高原地区婴幼儿化脓性关节炎的临床诊治

目的: 探讨高原地区婴幼儿化脓性关节炎的临床表现, 提高早期诊断水平, 寻求更好的诊治方法。方法: 回顾性分析研究 28例住院患者。结果: 婴幼儿化脓性关节炎在早期特别在新生儿期极易漏诊, 高原地区因文化、经济、交通、信仰等原因更容易漏诊, 早期诊断率较低, 后遗症严重, 致残率极高。结论: 婴幼儿化脓性关节炎的早期诊治是避免严重后遗症的关键因素, 特别在高原地区, 提高临床医师对本病的认识和了解, 重视专科查体, 必要的B超及关节穿刺是获得早期诊断的重要手段, 早期进行治疗是提高疗效、预防严重后遗症的重要保证。     

144例化脓性髋关节炎早期诊断与治疗临床探讨

目的:探讨化脓性髋关节炎早期诊治的临床意义。方法:将我院1990～2002年诊治的144例化脓性髋关节炎患者予总结分析。结果:入院确诊时间≤7天的患者,治疗后关节功能完全恢复正常者达96.7％,8～15天者为66.7％,≥15天者则只有6.7％能完全恢复正常。结论:化脓性髋关节炎的早期治疗对控制病情和减少遗留关节功能障碍最为重要。     

儿童早期化脓性髋关节炎:3.0TMR影像特征分析

目的探讨儿童早期化脓性髋关节炎3．0TMR影像特征。方法收集我院2004年1月2008年4月间发病时间在两周之内确诊为早期化脓性髋关节炎21例，所有病例均经临床血细菌培养、关节液细菌培养和组织学病理检查证实，所有患者均行3．0TMR双侧髋关节轴位及冠状位平扫，分析3．0TMR早期化脓性髋关节骨髓、骨骺、软骨、周围软组织影像特征性改变。结果MR表现：①患髋骨髓、骨骺及软骨信号改变：化脓性髋关节炎中13例患者股骨头骨骺及干骺端内部信号不均，骨骺形态失常，呈斑片状长T1长T2信号，为骨质破坏的表现，累及骺板者表现为穿越骺板的T2WI条形高信号影，累及骨骺软骨者表现为骺软骨薄厚不均，信号异常，还可以累及相邻的髂骨、耻骨。②患髋关节周围软组织信号改变：19例化脓性髋关节炎患者髋周软组织T2W—SPAIR上高信号（水肿表现），多累及髂肌、臀肌、耻骨肌及股内外侧肌，其中1例化脓性关节炎患者仅表现为肌间隙条片状高信号。③髋关节积液：21例均出现患侧髋关节积液，其中2例同时出现健侧髋关节积液。结论3．0TMR检查有助于儿童早期化脓性髋关节炎诊断与鉴别诊断，儿童早期化脓性髋关节炎3．0TMRI影像特征为骨髓、骨骺及软骨信号的异常升高和患髋关节周围软组织水肿。     

婴幼儿化脓性髋关节炎后遗症的处理

本文报告１０例婴幼儿化脓性髋关节炎后遗症的治疗，年龄２～１１岁，大多数为新生儿时期发病，严重者股骨头战坏死吸收致头颈缺如，患肢短缩畸形。对１０例不同术式治疗病例经２～８年平均３．７年随访，作者认为股骨牵引下移同时行髋臼成形术，以大转子代替股骨头负重，股骨不短缩，髋关节功能好，而且大转子骨骺随着生长进一步生长发育，临床效果较其它术式满意。     

婴幼儿急性化脓性髋关节炎贻误诊断原因探讨

目的 :探讨婴幼儿急性化脓性髋关节炎不能被早期确诊的原因。方法 :对 1987年 3月～ 2 0 0 2年 12月收治的 3 9例婴幼儿急性化脓性髋关节炎病例进行了统计、分析、随访。结果 :因对早期症状和体征不熟悉 ,忽略了常规的物理和传统的检查方法 ,过分的依赖现代化的辅助检查手段 ,这是早期不能确诊的主要原因。结论 :婴幼儿的躁动不安、蹄哭、发热 ,一侧下肢的肌痉挛不活动应视为急性化脓性髋关节炎的早期体征 ,加上关节穿刺的异常改变 ,发病初期可确立诊断     

骨痂延长术治疗婴幼儿期化脓性髋关节炎后遗短肢畸形

目的 评价骨痂延长术治疗婴幼儿期化脓性髋关节炎后严重短肢畸形的疗效。方法采用长骨髓内延长器对24例婴幼儿期化脓性髋关节炎后遗肢体短缩畸形行股骨骨痂延长术，术前患肢平均短缩8．4(6-12．5)cm。结果随访3-5年，24例患短肢畸形全部纠正，股骨延长6．2-12．5cm，平均0．6mm／d。20例跛行消失，4例跛行明显减轻。结论股骨骨痂延长术是治疗婴幼儿期化脓性髋关节炎后严重短肢畸形的较好方法。     

