Department of Orthopaedic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands.
Hip Int. 2022 Sep;32(5):685-693. doi: 10.1177/1120700021989666. Epub 2021 Feb 10.
The hip is one of the most commonly affected joints in paediatric septic arthritis. Drainage can be performed using arthrocentesis (articular needle aspiration), arthroscopy or arthrotomy. The objective of this systematic review was to identify the most effective drainage technique for septic hip arthritis in the paediatric population.
The electronic MEDLINE, EMBASE and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the paediatric hip. Outcome parameters were additional drainage procedures, clinical outcomes and radiological sequelae. The quality of each of the included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) score.
Out of 2428 articles, 19 studies with a total of 406 hip joints were included in the systematic review. Additional arthroscopy or arthrotomy was performed in 15% of the hips treated with arthrocentesis, in 14% after arthroscopy and in 3% after arthrotomy. Inferior clinical outcomes and more radiological sequelae were seen in patients treated with an arthrotomy. A meta-analysis could not be performed due to the diversity and low quality of the studies (MINORS median 4 [range 2-15]).
This systematic review gives a comprehensive overview of the available literature on treatment for septic hip arthritis in children. Arthrocentesis and arthroscopic procedures may have a higher risk of additional drainage procedures in comparison with arthrotomy. However, arthrotomy might be associated with inferior outcomes in the longer term. The included studies are diverse and the scientific quality is generally low.
髋关节是小儿化脓性关节炎最常受累的关节之一。可以通过关节穿刺（关节针抽吸）、关节镜检查或关节切开术进行引流。本系统评价的目的是确定小儿化脓性髋关节炎最有效的引流技术。
系统检索了电子 MEDLINE、EMBASE 和 Cochrane 数据库中关于关节穿刺术、关节镜检查或关节切开术治疗小儿髋关节化脓性关节炎的原始文章，以报告关节穿刺术、关节镜检查或关节切开术的结果。结果参数为额外的引流程序、临床结果和放射学后遗症。使用非随机研究方法学指数（MINORS）评分评估纳入研究的质量。
在 2428 篇文章中，共有 19 项研究，共 406 个髋关节纳入了系统评价。关节穿刺治疗的髋关节中有 15%需要进一步进行关节镜检查或关节切开术，关节镜检查后的髋关节中有 14%需要进一步进行，关节切开术后的髋关节中有 3%需要进一步进行。关节切开术治疗的患者临床结果较差，放射学后遗症更多。由于研究的多样性和低质量，无法进行荟萃分析（MINORS 中位数 4 [范围 2-15]）。
本系统评价全面概述了小儿化脓性髋关节炎治疗的现有文献。与关节切开术相比，关节穿刺术和关节镜检查可能有更高的额外引流程序风险。然而，关节切开术可能与长期较差的结果相关。纳入的研究存在差异，科学质量普遍较低。
