新生儿化脓性肩关节炎的外科诊治

Experiences in surgical diagnosis and treatment of neonatal suppurative shoulder arthritis

目的探讨新生儿化脓性肩关节炎的外科诊治策略。方法收集2013至2017年收治的22例新生儿,其中行手术切开引流灌洗治疗18例,行保守治疗4例。随访1～3年,分析患儿的临床及影像学表现。结果行肩关节切开灌洗引流的患儿,术后血液生化指标恢复显著,影像学指标恢复良好,依据Constant-Murley肩关节评分,19例患儿肩关节功能优,X线显示肱骨近端骨骺形态正常,1例患儿肩关节功能良,2例患儿肩关节功能差,X线显示肱骨近端骨骺消失。结论新生儿化脓性肩关节炎容易延误诊治,在早期明确诊断后,选择适当的抗生素并积极行手术治疗,显得尤为重要,术中需仔细探查肱骨近端及骨骺的情况,如存在骨质破坏,则需在干骺端行钻孔或开窗减张。

Objective To explore the strategy of surgical diagnosis and treatment of suppurative shoulder arthritis in neonates.Methods A total of 22 neonates with suppurative shoulder arthritis who were admitted and treated in our hospital from 2013 to 2017 were enrolled in the study,in whom, 18 cases were treated by surgical incision,drainage and lavage.and 4 cases were treated by conservative treatment,with 1~3 years follow up.The clinical symptoms and imaging manifestations were analyzed.Results For the neonates undergoing shoulder joint incision,lavage and drainage,the blood biochemical indexes recovered significantly and the imaging indexes recovered well after operation.According to Constant-Murley shoulder joint,19 cases had excellent shoulder joint function and X-ray showed that the proximal humerus epiphysis morphous was normal,and 1 cases had good shoulder joint function,however,2 cases had poor shoulder joint function,and X-ray showed that the proximal humerus epiphysis was disappeared.Conclusion Neonatal suppurative shoulder arthritis is prone to delay diagnosis and treatment.After early diagnosis,it is particularly important to select appropriate antibiotics and actively perform surgical treatment.During the operation,the proximal humerus and epiphysis should be carefully explored.If there is bone destruction,drilling or fenestration should be performed at bone metaphyseal end.