婴儿髋关节化脓性关节炎的预后影响因素分析
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摘要
目的探讨婴儿髋关节化脓性关节炎后遗症的影响因素,为预防和评估预后提供临床依据。方法回顾性分析45例髋关节化脓性关节炎患儿的临床资料,患儿均为6个月以内的婴儿,平均年龄(1.97±1.67)个月。研究其可能影响预后的因素,如性别、年龄、髋的侧别、发病至就诊时间、合并股骨近端骨髓炎、细菌种类,并对各因素利用Chi-Square Test进行单因素分析,而后进行多因素Logistc回归分析。结果 38例获得随访。25例患儿髋关节化脓性关节炎无后遗症,13例患儿存在髋关节化脓性关节炎后遗症,后遗症率为34.2%。92.3%(12例)存在后遗症患儿年龄≤2个月,61.5%(8例)存在后遗症患儿发病至就诊时间>7d,合并股骨近端骨髓炎均存在后遗症,且存在后遗症组与不存在后遗症组的患儿年龄、发病至就诊时间、合并股骨近端骨髓炎之间差异有统计学意义。多因素Logistic回归分析显示,患儿年龄、发病至就诊时间、合并股骨近端骨髓炎是髋关节化脓性关节炎后遗症发生的危险因素(P<0.05)。结论婴儿髋关节化脓性关节炎产生后遗症率高,患儿年龄、发病至就诊时间、合并股骨近端骨髓炎是其高危因素。新生儿和年龄≤2个月婴儿髋关节化脓性关节炎后遗症发生率明显增加,一般在1周之内确诊并给予合理治疗可减少后遗症的发生。
Objective To investigate the influencing factors of sequelae of septic arthritis of the hip in infants and to provide a clinical basis for prevention and evaluation of prognosis.Methods The data of 45 children with septic arthritis of the hip were collected and analyzed retrospectively.All children were infants within 6 months with an average age of(1.97±1.67)month.Factors such as gender,age,hip side,delayed treatment time,proximal femoral osteomyelitis,bacterial species,and Chi-Square Test were used for univariate analysis of each factors,Logistc regression was used for multivariate analysis based on factors that may influence the prognosis.Results The 38 patients were followed up,and 13 cases had sequelae of septic arthrit of the hip,25 cases didn't have,and the sequelae rate was 34.2%.92.3%(12 cases)of the infants with sequelae of septic arthritis of the hip are less than 2 months old,61.5%(8 cases)of the time of diagnosis were longer than 7 days,and all the infants with proximal femoral osteomyelitis had sequelae of septic arthritis of the hip.In addition,there was a significant difference between infants with sequelae and those with no sequelae in age,the time of diagnosis and proximal femoral osteomyelitis.The multivariate Logistc regression showed that age,delayed treatment time,proximal femoral osteomyelitis were significantly associated with the incidence of sequelae of hip of septic arthritis(P<0.05).Conclusion Septic arthritis of the hip has a high rate of sequelae on infant,and its prognosis is related to age,delayed treatment time,and proximal femoral osteomyelitis.The incidence of sequelae of hip of septic arthritis in neonates and infants less than two month is significantly increased.Generally,within a week,diagnosis and reasonable treatment can reduce the occurrence of sequelae.
Objective To investigate the influencing factors of sequelae of septic arthritis of the hip in infants and to provide a clinical basis for prevention and evaluation of prognosis.Methods The data of 45 children with septic arthritis of the hip were collected and analyzed retrospectively.All children were infants within 6 months with an average age of(1.97±1.67)month.Factors such as gender,age,hip side,delayed treatment time,proximal femoral osteomyelitis,bacterial species,and Chi-Square Test were used for univariate analysis of each factors,Logistc regression was used for multivariate analysis based on factors that may influence the prognosis.Results The 38 patients were followed up,and 13 cases had sequelae of septic arthrit of the hip,25 cases didn't have,and the sequelae rate was 34.2%.92.3%(12 cases)of the infants with sequelae of septic arthritis of the hip are less than 2 months old,61.5%(8 cases)of the time of diagnosis were longer than 7 days,and all the infants with proximal femoral osteomyelitis had sequelae of septic arthritis of the hip.In addition,there was a significant difference between infants with sequelae and those with no sequelae in age,the time of diagnosis and proximal femoral osteomyelitis.The multivariate Logistc regression showed that age,delayed treatment time,proximal femoral osteomyelitis were significantly associated with the incidence of sequelae of hip of septic arthritis(P<0.05).Conclusion Septic arthritis of the hip has a high rate of sequelae on infant,and its prognosis is related to age,delayed treatment time,and proximal femoral osteomyelitis.The incidence of sequelae of hip of septic arthritis in neonates and infants less than two month is significantly increased.Generally,within a week,diagnosis and reasonable treatment can reduce the occurrence of sequelae.
