超声引导下微创治疗儿童化脓性髋关节炎10例  

Mini-invasive treatment of pyogenic hip arthritis in children under ultrasonic guidance

作　　者：栾志勇[1] 高凤奇[1] 姚大陆[1] 王贺 Luan Zhiyong;Gao Fengqi;Yao Dalu;Wang He(Department of Orthopedics,Municipal Children's Hospital,Changchun 130000,China)

机构地区：[1]长春市儿童医院,吉林省长春市130031

出　　处：《临床小儿外科杂志》2021年第5期469-473,共5页Journal of Clinical Pediatric Surgery

基　　金：吉林省卫生与健康技术创新项目(编号:2020J083)。

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。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.

关 键 词：超声检查 骨关节炎 髋/病因学 穿刺抽液术/方法 骨关节炎 髋/康复 治疗结果 

分 类 号：R445[医药卫生—影像医学与核医学] R684.3[医药卫生—诊断学]