Griffet J, El Hayek T
Service de Chirurgie Orthopédique Infantile, Hôpital de Cimiez, Nice.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(3):251-54.
Hip arthritis is a therapeutic emergency which requires sure diagnosis and pus evacuation. Two methods are presently in use: isolated or oriterative punction and arthrotomy.
A Pleurocath is introduced under general anesthesia and under fluoroscopic control by an obturator approach. It contains a perforated trocart which allows a flexible catheter, perforated over the last few centimeters to be inserted. The introduction point must be as far posterior as possible, in the plane of the anterior border of the femoral neck to promote declivious downward. It allows for pus evacuation, confirmation of the diagnosis and bacteriological samples to be taken. The lavage is done using ionized polyvidone dilution in physiological saline solution. The catheter is inserted in the center of the trocart and pushed intra-articularly under fluoroscopic control. The trocart is pulled out. The catheter is fixed on the skin using non resorbable thread. An occlusive dressing is made. A three way cock is installed for aspiration and lavage. Drainage is declivious.
This percutaneous drainage technique was used in three cases of septic hip arthritis in children. Treatment associated drainage, immobilization by traction and double or triple intravenous antibiotics. The hips healed without any detrimental effects.
The punction had both a diagnosis and a therapeutic objective, as it allows pus evacuation in the same time. It can be repeated according to the patient's progress. Most authors prefer arthrotomy with careful lavage and good drainage. We suggest an intermediate technique which includes punction and allows clinical and bacteriological diagnosis, joint lavage and drainage. Using permanent drainage, the hip joint is protected from high pressure. It makes repeated lavage possible when the pus is thick, and avoids the drain from becoming plugged.
This approach enables the pus to be evacuated, bacteriological samples to be taken, lavage and drainage. The drainage must be left until apyrexia and normal biological inflammation criteria are obtained.
髋关节炎是一种需要明确诊断和排脓的治疗急症。目前有两种方法：单次或反复穿刺及关节切开术。
在全身麻醉和透视控制下，通过闭孔入路插入一根胸膜腔导管。它包含一个带孔的套管针，可插入一根在最后几厘米有孔的柔性导管。插入点必须尽可能靠后，在股骨颈前缘平面，以利于向下倾斜引流。它可用于排脓、确诊及采集细菌学样本。冲洗使用生理盐水中的离子化聚维酮稀释液进行。导管插入套管针中心，在透视控制下向关节内推进。拔出套管针。用不可吸收线将导管固定在皮肤上。制作封闭敷料。安装三通旋塞用于抽吸和冲洗。引流呈倾斜状。
这种经皮引流技术用于3例儿童化脓性髋关节炎。治疗包括引流、牵引固定及双重或三重静脉抗生素治疗。髋部愈合良好，无任何不良影响。
穿刺兼具诊断和治疗目的，因为它能同时排脓。可根据患者病情进展重复进行。大多数作者倾向于关节切开术并仔细冲洗和充分引流。我们建议采用一种中间技术，包括穿刺，可进行临床和细菌学诊断、关节冲洗和引流。通过持续引流，可保护髋关节免受高压。当脓液浓稠时可进行反复冲洗，避免引流管堵塞。
这种方法能够排脓、采集细菌学样本、冲洗和引流。引流必须留置至体温正常且生物学炎症指标恢复正常。