引文
[1]Miyahara HDS,Helito CP,Oliva GB,et al.Clinical and epidemiological characteristics of septic arthritis of the hip,2006to 2012,a seven-year review[J].Clinics(Sao Paulo),2014,69(7):464-468.
[2]Choi IH,Pizzutillo PD,Bowen JR,et al.Sequelae and reconstruction after septic arthritis of the hip in infants[J].J Bone Joint Surg Am,1990,72(8):1150-1165.
[3]Montgomery NI,Epps HR.Pediatric Septic Arthritis[J].Orthop Clin North Am,2017,48(2):209-216.
[4]Johari AN,Hampannavar A,Johari RA,et al.Coxa vara in postseptic arthritis of the hip in children[J].J Pediatr Orthop B,2017,26(4):313-319.
[5]彭明惺,刘利君,张凌燕.新生儿急性化脓性髋关节炎后遗病理性脱位的治疗与预防[J].中华骨科杂志,2000,20(10):625-629.
[6]Telleria JJM,Cotter RA,Viviana B,et al.Laboratory predictors for risk of revision surgery in pediatric septic arthritis:[J].J Child Orthop,2016,10(3):247-254.
[7]García-Arias M,Balsa A,Mola E M.Septic arthritis[J].Best Pract Res Clin Rheumatol,2011,25(3):407-421.
[8]Brischetto A,Leung G,Marshall CS,et al.A Retrospective Case-Series of Children With Bone and Joint Infection From Northern Australia[J].Medicine(Baltimore),2016,95(8):e2885.
[9]徐宏文,黎艺强,周庆和,等.新生儿化脓性关节炎治疗方式的选择[J].中华小儿外科杂志,2016,37(8):582-588.
[10]Li Y,Zhou Q,Liu Y,et al.Delayed treatment of septic arthritis in the neonate:a review of 52cases[J].Medicine(Baltimore),2016,95(51):e5682.
[11]Mccarthy JJ,Dormans JP,Kozin SH,et al.Musculoskeletal infections in children:basic treatment principles and recent advancements[J].Instr Course Lect,2005,54(4):515-528.
[12]金斌,孙军.6月龄以下婴儿化脓性髋关节炎诊疗分析[J].临床小儿外科杂志,2015(4):316-318.
[13]Chaudhari N,Gajjar S,Menon H,et al.Risk factors for septic arthritis of hip in neonates and infants[J].Int J Res Orthop,2017,3(3):508-511.
[14]Monsalve J,Kan JH,Schallert EK,et al.Septic arthritis in children:frequency of coexisting unsuspected osteomyelitis and implications on imaging work-up and management[J].AJR Am J Roentgenol,2015,204(6):1289-1295.
[15]Chaudhari N,Menon H,Naik PV,et al.A short term outcome of septic arthritis of hip in children[J].Int J Orthop Sci,2017,3(2):496-499.
[16]Chen CE,Ko JY,Li CC,et al.Acute septic arthritis of the hip in children[J].Arch Orthop Trauma Surg,2001,121(9):521-526.
[17]Chul LS,Sup SJ,Wook SS,et al.Prognostic Factors of Septic Arthritis of Hip in Infants and Neonates:Minimum5-Year Follow-up[J].Clin Orthop Surg,2015,7(1):110-119.
[18]Vidigal Júnior EC,Vidigal EC,Fernandes JL.Avascular necrosis as a complication of septic arthritis of the hip in children[J].Int Orthop,1997,21(6):389-392.
[19]Agarwal A,Aggarwal A N.Bone and Joint Infections in Children:Septic Arthritis[J].Indian J Pediatr,2016,83(8):825-833.
[20]王悦,杨敬芳,张鲁涛,等.318株金黄色葡萄球菌的临床科室分布、耐药性及其感染的预防[J].河北医科大学学报,2008,29(6):869-873.
[21]Wang CL,Wang SM,Yang YJ,et al.Septic arthritis in children:relationship of causative pathogens,complications,and outcome[J].J Microbiol Immunol Infect,2003,36(1):41-46.
