儿童肩关节和髋关节感染的临床分析

A clinical analysis of shoulder and hip joint infections in children.

作者信息

Belthur Mohan V, Palazzi Debra L, Miller Jerry A, Phillips William A, Weinberg Jacob

机构信息

Pediatric Orthopaedics and Scoliosis Surgery, Texas Children's Hospital, Houston, TX 77030, USA.

出版信息

J Pediatr Orthop. 2009 Oct-Nov;29(7):828-33. doi: 10.1097/BPO.0b013e3181b76a91.

DOI:10.1097/BPO.0b013e3181b76a91

PMID:20104170

Abstract

BACKGROUND

Septic arthritis of the shoulder is a rare infection in healthy children. This infection requires prompt surgical drainage and antibiotic treatment. A delay in surgical intervention can result in damage to the articular surface of the glenohumeral joint, adjacent osteomyelitis, and possible growth disturbance. The clinical course of septic arthritis of the shoulder was compared with that of septic arthritis of the hip, a more common disease in children.

METHODS

We identified 9 children with infections of the glenohumeral joint who presented to our pediatric hospital between 2001 and 2007. The average age at presentation was 7 years (range: 7 mo to 12 y). These patients were compared with 14 selected patients treated for septic arthritis of the hip (mean age 7 y, range: 1 to 12 y). Surgical drainage was performed by open arthrotomy in each case. A retrospective review and analysis of the medical records, laboratory tests, and radiographs of these patients were performed.

RESULTS

Children with shoulder infections differed significantly (P<0.05) from patients with hip infections with regard to temperature, white blood cell count, and erythrocyte sedimentation rate at the time of admission. The average time from the onset of symptoms to presentation was notably longer in the shoulder group compared with the hip group (P=0.012). Adjacent osteomyelitis was found in 67% of the shoulders and 36% of the hips (P=0.214). Children suffering from septic arthritis of the shoulder showed higher rates of repeat surgical drainage (P=0.056) and extended hospitalizations (P=0.028). The total duration of antibiotics was longer in the shoulder group (P=0.059).

CONCLUSIONS

Septic arthritis of the shoulder in the pediatric population often has a delayed presentation with a more complicated disease course than an infection of the hip. Children with shoulder infections require a longer duration of treatment and may experience a higher likelihood of skeletal complications.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

摘要

背景

肩关节化脓性关节炎在健康儿童中是一种罕见的感染。这种感染需要及时进行手术引流和抗生素治疗。手术干预延迟可能导致肱盂关节的关节面受损、邻近骨髓炎以及可能的生长发育障碍。将肩关节化脓性关节炎的临床病程与髋关节化脓性关节炎（儿童中更常见的疾病）的临床病程进行了比较。

方法

我们确定了9例2001年至2007年间到我们儿科医院就诊的肱盂关节感染患儿。就诊时的平均年龄为7岁（范围：7个月至12岁）。将这些患者与14例因髋关节化脓性关节炎接受治疗的选定患者（平均年龄7岁，范围：1至12岁）进行比较。每例均通过切开关节术进行手术引流。对这些患者的病历、实验室检查和X线片进行了回顾性审查和分析。

结果

肩关节感染患儿与髋关节感染患者在入院时的体温、白细胞计数和红细胞沉降率方面存在显著差异（P<0.05）。与髋关节组相比，肩关节组从症状出现到就诊的平均时间明显更长（P=0.012）。67%的肩关节和36%的髋关节发现有邻近骨髓炎（P=0.214）。患有肩关节化脓性关节炎的儿童重复手术引流率（P=0.056）和住院时间延长率（P=0.028）较高。肩关节组抗生素的总使用时间更长（P=0.059）。