Benjamin B, Khan M R
King Saud University, Abha, Saudi Arabia.
J Bone Joint Surg Br. 1994 Jul;76(4):544-7.
We reviewed 190 children with brucellosis admitted over a 7.8-year period. Seventy of these had articular involvement (36%) and the most common site was the hip (18%). All but one patient had unilateral infection. The hip was the only joint infected in 20 patients (57%). The next most common articular site was the knee. All patients had painful limitation of movement and this was the only articular sign in 28 (80%). Extra-articular signs included fever and hepatosplenomegaly. Brucella infection should be considered in every child from an endemic area who presents with fever and joint symptoms. The insidious onset and a normal or low leucocyte count help the differentiation from acute septic arthritis. Children with hip involvement had a slower response to treatment, longer hospital stays and a higher incidence of complications and relapse than those without. Complications included dislocation (n = 4) and avascular necrosis of the femoral head (n = 1). Treatment by combination chemotherapy for 6 to 12 weeks usually achieves cure and prevents relapse. A multidisciplinary team approach to management is recommended.
我们回顾了7.8年间收治的190例布鲁氏菌病患儿。其中70例有关节受累（36%），最常见的部位是髋关节（18%）。除1例患者外，均为单侧感染。髋关节是20例（57%）患者唯一感染的关节。其次最常见的关节部位是膝关节。所有患者均有活动疼痛受限，这是28例（80%）患者唯一的关节体征。关节外体征包括发热和肝脾肿大。对于来自疫区且出现发热和关节症状的每个儿童，都应考虑布鲁氏菌感染。隐匿性起病以及白细胞计数正常或降低有助于与急性化脓性关节炎相鉴别。与未累及髋关节的患儿相比，累及髋关节的患儿对治疗反应较慢，住院时间更长，并发症和复发的发生率更高。并发症包括脱位（4例）和股骨头缺血性坏死（1例）。联合化疗6至12周通常可治愈并预防复发。建议采用多学科团队管理方法。
