关节镜清创滴注引流治疗儿童急性关节感染

Arthroscopic debridement and irrigation combined intraarticular antibiotic dropping and suction drainage for septic arthritis in children

[目的]探讨关节腔持续抗菌药物灌洗治疗儿童急性骨关节感染的临床效果。[方法] 2015年1月~2019年7月,本院收治急性膝关节和髋关节感染患儿80例。采用随机数字表法分为两组,每组40例,两组均实施关节镜清创灌洗术,滴注引流组关节腔持续抗菌药物滴注引流,单纯引流组单纯引流。比较两组患儿临床与实验室检查结果。[结果]滴注引流组在下地行走时间和完全负重活动时间均显著早于单纯引流组(P<0.05)。随时间推移,两组患者VAS评分显著降低(P<0.05),而ROM显著增加(P<0.05)。术后7 d和6个月,滴注引流组VAS评分和ROM显著优于单纯滴注组(P<0.05)。两组细菌培养结果的差异无统计学意义(P>0.05)。随术后时间推移,两组患者CRP、TNF-α和IL-6均显著下降(P<0.05)。术后第1d,两组间血清CRP、TNF-α、IL-6水平差异无统计学意义(P>0.05);术后第3 d,滴注引流组的血清CRP、TNF-α、IL-6水平显著低于单纯引流组(P<0.05),术后第7 d,滴注引流组的血清CRP、TNF-α、IL-6水平仍低于单纯引流组,但差异无统计学意义(P>0.05)。[结论]关节清理手术联合关节腔持续抗菌药物滴注引流治疗儿童急性骨关节感染较单纯引流更为有效。

[Objective]To explore the clinical outcomes of arthroscopic debridement and irrigation combined intraarticular antibiotic dropping and suction drainage for septic arthritis in children.[Methods]From January 2015 to July 2019,a total of80 children who suffered from knee or hip septic arthritis were randomly divided into two group with 40 children in each group.After arthroscopic debridement and irrigation,the patients in the dropping-suction drainage group received intraarticular sensitive antibiotic dropping and suction drainage,while those in the simple drainage group had suction drainage only.The clinical and laboratory test consequences were compared between the two groups.[Results]The patients in the dropping-drainage group returned to ambulation and full weight bearing activity significantly earlier than those in the simple drainage group(P<0.05).The VAS score significantly decreased,while ROM significantly increased in both groups over time(P<0.05).Although there were no statistical differences in VAS score and ROM between the two groups before operation,the dropping-drainage group proved significantly superior to the simple drainage groups regarding VAS score and ROM at 7 days and 6 months postoperatively(P<0.05).With respect to laboratory tests,there was no a statistically significant difference in bacterial culture results between the two groups(P>0.05).The serum CRP,TNF-αand IL-6 significantly decreased in both groups over time postoperatively(P<0.05).Although there were no significant differences in CRP,TNF-αand IL-6 at 1 day postoperatively between the two group(P>0.05),the dropping-drainage group had significantly lower CRP,TNF-αand IL-6 than the simple drainage group at 3 days after operation,which became statistically insignificant at 7 days postoperatively(P>0.05).[Conclusion]The arthroscopic debridement and irrigation combined with intraarticular sensitive antibiotic dropping and drainage are superior to the drainage only in clinical and laboratory test outcomes for septic arthritis in children.