Agarwal Anil, Rastogi Prateek
Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
J Pediatr Orthop B. 2021 Nov 1;30(6):563-571. doi: 10.1097/BPB.0000000000000828.
The presented retrospective study is a report of 18 patients (23 hips) with infantile post sepsis hip sequelae. There were two groups of patients. The observation group comprised of 6 patients (8 hips). The intervention group included 12 patients (15 hips) of which 12 hips had been surgically intervened for the sequelae and 3 contralateral hips which were again serially observed. The sequelae hips were classified by Choi's radiological types. The clinical evaluation was done by modified Moon's criteria. The average patient age at follow-up was 9.3 years. There were 3 type I (13%), 10 type II (43%), 2 type III (8%), and 8 Choi type IV (35%) at presentation. The Choi radiological type showed propensity to change over time/following intervention. At follow-up, there 3 type I (13%), 17 type II (74%), and 3 type IV (13%) hips. At follow-up, there were seven excellent, seven good, and four fair results. The observation group had mostly type I or II and intervention group IIIB or IV Choi types. Findings common to both groups: same Choi radiological type fared different clinically, multiple joint involvement contributed to deterioration of function and late changes in acetabulum or proximal femur lead to deterioration of clinical function. The sequelae of septic hips likely to be kept under supervised observation were Choi type I or II. In select types, intervention changed the natural history of septic sequelae significantly.
本回顾性研究报告了18例(23髋)婴儿期败血症后髋关节后遗症患者。患者分为两组。观察组包括6例患者(8髋)。干预组包括12例患者(15髋),其中12髋因后遗症接受了手术干预,另外3例对侧髋关节再次进行了连续观察。后遗症髋关节根据崔氏放射学类型进行分类。临床评估采用改良的穆恩标准。随访时患者的平均年龄为9.3岁。就诊时,有3例I型(13%)、10例II型(43%)、2例III型(8%)和8例崔氏IV型(35%)。崔氏放射学类型显示出随时间/干预后有变化的倾向。随访时,有3例I型(13%)、17例II型(74%)和3例IV型(13%)髋关节。随访时,有7例结果为优、7例为良、4例为中。观察组大多为I型或II型,干预组为IIIB型或IV型崔氏类型。两组共同的发现:相同的崔氏放射学类型在临床上表现不同,多关节受累导致功能恶化,髋臼或股骨近端的晚期变化导致临床功能恶化。败血症后髋关节后遗症可能需要密切观察的类型为崔氏I型或II型。在某些类型中,干预显著改变了败血症后遗症的自然病程。