Agarwal Anil, Rastogi Prateek
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 110031, India.
J Clin Orthop Trauma. 2020 Dec 5;13:95-98. doi: 10.1016/j.jcot.2020.12.007. eCollection 2021 Feb.
Pathological dislocation of hip following episode of septic arthritis is a long recognized complication. We determined clinicoradiological outcome in 14 children presenting with acute septic dislocation of hip and reduced at the time of emergency arthrotomy and drainage.
The retrospective study was conducted at a tertiary care health centre located at suburb of a low income country. The study involved a 10 years chart review of children with confirmed septic arthritis of hip presenting with complication of acute joint dislocation and treated with open reduction at the time of arthrotomy and surgical drainage. All included patients were provided postoperative abduction splintage for minimum 3 months. The clinical evaluation at final follow up was done using modified Moon's criteria for outcome assessment. The radiological outcome was analyzed in terms of containment (Severin class), sequelae (Choi radiological types) and effect on acetabular development (acetabular index, AI). The AI on normal and reduced sides was compared statistically.
Average patient age at the time of presentation was 7.2 months and follow up available was 32 months (range, 12-70 months). Functionally, 5 had excellent and 6 had good outcomes at the final follow up. Two patients had fair whereas 1 had poor outcome. Seven hips were Severin class II, 4 class III and 2 class IV and 1 was class VI. One patient had Choi type IA, 3 type IB, 8 type IIA, 1 type IIB and only 1 had type IVA at follow up. The mean AI of reduced hip was 23.4° and was significantly higher than that of unaffected side (mean 15.7°).
The complication of acute septic dislocation of hip in children may not have a sinister prognosis as commonly believed. These hips however were associated with significant acetabular dysplasia in the follow up period.
化脓性关节炎发作后髋关节病理性脱位是一种早已被认识到的并发症。我们确定了14例急性化脓性髋关节脱位且在急诊关节切开引流时得到复位的儿童的临床放射学结局。
这项回顾性研究在一个低收入国家郊区的三级医疗保健中心进行。该研究涉及对确诊为髋关节化脓性关节炎并伴有急性关节脱位并发症且在关节切开术和手术引流时接受切开复位治疗的儿童进行为期10年的病历回顾。所有纳入的患者均接受了至少3个月的术后外展夹板固定。末次随访时的临床评估采用改良的穆恩标准进行结局评估。从包容情况（塞韦林分级）、后遗症（崔氏放射学类型）以及对髋臼发育的影响（髋臼指数，AI）方面分析放射学结局。对正常侧和复位侧的髋臼指数进行统计学比较。
就诊时患者的平均年龄为7.2个月，可获得的随访时间为32个月（范围12 - 70个月）。功能方面，末次随访时有5例结局为优，6例为良。2例患者结局为中，1例为差。7个髋关节为塞韦林Ⅱ级，4个为Ⅲ级，2个为Ⅳ级，1个为Ⅵ级。随访时1例患者为崔氏ⅠA型，3例为ⅠB型，8例为ⅡA型，1例为ⅡB型，仅1例为ⅣA型。复位髋关节的平均髋臼指数为23.4°，显著高于未受影响侧（平均15.7°）。
儿童急性化脓性髋关节脱位的并发症可能不像通常认为的那样预后险恶。然而，这些髋关节在随访期间伴有明显的髋臼发育不良。
