急性化脓性髋关节炎压力测定及病理检查

Intra articular pressure measurement and pathological examination of acute septic arthritis of the hip joint

目的 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 2 2髋 ,作关节腔、股骨头颈压力测定和股骨头、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。股骨头颈骨髓涂片 18例查见脓球 ,病理可见头颈骨质有不同程度的炎变。治疗结果优 10髋 ,良 6髋 ,差 6髋。结论 急性血源性化脓性髋关节炎是包括整个髋关节的化脓性改变 ,即股骨头颈骨髓炎、滑膜及关节囊的炎症。

Objective To investigate the mechanisms and surgical treatment of acute septic arthritis(ASA) of the hip. Methods 19 children with 22 hips suffered from ASA were performed surgical drainage, which includes capsule opened drainage and core decompression of the femoral head neck. The intraarticular pressure and the intraosseous pressure of the femoral head neck were measured and an aspiration for gram stain and a biopsy of the femoral head neck were performed in every surgical proledine. Results There were remarkable rising of the intraarticular pressure(average 5 43 kPa) and the intraosseous pressure(higher than 2 94 kPa in 13 hips). Bone marrow smear of femoral head and neck showed pus cells in 18 patients. Pathological examination revealed different degrees of inflamation in bone structure of the head and neck. 10,6 and 6 patients obtained excellent,good and poor results, respectively. Conclusion Acute hematogenous septic arthritis of the hip involves the total joint, which consists of osteomyelitis of the femoral head neck, septic synovitis as well as capsule inflammation. Thus, early capsule opened drainage and drilling decompression of the femoral head neck is the key to treating ASA of the hip.