小儿化脓性髋关节发生血管性坏死的风险与手术方式的选择有关吗?

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2024-06-17 eCollection Date: 2024-08-01 DOI:10.1177/18632521241262167
Shrey Nihalani, Francis Cruz, Jacob K Hawkins, Branum Gage Griswold, Scott E Mabry, Gerald McGwin, Shawn R Gilbert, Michael J Conklin
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引用次数: 0

摘要

目的:儿童和青少年髋关节化脓性关节炎是一种常见病,需要及时诊断和干预。由于担心损伤股骨内侧环状动脉导致血管性坏死,手术冲洗和清创通常通过前路进行。虽然有多项研究调查了前方和内侧入路减少髋关节发育性脱位的后遗症,但没有一项研究比较了这两种入路对小儿化脓性髋关节的治疗效果。我们假设,在比较小儿败血症髋关节的内侧和前方入路时,血管性坏死的发生率不会有明显差异:方法: 我们对一家医疗机构 18 年来采用内侧或前方入路进行冲洗和清创治疗的小儿化脓性髋关节进行了回顾性研究。主要结果指标为是否发生血管性坏死:164例患者中有13例(7.9%)发生了血管性坏死。101名采用前路手术的患者中有9名出现了血管坏死,63名采用内路手术的患者中有4名出现了血管坏死(P = 0.76)。发生血管坏死的患者平均年龄为 10.0 岁,而未发生血管坏死的患者平均年龄为 6.8 岁(P = 0.01)。发生血管性坏死的患者平均随访3.3年,而未发生血管性坏死的患者平均随访1.5年(P = 0.01):结论:与前入路相比,小儿化脓性髋关节内侧入路不会增加血管性坏死的发生率:证据级别:回顾性对比研究,III级。
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Is choice of approach associated with risk of avascular necrosis in pediatric septic hip?

Purpose: Septic arthritis of the hip in children and adolescents is a common condition requiring timely diagnosis and intervention. Surgical irrigation and debridement is typically performed through the anterior approach because of concerns about injury to the medial femoral circumflex artery leading to avascular necrosis. While there are multiple studies investigating the sequelae of anterior and medial approaches for reduction of developmental dislocation of the hip, none have compared these approaches for the pediatric septic hip. We hypothesize that there will be no significant difference in the rate of avascular necrosis when comparing the medial and anterior approaches to the septic hip in pediatric patients.

Methods: A retrospective review was performed of pediatric septic hips treated with irrigation and debridement through either a medial or anterior approach at a single institution over an 18-year period of time. The primary outcome measure was the development of avascular necrosis.

Results: Thirteen of 164 patients (7.9%) developed avascular necrosis. Avascular necrosis was noted in 9 of 101 patients who had anterior approach and 4 of 63 patients who underwent medial approach (p = 0.76). The average age for patients developing avascular necrosis was 10.0 years old versus 6.8 years old in patients who did not develop avascular necrosis (p = 0.01). The average follow-up was 3.3 years in patients with avascular necrosis versus 1.5 years for patients who did not develop avascular necrosis (p = 0.01).

Conclusion: Medial approach to the pediatric septic hip does not increase the rate of avascular necrosis compared to the anterior approach.

Level of evidence: Retrospective comparison study, Level III.

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来源期刊
Journal of Childrens Orthopaedics
Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
2.70
自引率
14.30%
发文量
61
审稿时长
23 weeks
期刊介绍: Aims & Scope The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery. It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents. The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology. The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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