急性化脓性髋关节炎的关节镜治疗

目的：对成人急性化脓性髋关节炎关节镜下施行引流术后评价其疗效。对象及方法：9例成人急性化脓性髋关节炎，根据理学检查和关节穿刺确诊后关节镜下急诊行边缘切除术及冲洗术，术后监测ESR(血沉)及CRP(C-反应蛋白)值观察其疗效。结果：ESR恢复正常需11．9d，CRP恢复正常需8．9d。术后随访1年全部病例关节功能恢复正常，化验检查未发现感染征象。结论：成人急性化脓性髋关节炎在关节镜下行关节边缘切除术及冲洗、引流术比关节切开引流术能减少术后并发症，是能取得良好疗效的有效术式。     

髋关节穿刺置管冲洗引流治疗急性化脓性髋关节炎

急性化脓性髋关节炎系关节内化脓性细菌感染，多为金葡萄。如果治疗不及时或治疗不当，轻可致残。重则危及生命。传统的处理方法是在联台应用足量有效抗生素。加强全身支持疗法和患肢制动的条件下早期切开减压、置管持续冲洗引流。     

婴幼儿感染性股部肿胀临床分析

目的:为深入了解感染引起的婴幼儿股部肿胀的临床特点,本文结合临床病例作了分析。方法:对14例感染性股部肿胀患儿的有关临床资料进行了回顾性分析和讨论。结果:婴幼儿感染性股部肿胀主要由股深部脓肿、股骨骨髓炎和化脓性髋关节炎引起。经治疗10例愈合良好,4例遗留不同程度的后遗症。结论:婴幼儿感染性股部肿胀需要早期准确认识,及时合理治疗。     

急性化脓性髋关节炎压力测定及病理检查

探讨急性化脓性髋关节炎的病理过程及其外科治疗。方法选择急性血源性化脓性髋关节炎１９例２２髋,作关节腔、股骨头颈压力和股骨头、颈骨髓涂片及病理检查,并行髋关节切开减压及股骨头颈钻孔减压引流。结果急性血源性化脓性髋关节炎的关节腔压力明显增高,平均为５．４３ｋＰａ,股骨头颈压力高于２．９４ｋＰａ为１３髋。     

Septic physeal separation of proximal femur in a newborn

In newborns physeal separations and septic osteomyelitis or arthritis are unusual, representing a problem in diagnosis and treatment. Therapy needs to be carried out soon in order to prevent anatomical and functional consequences. Association between septic event and physeal separation is rare. We report a 28-day-old female, admitted for elevated temperature, who underwent three nonorthopaedic surgical procedures before, and orthopaedic evaluation 8 days after admission. After an X-ray and an ultrasonography a septic arthritis with consequent hip dislocation was supposed. Only at the time of surgery a separation between the epiphysio-trochanteric nuclei complex and the femoral shaft was observed, with clear hip joint. The interest in this case consists in the difficulty of the differential diagnosis at the first evaluation, the orthopaedic misdiagnosis based on the lack of complete preoperative imaging, and finally the long-term excellent result after a prompt surgical treatment.     

Hematogenous septic arthritis of the adult hip

A retrospective review of 10 patients admitted to 4 regional hospitals between 1987 and 1997 in whom acute septic hip arthritis was diagnosed was performed to compare presentation, laboratory and radiographic findings, treatment, and outcome. Patients presented with fever, hip or groin pain, and an inability to bear weight. Most patients manifested a leukocytosis, and all patients had an elevated erythrocyte sedimentation rate. Hematogenous septic hip arthritis is rare. The consequences of a missed diagnosis are serious and include death. Clinical examination combined with appropriate laboratory and radiographic studies leads to prompt diagnosis and treatment.     

Septic arthritis of the hip in a hemophiliac. Report of a case

Septic arthritis of the hip occurred in a 32-year-old hemophiliac with circulating Factor VIII antibodies. The clinical presentation suggested a soft tissue hematoma, but failure of early resolution with immobilization and Factor VIII replacement led to a correct diagnosis. A non-invasive method of management is essential if antibodies to Factor VIII are present. Compression and Plaster of Paris immobilization of the joint with adequate antibiotic therapy allows resolution of the infection and return to normal function. To avoid the serious complication of septic arthritis in hemophilia, expeditious treatment of all foci of infection is a necessity.     

