上海交通大学学报(医学版)

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持续闭式冲洗在儿童化脓性膝关节炎治疗中的方案选择

缪明远, 蔡海清, 王志刚   

  1. 上海交通大学 医学院附属上海儿童医学中心骨科, 上海 200127
  • 出版日期:2016-10-28 发布日期:2016-11-29
  • 通讯作者: 王志刚, 电子信箱: gangqing@vip.sina.com。
  • 作者简介:缪明远(1984—), 男, 住院医师, 博士; 电子信箱: mmy0201121@163.com。
  • 基金资助:

    上海市自然科学基金(14ZR1426400);上海市卫生和计划生育委员会青年科研项目(20134y085)

Selection of constant irrigation drainage plan for the treatment of children with septic gonarthritis

MIAO Ming-yuan, CAI Hai-qing, WANG Zhi-gang   

  1. Department of Orthopedics, Shanghai Childrens Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2016-10-28 Published:2016-11-29
  • Supported by:

    Natural Science Foundation of Shanghai, 14ZR1426400; The Youth Scientific Research Project of Shanghai Municipal Health and Family Planning Commission, 20134y085

摘要:

目的·观察持续闭式冲洗对不同病程阶段儿童化脓性膝关节炎的治疗效果,探讨其在儿童化脓性关节炎治疗中的方案选择。方法·回顾分析21例化脓性膝关节炎。入院后急诊手术,所有患儿均进行常规影像学及实验室检查, C反应蛋白(CRP)平均51 mg/L, 红细胞沉降率(ESR)平均75 mm/h。手术方式依据发病时间及影像学表现决定行关节镜下单纯冲洗,或关节镜下滑膜清扫或直接切开引流,术后均行闭式冲洗。结果·病程短于1周组平均冲洗10.9 d,平均住院21.2 d。病程大于1周组平均冲洗19.3 d,平均住院29.9 d。出院时2组平均CRP分别为3、2 mg/L,平均ESR分别为18、16 mm/h。平均随访26个月,无感染复发,Lysholm功能评分均为90分以上。结论·在儿童化脓性膝关节不同病程合理选择持续闭式冲洗方案有利于尽早控制感染,保护关节软骨,恢复关节功能,防止感染迁延反复。

关键词: 儿童, 化脓性膝关节炎, 持续闭式冲洗

Abstract:

Objective·To observe the therapeutic effect of constant irrigation drainage on the treatment of septic gonarthritis in children at different stages of disease and to explore the choice of treatment plan. Methods·Twenty-one cases of septic gonarthritis were retrospective analyzed. All patients underwent emergency operations and conventional imaging and laboratory tests. The average CRP and ESR were 51 mg/L and 75 mm/h. Emergency operations were determined according to the onset time and imaging results, including arthroscopic irrigation, arthroscopic synovial membrane cleaning, and direct incision and drainage. All patients accepted constant irrigation drainage. Results·The average drainage duration and hospital stay were 10.9 d and 21.2 d for patients with the course of disease <1 week and 19.3 d and 29.9 d for patients with the course of disease > 1 week. The average CRP and ESR at discharge were 3 mg/L and 18 mm/h for patients with the course of disease <1 week and 2 mg/L and 16 mm/h for patients with the course of disease > 1 week. The average follow-up period was 26 months and there were no incidences of recurrence. Their Lysholm scores were all above 90 points. Conclusion·Reasonable selection of constant irrigation drainage for the treatment of septic gonarthritis in children at different stages of disease facilitates early control of infection, protects articular cartilage, recovers joint function, and prevents persistent or repeated infection.

Key words: child, septic gonarthritis, constant irrigation drainage