例，平均起病年龄（17．5±7．6）d，入院年龄（32．6±10．7）d。44例（48个关节）获得8个月至10年的随访，平均随访（4．5±1．2）年。根据治疗方式将获得随访的48个关节分成A组（保守治疗）、B组（传统切开排脓一期关闭伤口＋术后灌洗引流）和c组（切开排脓VSD引流＋二期关闭伤口）。分析患儿的临床表现、影像学结果、治疗方式以及最终结局。结果52例患儿中，36例（69．2％）接受了手术治疗，14例（26．9％）接受保守治疗。A、B、C三组的平均延误治疗时间（15．0±8．7）d；A组的延误治疗时间（20．0±8．2）d，显著大于B组[（9．7±7．1）d]和C组[（14．6±8．2）d]（P〈0．05）。A、B、C三组患儿的静脉滴注抗生素时间为（16．9±8．5）d。A组的静脉用药时间[（13．9±5．8）d]显著小于B组[（21．6±12．6）d]（P=0．015）。A、B、C三组的起病年龄、入院年龄、住院天数、术前影像学评分差异无统计学意义（P〉0．05）。在获得随访的48个关节中，35个关节获得完全恢复（72．9％），A、B、C三组痊愈率差异无统计学意义（P=1．000）。B组和C组合并为一个手术组，其痊愈率为72．7％，手术组和非手术组痊愈率差异无统计学意义（P=0．882）。髋关节的痊愈率为33．3％，显著低于膝／踝关节（85．0％），以及肩／肘关节（78．9％）。根据Logistic回归分析，术前影像学评分（RR=2．991）、以及是否累及髋关节（RR=9．743）是预测患儿是否有残留畸形或功能障碍的影响因素（P〈0．05）。结论新生儿期起病的化脓性关节炎患儿起病隐匿，容易漏诊和延误就诊。对于起病早期的患儿和累及髋关节的患儿，推荐积极手术�Objective To explore the treatment strategies of septic arthritis with a neonatal onset. Methods From 2004 to 2015,52 babies of septic arthritis with a neonatal onset were treated. There were 37 boys and 15 girls with a mean onset age of 17. 5 ± 7. 6 days and a mean admission age of 32. 6 ± 10. 7 days. And 44 patients （48 joints） were followed up for a mean period of （4. 5 ±1.2） （2/3- 10） years. Based upon treatments, these 48 joints were divided into groups of A （conservative treatment）, B （traditional open operative drainage） and C （open operative drainage with vacuum sealing drainage）. Their clinical characteristics, treatments and outcomes were analyzed. Results Among 52 patients, 36 patients （69. 2%） were operated while another 14 （26.9%） received conservative treatment. The mean time from onset of infection to hospitalization was 15.0 ± 8. 7 days. And this time was significantly larger in group A （20. 0 ±8.2 days） than group B （9. 7 ± 7. 1 days） and group C （14. 6± 8. 2 days） （P〈0. 05）. The mean time of intravenous antibiotic therapy was 16. 9 ± 8. 5 days. And this time was significantly shorter in group A than that in group B （13. 9 ± 5.8 vs. 21.6 ± 12. 6 days） （P = 0. 015）. Among groups A,B,and C,no significant differences existed in age of onset,age at admission and pre-treatment imaging score （P〉 0. 05）. During follow-ups, 35 joints recovered completely （72. 9%）. No differences existed among groups A, B, and C （P = 1. 000）. The combined recovery rate of groups B and C （operative group） was 72. 7%. No difference existed between operative and non-operative groups. And 33. 3% of hips recovered completely. And it was significantly lower than knee/ankle （85.0%） and shoulder/elbow （78. 9%）. According to logistic regression analysis, pre-treatment imaging score （RR = 2. 991 ） and hip joint involvement （RR = 9. 743） were important predictors of unfavorable outcomes （P〈0. 05）. Conclusions Difficulties in a

关 键 词：新生儿 骨髓炎 关节炎 脓毒性 

分 类 号：R722.1[医药卫生—儿科]