关节镜治疗婴幼儿化脓性膝关节炎的疗效分析  

Arthroscopic Treatment for Septic Arthritis of the Knee in Infants

作　　者：吕辉照 梁志白 艾建国[1] 赵枫[1] 张爱玲[1] LYU Huizhao;LIANG Zhibai;AI Jianguo;ZHAO Feng;ZHANG Ailing(Department of Pediatric Orthopaedics,910th Hospital of PLA,Quanzhou 362000,China)

机构地区：[1]中国人民解放军联勤保障部队第910医院小儿骨科,福建泉州362000

出　　处：《骨科》2023年第4期347-352,共6页ORTHOPAEDICS

摘　　要：目的探讨关节镜治疗婴幼儿化脓性膝关节炎的疗效。方法回顾性分析2016年2月至2020年3月我院小儿骨科收治的16例婴幼儿化脓性膝关节炎的临床资料,患儿入院即给予足量敏感抗生素治疗,择期采用直径2.7 mm关节镜系统行膝关节清创术,其中10例术后留置冲洗引流、6例未行引流。记录患儿体温、儿童疼痛行为量表(FLACC)评分、应用躁动评分(SAS)、MRI髌上囊积液最大宽度及白细胞计数(WBC)、中性粒细胞计数(NEUT)、红细胞沉降率(ESR)、C-反应蛋白(CRP)及降钙素原(PCT)等感染指标。结果所有患儿均获得随访,随访时间为(38.44±11.44)个月(23~63)个月。术后体温[(36.86±0.22)℃]、FLACC评分[(2.19±0.91)分]、SAS评分[(1.25±0.45)分]、MRI髌上囊积液最大宽度[(4.88±1.67)mm]、WBC[(7.45±2.01)109/L]、NEUT[(3.86±1.18)109/L]、ESR[(14.81±4.00)mm/h]、CRP[(14.75±5.90)mg/L]及PCT[(0.04±0.02)ng/mL]均低于术前(P<0.05)。但引流组与未引流组体温、FLACC评分、SAS评分、MRI髌上囊积液最大宽度及WBC、NEUT、ESR、CRP及PCT的差异无统计学意义(P>0.05)。末次随访时患儿两侧膝关节活动度比较,差异无统计学意义(P>0.05),未见膝关节内外翻畸形或下肢短缩等并发症。结论采用直径2.7 mm的关节镜系统治疗婴幼儿化脓性膝关节炎,可以有效显露和清理脓性组织,增加感染治愈率,避免切开引流造成的继发损伤。Objective To evaluate the curative effect of arthroscopic treatment for septic arthritis of the knee in infants.Methods Sixteen infants with septic arthritis of the knee between February 2016 and March 2020 were intravenously administrated with sufficient sensitive antibiotics,and then underwent knee debridement by 2.7 mm arthroscopy.Postoperatively,10 infants had irrigation and drainage,and 6 infants had no drainage.Temperature,FLACC score,sedation⁃agitation scale(SAS)score,max width of suprapatellar bursa in MRI,white blood cell(WBC)count,neutrophil(NEUT)count,erythrocyte sedimentation rate(ESR),C⁃reactive protein(CRP)and procalcitonin(PCT)were recorded.Results All infants were followed up for(38.44±11.44)months(23⁃63 months).Postoperative temperature[(36.86±0.22)℃],FLACC score(2.19±0.91),SAS score(1.25±0.45),max width of suprapatellar bursa in MRI[(4.88±1.67)mm],WBC count[(7.45±2.01)109/L],NEUT count[(3.86±1.18)109/L],ESR[(14.81±4.00)mm/h],CRP[(14.75±5.90)mg/L]and PCT[(0.04±0.02)ng/mL]were lower than preoperation(P<0.05).Temperature,FLACC score,SAS score,max width of suprapatellar bursa in MRI,WBC count,NEUT count,ESR,CRP and PCT between drainage group and nondrainage group were similar(P>0.05).At last follow⁃up,range of motion of bilateral knees were similar between two groups(P>0.05),and no varus and valgus deformity of the knee and leg length discrepancy occurred.Conclusion Treatment for septic arthritis of the knee in infants with 2.7 mm arthroscopy could effectively expose the knee and debride purulent tissue,and then increase the cure rate of infection and avoid secondary injury of arthrotomy.

关 键 词：化脓性关节炎 膝关节 婴幼儿 关节镜 冲洗引流 

分 类 号：R726.8[医药卫生—儿科]