髋关节穿刺后滑液白细胞计数为25,000至75,000个/立方毫米的儿科患者的管理

Management of pediatric patients with synovial fluid white blood-cell counts of 25,000 to 75,000 cells/mm³ after aspiration of the hip.

作者信息

Heyworth Benton E, Shore Benjamin J, Donohue Kyna S, Miller Patricia E, Kocher Mininder S, Glotzbecker Michael P

机构信息

Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 217, Boston MA 02115. E-mail address for B.E. Heyworth:

Department of Orthopedic Surgery, Boston Children's Hospital, 1 Autumn Street, Floor 2, Office 229, Boston, MA 02115.

出版信息

J Bone Joint Surg Am. 2015 Mar 4;97(5):389-95. doi: 10.2106/JBJS.N.00443.

DOI:10.2106/JBJS.N.00443

PMID:25740029

Abstract

BACKGROUND

In this study, we sought to elucidate the presentation, clinical course, treatments pursued, final diagnosis, and risk factors for septic arthritis in a series of children with hip pain and intermediate synovial fluid values (white blood-cell [WBC] counts of 25,000 to 75,000 cells/mm(3) [25 to 75 × 10(9) cells/L]).

METHODS

We reviewed the records of pediatric patients who underwent hip aspiration between 2005 and 2012 at a tertiary-care pediatric hospital. Demographic data, laboratory values, final diagnosis, and treatment details were recorded for the subpopulation of patients with an aspirate WBC count of 25,000 to 75,000 cells/mm(3) (25 to 75 × 10(9) cells/L). Univariate and multivariable logistic regression analysis was used to assess risk factors for septic arthritis of the hip across final diagnostic groups and subgroups with WBC values of <50,000 and ≥50,000 cells/mm(3) (<50 and ≥50 × 10(9) cells/L).

RESULTS

Forty-six children (twenty-seven males and nineteen females) with a mean age of 7.6 years met the inclusion criteria. The final diagnoses were septic arthritis of the hip (n = 15; 33%), Lyme arthritis (n = 13; 28%), transient synovitis (n = 8; 17%), and other findings (n = 10; 22%). Subjects with a synovial fluid WBC count of ≥50,000 cells/mm(3) (≥50 × 10(9) cells/L) were more likely to be diagnosed with septic arthritis of the hip (odds ratio, 4.4; 95% confidence interval, 1.1 to 16.9; p = 0.03). While septic arthritis of the hip was the most common diagnosis (48%) in patients with WBC values of ≥50,000 cells/mm(3) (≥50 × 10(9) cells/L), it also represented 17% of cases with WBC values of <50,000 cells/mm(3) (<50 × 10(9) cells/L).

CONCLUSIONS

Septic arthritis of the hip is the most common ultimate diagnosis in children with synovial fluid WBC values of 25,000 to 75,000 cells/mm(3) (25 to 75 × 10(9) cells/L) following hip aspiration, and it should be high on the differential diagnosis, even in cases with synovial fluid WBC values of <50,000 cells/mm(3) (<50 × 10(9) cells/L).

摘要

背景

在本研究中，我们试图阐明一系列髋关节疼痛且滑膜液白细胞计数处于中等水平（25,000至75,000个细胞/mm³ [25至75×10⁹个细胞/L]）的儿童中，化脓性关节炎的表现、临床病程、所采取的治疗方法、最终诊断以及危险因素。

方法

我们回顾了2005年至2012年在一家三级儿科医院接受髋关节穿刺的儿科患者记录。记录了穿刺白细胞计数为25,000至75,000个细胞/mm³（25至75×10⁹个细胞/L）的患者亚组的人口统计学数据、实验室值、最终诊断和治疗细节。采用单因素和多因素逻辑回归分析，评估最终诊断组以及白细胞值<50,000和≥50,000个细胞/mm³（<50和≥50×10⁹个细胞/L）的亚组中髋关节化脓性关节炎的危险因素。

结果

46名平均年龄为7.6岁的儿童（27名男性和19名女性）符合纳入标准。最终诊断为髋关节化脓性关节炎（n = 15；33%）、莱姆关节炎（n = 13；28%）、短暂性滑膜炎（n = 8；17%）和其他病症（n = 10；22%）。滑膜液白细胞计数≥50,000个细胞/mm³（≥50×10⁹个细胞/L）的受试者更有可能被诊断为髋关节化脓性关节炎（比值比，4.4；95%置信区间，1.1至16.9；p = 0.03）。虽然髋关节化脓性关节炎是白细胞值≥50,000个细胞/mm³（≥50×10⁹个细胞/L）患者中最常见的诊断（48%），但在白细胞值<50,000个细胞/mm³（<50×10⁹个细胞/L）的病例中也占17%。