新生儿及小婴儿化脓性髋关节炎的超声诊断:病例系列研究

Ultrasound diagnosis of septic hip arthritis in neonates and small infants: a case series

目的探讨新生儿及小婴儿化脓性髋关节炎的超声表现,评估其在早期诊断、治疗及随访中的作用。方法选取2015年1月至2021年1月经深圳市儿童医院确诊为化脓性髋关节炎,年龄<6个月的婴儿及新生儿患者22例,回顾性分析化脓性髋关节炎的临床资料、主要超声表现及影像学特征,以及治疗结局和超声随访复查结果。结果22例化脓性髋关节炎患儿,其中男8例,女14例;年龄中位数52 d(1~180 d)。累及单侧髋关节21例、双侧1例。髋关节超声表现:髋关节滑膜增厚、关节腔积液21例(22个髋关节),其中14例(15个髋关节)积液伴点状回声、1例积液呈絮状回声;髋关节周围软组织增厚、回声增强22例;股骨头关节面软骨回声欠光滑9例;股骨头髋臼关系异常5例(3例髋关节不稳定、2例脱位)。患儿经保守治疗10例,行手术治疗12例。最终治愈18例,超声复查显示股骨头变小1例,3例仍存在关节腔积液伴点状回声,其中进展为股骨头坏死2例,异位骨化1例。结论新生儿及小婴儿化脓性髋关节炎超声声像图以关节腔积液伴髋关节脱位为主要表现。髋关节超声有助于化脓性髋关节炎的诊断、随访复查以及改善患儿预后。

ObjectiveTo explore the ultrasound manifestations of septic hip arthritis in neonates and infants,and evaluate its role in early diagnosis,treatment,and follow-up.MethodsTwenty-two cases of neonates or infants less than 6 months old who were diagnosed as having septic hip arthritis at Shenzhen Children's Hospital from January 2015 to January 2021 were selected to retrospectively analyze the clinical data,main ultrasonic manifestations,and imaging characteristics of septic hip arthritis,as well as the treatment outcome and ultrasonic follow-up results.ResultsA total of 22 patients with septic hip arthritis were analyzed,including 8 males and 14 females,with a median age of 52 days(range,1-180 days).Ultrasonic findings of the hip joint included hip joint synovial thickening and joint cavity effusion in 21 cases(22 hip joints),including 14 cases(15 hip joints)of effusion with punctate echo,and 1 case of effusion with flocculent echo;thickening and echo enhancement of soft tissue around the hip joint in 22 cases;unsmooth echo of articular cartilage of the femoral head in 9 cases;abnormal positional relationship between the femoral head and acetabulum in 5 cases(3 cases of hip joint instability and 2 cases of dislocation).Ten cases were treated conservatively and 12 cases received surgical treatment.Eighteen cases were cured.In the follow-up review,ultrasound showed 1 case of femoral head reduction,2 cases of femoral head necrosis,and 1 case of heterotopic ossification.ConclusionThe ultrasound findings of septic hip arthritis in neonates and infants are mainly joint cavity effusion with hip dislocation.Hip ultrasound is helpful for the diagnosis and follow-up of septic hip arthritis,which can improve the prognosis of children.