儿童化脓性髋关节炎预后不良的危险因素分析  

Analysis of risk factors for poor prognosis of septic hip arthritis in children

作　　者：冯伟[1] 朱丹江[1] 宋宝健[1] 王强[1] FENG Wei;ZHU Danjiang;SONG Baojian;WANG Qiang(Department of Orthopedics,Beijing Children’s Hospital Affiliated to Capital Medical University,China,100045)

机构地区：[1]首都医科大学附属北京儿童医院骨科,100045

出　　处：《武警医学》2024年第11期965-970,975,共7页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的 分析化脓性髋关节炎患者的临床特征、治疗及转归,探讨儿童化脓性髋关节炎预后不良的危险因素。方法 回顾性分析2010-01至2020-12北京儿童医院骨科收治的化脓性髋关节炎患者临床资料,所有患者接受经验性广谱抗生素治疗和关节切开减压冲洗引流术,并根据细菌培养结果调整使用抗生素。评估指标包括Choi分型、实验室检查、影像学资料、细菌学检查及预后情况。统计并分析预后不良的独立危险因素,并绘制ROC曲线计算最佳截断值。结果 共纳入化脓性髋关节炎76例,细菌培养阳性率为48.7%(37例),其中金黄色葡萄球菌最常见,占阳性组的70.3%。预后不良组(ChoiⅡ-Ⅳ型)与预后良好组(ChoiⅠ型)在C-反应蛋白(CRP)、发病至手术时间、髋脱位、骨髓炎、化脓性肌炎等方面单因素分析存在统计学差异(P<0.05)。预后不良组中位CRP为87.00(25.3, 107.5),显著高于预后良好组的42.0 (17.0, 96.0)(P=0.029)。预后不良组的发病至手术时间中位数为22.0 (15.0, 32.0)d,显著长于预后良好组的12.5 (9.0, 16.8)(P<0.001)。二元logistic回归分析显示,CRP升高(OR=1.017;95%CI:1.004, 1.031;P=0.010)和发病至手术时间延长(OR=1.229;95%CI:1.081, 1.397;P=0.002)是预后不良的独立危险因素。ROC曲线分析显示,当CRP>93 mg/L时,预后不良的灵敏度和特异度分别为70.8%和82.7%;当发病至手术时间>13.5 d时,预后不良的灵敏度和特异度分别为88.3%和61.5%。结论 化脓性髋关节炎的预后与CRP水平和发病至手术时间密切相关。早期明确诊断、及时手术及积极抗感染治疗是改善患者预后的关键。Objective To analyze the clinical features,treatment,and outcome of patients with septic hip arthritis,and to explore the risk factors for poor prognosis of children with septic hip arthritis.Methods Clinical data of patients with septic hip arthritis admitted to the Department of Orthopedics of Beijing Children's Hospital from January 2010 to December 2020 were retrospectively analyzed.All patients received empirical broad-spectrum antibiotics and joint incision and drainage surgery,followed by antibiotic adjustments based on bacterial culture results.Evaluation indicators included Choi classification,laboratory tests,imaging data,bacteriological examinations,and prognosis.Data were statistically analyzed using SPSS 26.0,with binary logistic regression employed to identify independent risk factors for poor prognosis.ROC curves were constructed to determine optimal cutoff value.Results A total of 76 cases of septic hip arthritis were included,the positive rate of bacterial culture was 48.7%(37 cases),among which Staphylococcus aureus was the most common,accounting for 70.3%of positive group.There were statistically significant differences between the poor prognosis group(Choi typeⅡ-Ⅳ)and the good prognosis group(Choi typeⅠ)in terms of CRP levels,time from onset to surgery,hip dislocation,osteomyelitis,and pyomyositis(P<0.05).The median CRP in the poor prognosis group was 87.00(25.3,107.5),significantly higher than that in the good prognosis one,which was 42.0(17.0,96.0)(P=0.029).The median time from onset to surgery in the poor prognosis group was 22.0(15.0,32.0)days,significantly longer than the 12.5(9.0,16.8)days in the good prognosis group(P<0.001).Binary logistic regression analysis indicated that elevated CRP(OR=1.017,95%CI:1.004,1.031,P=0.010)and prolonged time from onset to surgery(OR=1.229,95%CI:1.081,1.397,P=0.002)were independent risk factors for poor prognosis.ROC curve analysis showed that when CRP>93 mg/L,the sensitivity and specificity for poor prognosis were 70.8%and 82.7%,respectively;when t

关 键 词：化脓性髋关节炎 儿童 手术治疗 危险因素 预后不良 

分 类 号：R726.8[医药卫生—儿科]