超声引导下穿刺治疗儿童化脓性关节炎的可行性和安全性。
The feasibility and safety of ultrasound-guided puncture for treatment of septic arthritis in children.
机构信息
Orthopedic Pediatric Surgery Department, Lapeyronie Hospital, CHU Montpellier, Montpellier University Hospital, University of Montpellier, 191 avenue du Doyen Gaston Giraud, Montpellier Cedex 5, 34295, France.
Pediatric Post-Emergency Department, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France.
出版信息
Ital J Pediatr. 2024 Sep 27;50(1):198. doi: 10.1186/s13052-024-01746-2.
BACKGROUND
In septic arthritis, joint lavage can be performed using arthrocentesis (articular needle aspiration) or arthrotomy. The use of fluoroscopy to guide the puncture involves radiation. Ultrasound (US) guidance is still little recommended to guide the treatment of septic arthritis in children. We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance.
METHODS
We retrospectively included 67 children (mean age, 3.0 years; range: 1 month-12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up.
RESULTS
We found no significant difference between the groups. After arthrocentesis, patients in the US group remained in hospital for 0.8 days longer than those in the non-US group, but the difference was not significant. After arthrotomy, the arthrotomy-US group required 0.4 more days of hospitalization than the non-US group, but the difference was not significant. Patients in the US group exhibited higher initial CRP and WBC values than patients treated without US, although the differences were not significant. The WBC values of the arthrocentesis-US groups were higher than those of the non-US groups initially and at 72 h, but non significantly so; they became similar on day 5. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications.
CONCLUSIONS
US guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery.
LEVEL OF EVIDENCE
IV (case series).
TRIAL REGISTRATION
IRB-MTP_2021_05_202100781.
背景
在化脓性关节炎中，关节灌洗可以通过关节穿刺（关节针抽吸）或关节切开术进行。使用透视引导穿刺会涉及辐射。尽管超声（US）引导在指导儿童化脓性关节炎的治疗方面仍未得到广泛推荐，但我们想知道在超声（US）引导下治疗儿童化脓性关节炎是否可行和安全。
方法
我们回顾性纳入了 67 名儿童（平均年龄 3.0 岁；范围：1 个月至 12 岁），这些儿童因髋关节、肩部或踝关节的化脓性关节炎接受关节穿刺或关节切开术治疗，这些手术均在超声（US）或透视（非-US 组）引导下进行，随访时间至少 2 年。
结果
我们未发现两组之间存在显著差异。关节穿刺后，US 组的患者在医院的住院时间比非-US 组长 0.8 天，但差异无统计学意义。关节切开术后，关节切开-US 组的住院时间比非-US 组多 0.4 天，但差异无统计学意义。US 组患者的初始 C 反应蛋白和白细胞计数均高于未接受 US 治疗的患者，尽管差异无统计学意义。US 组关节穿刺患者的白细胞计数最初和 72 小时高于非-US 组，但差异无统计学意义；第 5 天则变得相似。3 次穿刺失败需要进行关节切开术（2 次在 US 引导下）。3 名患者需要早期翻修手术：1 名患者接受 US 引导下的关节穿刺术，1 名患者接受非-US 引导下的关节穿刺术，1 名患者接受非-US 引导下的关节切开术。在最后一次随访时，没有临床后遗症，但 2 例髋关节切开术（1 例 US 引导，1 例非-US 儿童）显示无症状性钙化。
结论
US 引导治疗儿童化脓性关节炎是可行且安全的，它可以可视化 X 射线无法显示的结构，并避免手术期间的辐射暴露。
证据水平
IV（病例系列研究）。
试验注册
IRB-MTP_2021_05_202100781。
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