Shiv V K, Jain A K, Taneja K, Bhargava S K
Department of Radiology, University College of Medical Sciences, Delhi, India.
Can Assoc Radiol J. 1990 Apr;41(2):76-8.
The most important determinant of outcome of a hip infection is the delay between the onset of the infection and treatment. Transient synovitis, and septic and tubercular arthritis of the hip remain common diagnostic problems. Conventional radiographic examinations are of little help in early diagnosis. Computed tomography, scintigraphy and magnetic resonance imaging, though informative, are expensive and not universally available. Ultrasonography (US) of the hip was done in 50 patients to define sonographic anatomy, detect joint effusions and correlate sonographic features with the etiology of the disease. Even small collections of fluid could be detected with accuracy. Both hypo- and hyperechoic synovial fluid was seen in septic arthritis, but hyperechoicity and a thickened capsule were the most characteristic findings. Synovial fluid had mixed echogenicity in tubercular and transient synovitis. The use of other (invasive) imaging modalities can be minimized because US can be used not only to demonstrate effusions early in the disease but also the status of the intra-articular compartment, joint capsule, bony surface and adjacent soft tissues. Ultrasonography should be used more commonly to diagnose infective arthritis, and no patient should be subjected to arthrotomy or drainage if US has ruled out the presence of a fluid collection.
髋部感染预后的最重要决定因素是感染发作与治疗之间的延迟。髋部的 transient 滑膜炎、化脓性关节炎和结核性关节炎仍然是常见的诊断难题。传统的放射学检查对早期诊断帮助不大。计算机断层扫描、闪烁扫描和磁共振成像虽然提供信息，但费用昂贵且并非普遍可用。对 50 例患者进行了髋部超声检查，以明确超声解剖结构、检测关节积液并将超声特征与疾病病因相关联。即使是少量的液体聚集也能被准确检测到。在化脓性关节炎中可见低回声和高回声的滑液，但高回声和增厚的关节囊是最具特征性的表现。在结核性和 transient 滑膜炎中，滑液具有混合回声。由于超声不仅可用于在疾病早期显示积液，还可用于显示关节内间隙、关节囊、骨表面和相邻软组织的状态，因此可尽量减少使用其他（侵入性）成像方式。超声检查应更常用于诊断感染性关节炎，如果超声已排除积液的存在，则不应让任何患者接受关节切开术或引流。
