The feasibility and safety of ultrasound-guided puncture for treatment of septic arthritis in children.

IF 3.2 3区医学 Q1 PEDIATRICS Italian Journal of Pediatrics Pub Date : 2024-09-27 DOI:10.1186/s13052-024-01746-2

Jeffrey Michaud, Sarah Dutron, Julien Pico, Clément Jeandel, Pauline Joly-Monrigal, Petre Neagoe, Fanny Alkar, Thomas Sarradin, Léa Domitien, Olivier Prodhomme, Eric Jeziorski, Marion Delpont

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Abstract

Background: In septic arthritis, joint lavage can be performed using arthrocentesis (articular needle aspiration) or arthrotomy. The use of fluoroscopy to guide the puncture involves radiation. Ultrasound (US) guidance is still little recommended to guide the treatment of septic arthritis in children. We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance.

Methods: We retrospectively included 67 children (mean age, 3.0 years; range: 1 month-12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up.

Results: We found no significant difference between the groups. After arthrocentesis, patients in the US group remained in hospital for 0.8 days longer than those in the non-US group, but the difference was not significant. After arthrotomy, the arthrotomy-US group required 0.4 more days of hospitalization than the non-US group, but the difference was not significant. Patients in the US group exhibited higher initial CRP and WBC values than patients treated without US, although the differences were not significant. The WBC values of the arthrocentesis-US groups were higher than those of the non-US groups initially and at 72 h, but non significantly so; they became similar on day 5. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications.

Conclusions: US guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery.

Level of evidence: IV (case series).

Trial registration: IRB-MTP_2021_05_202100781.

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超声引导下穿刺治疗儿童化脓性关节炎的可行性和安全性。

背景：在化脓性关节炎中，可使用关节穿刺术（关节针穿刺术）或关节切开术进行关节灌洗。使用透视引导穿刺会产生辐射。目前仍很少推荐使用超声（US）引导来指导儿童化脓性关节炎的治疗。我们想知道在超声（US）引导下治疗儿童化脓性关节炎是否可行和安全：我们回顾性地纳入了 67 名儿童（平均年龄：3.0 岁；范围：1 个月-12 岁），这些儿童因髋关节、肩关节或踝关节化脓性关节炎而在超声或透视引导下接受关节穿刺术或关节切开术治疗（非超声组），并接受了至少两年的随访：结果：我们发现两组之间没有明显差异。关节穿刺术后，美国组患者的住院时间比非美国组多 0.8 天，但差异不显著。关节切开术后，美国关节切开术组比非美国关节切开术组多住院 0.4 天，但差异不显著。US组患者的初始CRP和WBC值高于未接受US治疗的患者，但差异不显著。关节穿刺-US 组的 WBC 值在最初和 72 小时内均高于非 US 组，但差异不显著；在第 5 天时，两者变得相似。有三例穿刺失败需要进行关节切开术（其中两例是在 US 引导下进行的）。三名患者需要进行早期翻修手术：一名患者在使用 US 的情况下进行了关节腔穿刺术，一名患者在未使用 US 的情况下进行了关节腔穿刺术，一名患者在未使用 US 的情况下进行了关节切开术。在最后一次随访中，患者没有出现临床后遗症，但有两例髋关节切开术（一例为US引导，一例为非US引导）出现了无症状的钙化：结论：US引导治疗儿童化脓性关节炎是可行且安全的，可观察到X射线无法显示的结构，避免了手术过程中的辐射暴露：IV（病例系列）：IRB-MTP_2021_05_202100781.

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来源期刊

Italian Journal of Pediatrics PEDIATRICS-

CiteScore

6.10

自引率

13.90%

发文量

192

审稿时长

6-12 weeks

期刊介绍： Italian Journal of Pediatrics is an open access peer-reviewed journal that includes all aspects of pediatric medicine. The journal also covers health service and public health research that addresses primary care issues. The journal provides a high-quality forum for pediatricians and other healthcare professionals to report and discuss up-to-the-minute research and expert reviews in the field of pediatric medicine. The journal will continue to develop the range of articles published to enable this invaluable resource to stay at the forefront of the field. Italian Journal of Pediatrics, which commenced in 1975 as Rivista Italiana di Pediatria, provides a high-quality forum for pediatricians and other healthcare professionals to report and discuss up-to-the-minute research and expert reviews in the field of pediatric medicine. The journal will continue to develop the range of articles published to enable this invaluable resource to stay at the forefront of the field.