Department of Pediatric Surgery, Pellegrin University Hospital, Bordeaux.
Spine Center, Trélazé, France.
J Pediatr Orthop B. 2024 Jul 1;33(4):374-378. doi: 10.1097/BPB.0000000000001119. Epub 2023 Aug 15.
How drainage of septic arthritis should be performed remains controversial. The aim of the present study was to compare arthrocentesis (Ac) using double intra-articular needle lavage to arthrotomy (At) as first-line drainage treatment for pediatric hip and knee septic arthritis. The secondary objective was to identify risk factors of second articular drainage. A retrospective review of medical records of children with knee and hip septic arthritis was conducted. Inclusion criteria were: children treated for septic arthritis between 2014 and 2020 with a positive culture of joint fluid. Clinical, biological, radiographical and ultrasound data were recorded at presentation and during follow-up. Patients were divided into 2 groups according to the type of drainage performed: Ac or At. 25 hips and 44 knees were included, 42 treated by Ac (15 hips, 27 knees) and 27 by At (10 hips, 17 knees). There is no significant difference between Ac and At regarding the need for repeated drainage and Ac nor At was reported as risk factor for repeated drainage. The presence of associated musculoskeletal infection (MSI) was a significant risk factor of repeated drainage [odds ratio = 11.8; 95% confidence interval = 1.2-114.2; P < 0.001]. Significantly more associated MSI ( P < 0.001), level I virulence germs ( P < 0.001) and positive blood culture (<0.001) were found in patients who underwent repeated drainage. There was no significant difference between Ac and At regarding rate of repeated drainage. The risk factors for repeated drainage were: associated with MSI, virulent germs and positive blood culture.
关节切开术还是关节穿刺术用于治疗儿童髋关节和膝关节化脓性关节炎仍存在争议。本研究旨在比较关节内双针冲洗与关节切开术作为小儿髋关节和膝关节化脓性关节炎一线引流治疗方法。次要目标是确定再次关节引流的危险因素。回顾性分析了 2014 年至 2020 年间患有膝关节和髋关节化脓性关节炎的儿童的病历。纳入标准为：关节液培养阳性的化脓性关节炎患儿；记录入院时和随访期间的临床、生物学、影像学和超声数据。根据引流方式将患者分为两组：关节穿刺术（Ac）或关节切开术（At）。共纳入 25 个髋关节和 44 个膝关节，其中 42 个髋关节接受 Ac 治疗（15 个髋关节，27 个膝关节），27 个髋关节接受 At 治疗（10 个髋关节，17 个膝关节）。重复引流方面，Ac 和 At 之间没有显著差异，Ac 和 At 也未被报道为重复引流的危险因素。合并的肌骨感染（MSI）是重复引流的显著危险因素[比值比=11.8；95%置信区间=1.2-114.2；P<0.001]。重复引流患者中，合并 MSI（P<0.001）、I 级毒力细菌（P<0.001）和血培养阳性（P<0.001）的比例显著更高。重复引流率方面，Ac 和 At 之间无显著差异。重复引流的危险因素包括：合并 MSI、毒力细菌和血培养阳性。
