儿童化脓性膝关节炎的诊治(附11例报道)

Treatment of suppurative gonarthritis in children: a report of 11 cases

目的：探讨儿童化脓性膝关节炎的发病特点及诊疗方法。方法：对确诊为化脓性膝关节炎的11例儿童早期即静脉给予足量敏感抗生素治疗，同时行关节镜下清理术。11例患者平均随访24个月（12～36个月）。疗效评价指标为体温、血常规、血沉及C反应蛋白、连续3次关节液细菌培养、症状及功能改善评价HSS量表评分。结果：所有患儿均疼痛消失，关节活动度、体温、血常规、血沉及C反应蛋白恢复正常，连续3次关节液细菌培养阴性，随访平均24个月（12～36个月）未见复发；患儿术前HSS评分平均为（55．70±14．70）分，而术后随访平均为（89．96±7．25）分，手术前后比较差异有统计学意义（P＜0．01）。结论：儿童化脓性膝关节炎极易误诊，但只要诊断及时，采取正确的治疗手段，仍可以获得满意的临床疗效。

Objective： To investigate the pathogenetic characteristics as well as the diagnostic and therapeutic strategies for suppurative gonarthritis in children .Methods：Sufficient sensitive antibiotics were early intravenously ad-ministrated to 11 cases of children with suppurative gonarthritis , and arthroscopic debridement as well as postoperative lavage were performed .The children were followed up for 12 to 36 months （ average of 24 months ） . The efficacy evaluation indicators were body temperature , blood count , erythrocyte sedimentation rate （ ESR ） , C reactive protein（CRP）, consecutive bacterial culture of synovial fluid for 3 times and the HSS rating scale conce-rning symptom-function improvement .Results：Pain of the children was significantly alleviated after treatment , mea-nwhile , the motion of joint , temperature , blood count , ESR and CRP were normalized , concurred with negative bacterial culture of synovial fluid for 3 times.Furthermore, there was no recurrence following 12-36 months with an average of 24 months.The average preoperative and postoperative HSS score of these children were 55.70 ±14.70 and 89.96 ±7.25, respectively, showing a significant difference （ P 〈0.01）.Conclusion： The suppurative gonarthritis in children is easily misdiagnosed .But satisfied therapy could be achieved through providing with timely and accurate diagnosis as well as correct treatment .