Nduaguba Afamefuna M, Flynn John M, Sankar Wudbhav N
Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Orthop. 2016 Jan;36(1):75-9. doi: 10.1097/BPO.0000000000000390.
Septic arthritis of the elbow in children is a rare but important musculoskeletal infection, and there is little published data to guide treating clinicians. The purpose of this study was to describe the clinical presentation and diagnostic findings, associated pathology, and microbiological profile of septic arthritis of the elbow in a pediatric population.
We retrospectively analyzed a consecutive series of children who had an elbow arthrocentesis for presumed septic arthritis and whose joint aspirates were positive for microbial growth. Data collected included demographics, presenting signs and symptoms, imaging, and laboratory data, including culture results.
Twelve children underwent diagnostic arthrocentesis of the elbow joint for septic arthritis at an average age of 6 years and 9 months (range, 2 mo to 13 y and 7 mo). Every child had pain, localized erythema and edema, and restricted range of motion; 10/12 were febrile. Mean duration of symptoms prior to joint tap was 4 days (range, 1 to 14 d). Concurrent osteomyelitis was found in 7 patients, as confirmed with magnetic resonance imaging (MRI): 5 at initial presentation and 2 after readmission for persistent symptoms. Causative pathogens were MSSA (7), MRSA (2), Group G streptococcus (1), Pseuodomonas aureginosa (1), and Streptococcus pneumonia (1). ESR was >40 mm/h in 8/11 patients, CRP was >2 mg/dL in all patients, and synovial WBC count was >50,000 cells/mm in 8/9 patients. One patient developed fulminant sepsis during hospitalization and 2 children were readmitted within 30 days of discharge for unrecognized osteomyelitis and/or recurrence of septic arthritis of the elbow.
In 12 children studied with septic arthritis, S. aureus was the most common pathogen. Diagnosis is often delayed, and in most cases inflammatory markers were elevated (ESR>40 mm/h, CRP>2 mg/dL). Concomitant osteomyelitis is quite common, and therefore magnetic resonance imaging should be considered as part of the diagnostic work-up for this condition.
Level IV—Case series.
儿童肘部化脓性关节炎是一种罕见但重要的肌肉骨骼感染疾病，目前公开的指导临床治疗的数据很少。本研究的目的是描述儿童肘部化脓性关节炎的临床表现、诊断结果、相关病理及微生物学特征。
我们回顾性分析了一系列因疑似化脓性关节炎而接受肘部关节穿刺术且关节穿刺液微生物培养呈阳性的儿童病例。收集的数据包括人口统计学资料、临床表现和症状、影像学检查以及实验室数据，包括培养结果。
12名儿童因肘部化脓性关节炎接受了诊断性关节穿刺术，平均年龄为6岁9个月（范围为2个月至13岁7个月）。每个儿童均有疼痛、局部红斑和水肿以及活动范围受限；12例中有10例发热。关节穿刺前症状的平均持续时间为4天（范围为1至14天）。7例患者经磁共振成像（MRI）证实并发骨髓炎：5例在初次就诊时发现，2例在因持续症状再次入院后发现。致病病原体包括甲氧西林敏感金黄色葡萄球菌（7例）、耐甲氧西林金黄色葡萄球菌（2例）、G组链球菌（1例）、铜绿假单胞菌（1例）和肺炎链球菌（1例）。11例患者中有8例血沉（ESR）>40 mm/h，所有患者的C反应蛋白（CRP）>2 mg/dL，9例患者中有8例滑膜白细胞计数>50,000个/mm³。1例患者在住院期间发生暴发性脓毒症，2例儿童在出院后30天内因未被识别的骨髓炎和/或肘部化脓性关节炎复发而再次入院。
在研究的12例儿童肘部化脓性关节炎病例中，金黄色葡萄球菌是最常见的病原体。诊断往往延迟，且在大多数情况下炎症标志物升高（ESR>40 mm/h，CRP>2 mg/dL）。并发骨髓炎相当常见，因此磁共振成像应被视为该疾病诊断检查的一部分。
IV级——病例系列。
