J Am Acad Orthop Surg. 2013 Oct;21(10):632-41. doi: 10.5435/JAAOS-21-10-632.
Septic arthritis of the hip in neonates is rare but can have devastating consequences. Presenting signs and symptoms may differ from those encountered in older children, which may result in diagnostic challenge or delay. Many risk factors predispose neonates to septic arthritis, including the presence of transphyseal vessels and invasive procedures. Bacterial infection of the joint occurs via hematogenous invasion, extension from an adjacent site, or direct inoculation. A strong correlation exists between younger age at presentation and severity of residual hip deformity. Diagnosis is based on clinical examination, laboratory markers, and ultrasound evaluation. Early management includes parenteral antibiotics and surgical drainage. Late-stage management options include femoral and pelvic osteotomies, trochanteric arthroplasty, arthrodesis, pelvic support procedures, and nonsurgical measures. Early diagnosis and management continues to be the most important prognostic factor for a favorable outcome in the neonate with septic arthritis.
新生儿髋关节化脓性关节炎虽然罕见，但可产生灾难性后果。其临床表现和症状与年长儿童不同，可能导致诊断困难或延误。许多危险因素使新生儿易患化脓性关节炎，包括存在干骺端滋养血管和有创操作。关节的细菌感染通过血行播散、邻近部位蔓延或直接接种而发生。起病年龄与髋关节残余畸形的严重程度之间存在很强的相关性。诊断基于临床检查、实验室标志物和超声评估。早期治疗包括静脉用抗生素和手术引流。晚期治疗方法包括股骨和骨盆截骨术、转子间关节成形术、关节融合术、骨盆支撑术和非手术措施。早期诊断和治疗仍然是新生儿化脓性关节炎获得良好预后的最重要的预测因素。