Significance of laboratory and radiologic findings for differentiating between septic arthritis and transient synovitis of the hip

Although significant differences exist in the methods of treatment and prognoses of septic coxitis and transient synovitis in children complaining of acute hip pain, similar symptoms are present in these two diseases at the early stages, and differential diagnosis is difficult. To differentiate between these two diseases, the authors evaluated the clinical, serologic, and radiologic findings and tried to determine factors that could be used as diagnostic criteria. The authors performed a retrospective study by evaluating medical records, plain hip radiographs, and clinical findings in 97 patients with transient synovitis and 27 patients with septic arthritis. Univariate analysis showed significant differences in body temperature, serum WBC count, and ESR and CRP levels of the two patient groups. Plain radiographs showed a displacement or blurring of periarticular fat pads in all patients with acute septic arthritis, and multivariate regression analysis showed that body temperature >37 degrees C, ESR >20 mm/h, CRP >1 mg/dL, WBC >11,000/mL, and an increased hip joint space of >2 mm were independent multivariate predictors of acute septic arthritis. The authors conclude that the independent multivariate predictors are effective indices for the differential diagnosis of acute septic coxitis and transient synovitis.     

Psoas abscess complicating Crohn’s disease: Report of a case

We describe herein the case of a psoas abscess complicating Crohn's disease, and present a review of the literature on this unusual disease entity. A 22-year-old Japanese man with a 5-year history of Crohn's ileocolitis presented with right lower abdominal and hip pain, and a diagnosis of right psoas abscess was subsequently made by abdominal computed tomography (CT). Following the administration of antibiotics and CT-guided percutaneous drainage of the abscess, the patient's symptoms temporarily improved; however, 2 weeks later, the abscess cavity was found to have extended around the periarticular tissue of the right hip joint. To prevent the development of septic arthritis of the hip joint, surgical drainage of the abscess cavity and ileocecal resection were immediately performed, after which the patient's condition greatly improved. The resected specimen showed Crohn's ileocolitis with an external fistula in the terminal ileum which was considered to have caused the psoas abscess. Since psoas abscess in Crohn's disease can result in serious complications such as septic arthritis of the hip joint if left untreated, aggressive treatment should be initiated without delay. Received: June 17, 1999 / Accepted: March 24, 2000     

Psoas abscess with associated septic arthritis of the hip in infants

We describe psoas abscess with concomitant septic hip arthritis in 2 infants, 3 and 7 months old. The common clinical features were a palpable mass in the inguinal region, irritable hip, and delayed treatment. The diagnosis of septic hip was delayed in one child, and they both had residual hip deformity at follow-up. It is possible that initial delay in diagnoses resulted in the concurrent pathologic condition because of spread of infection. These 2 cases demonstrate the first known reports of concurrent psoas abscess and septic hip arthritis in infancy. Magnetic resonance imaging is a valuable method to identify these concurrent pathologic conditions. A proposed etiologic mechanism is also discussed in the article.     

The Management of Septic Arthritis in Childhood

A prospective study of one hundred children with septic arthritis showed that the knee and hip were the joints most affected and that Staphylococcus aureus and Haemophilus influenzae Type B were the commonest bacteria grown. Our treatment, consisting of early arthrotomy and intravenous methicillin and ampicillin, followed by six weeks of joint immobilization and oral administration of cloxacillin and ampicillin, effectively reversed the inflammatory process and compared very favourably with other methods of treatment. Significant residual joint abnormalities, present in 7% of the children, resulted from severe joint damage occurring before treatment. To achieve the best results, this regime must be instituted before permanent joint damage has occurred. This will only be achieved if an early clinical diagnosis of septic arthritis is made     

Septic arthritis of the hip: a case report

A 61-year-old female presented to a chiropractic clinic complaining of right hip pain of three days duration. Examination revealed a stiff and painful hip. An AP pelvis radiograph taken on that day did not reveal radiographic signs of hip infection. A diagnosis of hip sprain was recorded. The patient was treated conservatively for 7 weeks with rest, NSAIDS and electrotherapy. Her condition failed to improve with this treatment and deteriorated further. The patient was then referred for an orthopaedic consultation. Results from a technetium-99m-labelled methylene diphosphonate ([^99mTc]MDP) bone scan and a gallium-67 (⁶⁷Ga) bone scan suggested a diagnosis of hip joint infection. Subsequent, radiographs of the right hip revealed marked destruction of the right femoral head and acetabulum. Staphylococcus aureus was isolated following aspiration of the painful hip confirming a diagnosis of septic arthritis. The patient went on to operative treatment and is awaiting a total hip replacement. Septic arthritis of the hip can be easily overlooked, initially, as a possible cause of hip pain. The differential diagnosis of a stiff and painful hip must include septic arthritis.     

Die septische Koxitis des Erwachsenen

Septic arthritis of the hip can be caused via a hematogenous route, by penetration of periarticular infections, open hip trauma, injections or operations. Ultrasound, hip puncture and elevation of inflammatory parameters lead to the diagnosis. Differentiation of septic arthritis from gout and chondrocalcinosis may be difficult. Nevertheless, early revision of the hip has to be performed to avoid joint destruction. Open revision is the therapy of choice in the majority of cases.