Zawin J K, Hoffer F A, Rand F F, Teele R L
Department of Radiology, Children's Hospital, Boston, MA 02115-5747.
Radiology. 1993 May;187(2):459-63. doi: 10.1148/radiology.187.2.8475290.
Ninety-six children with an irritable hip possibly representing septic arthritis underwent clinical and laboratory evaluation, radiography, and ultrasonography (US). Forty had normal US scans; none were later shown to have septic arthritis, although three had osteomyelitis. Fifty-six children had effusion at US. Thirty-one of these underwent US-guided aspiration, two unsuccessfully. On the basis of results of aspirate analysis, 15 of these 31 patients underwent surgical drainage, and septic arthritis was diagnosed in all 15. The mean peripheral white blood cell (WBC) count was not significantly higher in patients with septic arthritis (n = 21) than in patients with toxic synovitis (n = 24) (P = .44). However, the erythrocyte sedimentation rate and synovial fluid WBC count were significantly greater in those with septic arthritis than in those with toxic synovitis (P = .002 and P < .0001, respectively). Clinical evaluation, radiographs, and sonograms together determined the need for US-guided aspiration. US-guided aspiration allowed selection of only those with septic arthritis for operative drainage and shortened that procedure. Negative sonograms allow exclusion of septic arthritis but not osteomyelitis.
96名可能患有化脓性关节炎的髋关节疼痛儿童接受了临床和实验室评估、放射照相及超声检查（US）。40名儿童超声扫描结果正常；尽管其中3名患有骨髓炎，但后来均未发现患有化脓性关节炎。56名儿童超声检查发现有积液。其中31名儿童接受了超声引导下穿刺，2名穿刺未成功。根据穿刺液分析结果，这31名患者中有15名接受了手术引流，所有15名均被诊断为化脓性关节炎。化脓性关节炎患者（n = 21）的外周血白细胞（WBC）平均计数显著高于毒性滑膜炎患者（n = 24）（P = 0.44）。然而，化脓性关节炎患者的红细胞沉降率和滑液白细胞计数显著高于毒性滑膜炎患者（分别为P = 0.002和P < 0.0001）。临床评估、X光片和超声检查共同确定了是否需要进行超声引导下穿刺。超声引导下穿刺仅能选择那些患有化脓性关节炎的患者进行手术引流，并缩短了该手术过程。超声检查结果为阴性可排除化脓性关节炎，但不能排除骨髓炎。
