Tornero Eduard, De Bergua-Domingo Josep Maria, Domenech Pedro, Soldado Francisco, Torner Ferran, Castellanos Juan, Soriano Alex, Knörr Jorge
Department of Paediatric Orthopaedic Surgery, Maternal and Child Hospital, Sant Joan de Déu of Barcelona.
Department of Orthopaedic Surgery, Health Park, Sant Joan de Déu of Sant Boi de Llobregat, Barcelona, Spain.
J Pediatr Orthop. 2019 Mar;39(3):130-135. doi: 10.1097/BPO.0000000000000883.
Early joint decompression associated to antibiotic therapy is the most important procedure to reduce joint damage in septic knee arthritis in children. Several joint decompression methods have been described such as arthrotomy with open debriding, arthroscopic drainage or needle joint aspiration. The aim of the present study was to determinate which patients with acute septic knee arthritis could be safely treated with needle joint aspiration.
Patients with an acute knee arthritis diagnosed between September 2003 and December 2013 in our children's tertiary hospital were retrospective review. All cases were initially treated with needle joint aspiration. Primary end-point was failure of joint aspiration.
A total of 74 patients were included in the study. Forty-two (56.8%) were male and median age was 1.49 years. Mean delay between onset of symptoms and diagnosis was 3.6 days and in 25 (33.8%) cases patients needed more than 1 visit to the emergency room. Median C-reactive protein (CRP) value was 36.3 mg/L and was >20 mg/L in 59 (79.7%) cases. A total of 11 (14.9%) patients showed failure of the joint aspiration treatment between 3 and 21 days after initial joint aspiration. The stepwise forward logistic regression model only identified as independent predictor of joint aspiration failure an age older than 3 years old (odds ratio, 5.64; 95% confidence interval, 1.38-29.61; P=0.018). Joint aspiration did not fail in any patient younger than 12 months and neither in any patient younger than 3 years old with CRP value <20 mg/L. Otherwise, treatment failed in 38% of patients older than 3 years and in 16% of patients between 1 and 3 years with a CRP>20 mg/L.
Septic knee arthritis treated with needle joint aspiration succeed in all patients younger than 1 year and in all patients between 1 and 3 years with a CRP<20 mg/L. Alternative treatment such as arthroscopy debridement should be early considered in patients older than 3 years and patients between 1 and 3 years with CRP>20 mg/L.
Level III.
早期关节减压联合抗生素治疗是减少儿童化脓性膝关节炎关节损伤的最重要方法。已经描述了几种关节减压方法，如切开清创术、关节镜引流或关节穿刺抽吸。本研究的目的是确定哪些急性化脓性膝关节炎患者可以通过关节穿刺抽吸安全治疗。
回顾性分析2003年9月至2013年12月在我院儿科三级医院诊断为急性膝关节炎的患者。所有病例均首先采用关节穿刺抽吸治疗。主要终点是关节穿刺抽吸失败。
本研究共纳入74例患者。42例（56.8%）为男性，中位年龄为1.49岁。症状出现至诊断的平均延迟时间为3.6天，25例（33.8%）患者需要不止一次前往急诊室就诊。中位C反应蛋白（CRP）值为36.3mg/L，59例（79.7%）患者CRP>20mg/L。共有11例（14.9%）患者在初次关节穿刺抽吸后3至21天内关节穿刺抽吸治疗失败。逐步向前逻辑回归模型仅确定年龄大于3岁是关节穿刺抽吸失败的独立预测因素（比值比，5.64；95%置信区间，1.38 - 29.61；P = 0.018）。12个月以下的患者以及CRP值<20mg/L的3岁以下患者关节穿刺抽吸均未失败。否则，3岁以上患者中有38%治疗失败，1至3岁且CRP>20mg/L的患者中有16%治疗失败。
对于1岁以下的所有患者以及1至3岁且CRP<20mg/L的所有患者，采用关节穿刺抽吸治疗化脓性膝关节炎均成功。对于3岁以上患者以及1至3岁且CRP>20mg/L的患者，应尽早考虑采用关节镜清创等替代治疗。
三级。