[22]Gkiokas A,Papandreou N,Papasparakis D,et al.The prognosis of the Septic hip Arthritis in childhood[J].Orthopaedic Proceedings,2004,86(2):162-163.
[23]Okubo Y,Nochioka K,Marcia T.Nationwide survey of pediatric septic arthritis in the United States[J].J Orthop,2017,14(3):342-346.
[2]Choi IH,Pizzutillo PD,Bowen JR,et al.Sequelae and reconstruction after septic arthritis of the hip in infants[J].J Bone Joint Surg Am,1990,72(8):1150-1165.
[3]Montgomery NI,Epps HR.Pediatric Septic Arthritis[J].Orthop Clin North Am,2017,48(2):209-216.
[4]Johari AN,Hampannavar A,Johari RA,et al.Coxa vara in postseptic arthritis of the hip in children[J].J Pediatr Orthop B,2017,26(4):313-319.
[5]彭明惺,刘利君,张凌燕.新生儿急性化脓性髋关节炎后遗病理性脱位的治疗与预防[J].中华骨科杂志,2000,20(10):625-629.
[6]Telleria JJM,Cotter RA,Viviana B,et al.Laboratory predictors for risk of revision surgery in pediatric septic arthritis:[J].J Child Orthop,2016,10(3):247-254.
[7]García-Arias M,Balsa A,Mola E M.Septic arthritis[J].Best Pract Res Clin Rheumatol,2011,25(3):407-421.
[8]Brischetto A,Leung G,Marshall CS,et al.A Retrospective Case-Series of Children With Bone and Joint Infection From Northern Australia[J].Medicine(Baltimore),2016,95(8):e2885.
[9]徐宏文,黎艺强,周庆和,等.新生儿化脓性关节炎治疗方式的选择[J].中华小儿外科杂志,2016,37(8):582-588.
[10]Li Y,Zhou Q,Liu Y,et al.Delayed treatment of septic arthritis in the neonate:a review of 52cases[J].Medicine(Baltimore),2016,95(51):e5682.
[11]Mccarthy JJ,Dormans JP,Kozin SH,et al.Musculoskeletal infections in children:basic treatment principles and recent advancements[J].Instr Course Lect,2005,54(4):515-528.
[12]金斌,孙军.6月龄以下婴儿化脓性髋关节炎诊疗分析[J].临床小儿外科杂志,2015(4):316-318.
[13]Chaudhari N,Gajjar S,Menon H,et al.Risk factors for septic arthritis of hip in neonates and infants[J].Int J Res Orthop,2017,3(3):508-511.
[14]Monsalve J,Kan JH,Schallert EK,et al.Septic arthritis in children:frequency of coexisting unsuspected osteomyelitis and implications on imaging work-up and management[J].AJR Am J Roentgenol,2015,204(6):1289-1295.
[15]Chaudhari N,Menon H,Naik PV,et al.A short term outcome of septic arthritis of hip in children[J].Int J Orthop Sci,2017,3(2):496-499.
[16]Chen CE,Ko JY,Li CC,et al.Acute septic arthritis of the hip in children[J].Arch Orthop Trauma Surg,2001,121(9):521-526.
[17]Chul LS,Sup SJ,Wook SS,et al.Prognostic Factors of Septic Arthritis of Hip in Infants and Neonates:Minimum5-Year Follow-up[J].Clin Orthop Surg,2015,7(1):110-119.
[18]Vidigal Júnior EC,Vidigal EC,Fernandes JL.Avascular necrosis as a complication of septic arthritis of the hip in children[J].Int Orthop,1997,21(6):389-392.
[19]Agarwal A,Aggarwal A N.Bone and Joint Infections in Children:Septic Arthritis[J].Indian J Pediatr,2016,83(8):825-833.
[20]王悦,杨敬芳,张鲁涛,等.318株金黄色葡萄球菌的临床科室分布、耐药性及其感染的预防[J].河北医科大学学报,2008,29(6):869-873.
[21]Wang CL,Wang SM,Yang YJ,et al.Septic arthritis in children:relationship of causative pathogens,complications,and outcome[J].J Microbiol Immunol Infect,2003,36(1):41-46.
[22]Gkiokas A,Papandreou N,Papasparakis D,et al.The prognosis of the Septic hip Arthritis in childhood[J].Orthopaedic Proceedings,2004,86(2):162-163.
[23]Okubo Y,Nochioka K,Marcia T.Nationwide survey of pediatric septic arthritis in the United States[J].J Orthop,2017,14(3):342-346.