From the Service d'Imagerie Médicale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
Université Claude Bernard, Lyon 1, Lyon, France.
Pediatr Infect Dis J. 2021 May 1;40(5):411-417. doi: 10.1097/INF.0000000000003031.
Due to the low resolution of historical imaging technologies, descriptions of Septic Arthritis of Facet Joint (SAFJ) in children are scarce, though severe cases are known. We first aimed to estimate the incidence rate of SAFJ in children; we further aimed to specify SAFJ clinical, imaging and laboratory findings, and identify avenues for appropriate management.
A 10-year consecutive SAFJ case series using our imaging center database combined with a 50-year systematic review of literature cases.
The mean ± SD incidence of pediatric SAFJ was 0.23 ± 0.4/100,000 children-years. The key symptoms were potty refusal (in toddlers) or painful sitting (78%) and lateralized signs (paravertebral tenderness and/or swelling, 88%). SAFJ diagnosis and extension were obtained using magnetic resonance imaging (MRI) (94%), and found an epidural extension in 8/16 cases. The mean duration of antibiotic treatment was 5.1 weeks. The compliance with guidelines was 79% for empiric and 62% for targeted antibiotic therapies.
SAFJ incidence in children is much greater than expected from the literature. Half of cases were complicated by an epidural infection. Simple clinical symptoms detected as early as the bedside allow a strong suspicion of SAFJ, justifying the use of a first-line MRI to confirm the diagnosis and precisely describe the extension. Focusing on simple clinical signs is key to justify the transfer of a child or the shortening of the delay to obtain an MRI. However, as MRI availability increases in most Western countries, and the capacity for diagnosis increases, the awareness of SAFJ must be spread to avoid missed cases.
由于历史影像学技术分辨率较低，儿童的关节突关节炎（SAFJ）描述较少，但已知严重病例。我们首先旨在估计儿童中 SAFJ 的发病率；我们进一步旨在明确 SAFJ 的临床、影像学和实验室发现，并确定适当管理的途径。
使用我们的影像中心数据库进行了 10 年连续的 SAFJ 病例系列研究，并结合了 50 年的文献病例系统综述。
儿科 SAFJ 的平均发病率±SD 为 0.23±0.4/100,000 儿童年。主要症状是幼儿的拒绝排便（在幼儿中）或疼痛性坐姿（78%）和侧位体征（椎旁压痛和/或肿胀，88%）。使用磁共振成像（MRI）（94%）获得 SAFJ 的诊断和扩展，并在 16 例中有 8 例发现硬膜外扩展。抗生素治疗的平均持续时间为 5.1 周。经验性和靶向抗生素治疗的指南依从率分别为 79%和 62%。
儿童 SAFJ 的发病率远高于文献预期。一半的病例并发硬膜外感染。床边尽早发现的简单临床症状可强烈怀疑 SAFJ，这证明了使用一线 MRI 来确认诊断并准确描述扩展是合理的。关注简单的临床体征是证明转移儿童或缩短获得 MRI 的时间以避免漏诊的关键。然而，随着 MRI 在大多数西方国家的可用性增加和诊断能力的提高，必须传播对 SAFJ 的认识，以避免漏诊。
