切换至 "中华医学电子期刊资源库"

中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (12) : 1377 -1382. doi: 10.3877/cma.j.issn.1672-6448.2022.12.011

所属专题: 经典病例

小儿超声影像学

新生儿及小婴儿化脓性髋关节炎的超声诊断:病例系列研究
谢燕华1, 陈伟玲2,(), 唐子鉴2, 陶宏伟2, 何学智2, 黄兵旋2, 许娜2, 夏焙2   
  1. 1. 635000 达州市中西医结合医院·达州市第二人民医院超声科
    2. 518000 深圳市儿童医院超声科
  • 收稿日期:2021-05-14 出版日期:2022-12-01
  • 通信作者: 陈伟玲

Ultrasound diagnosis of septic hip arthritis in neonates and small infants: a case series

Yanhua Xie1, Weiling Chen2,(), Zijian Tang2, Hongwei Tao2, Xuezhi He2, Bingxuan Huang2, Na Xu2, Bei Xia2   

  1. 1. Department of Ultrasound, Dazhou Integrated Traditional Chinese and Western Medicine (Second People's) Hospital, Dazhou 635000, China
    2. Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen 518000, China
  • Received:2021-05-14 Published:2022-12-01
  • Corresponding author: Weiling Chen
引用本文:

谢燕华, 陈伟玲, 唐子鉴, 陶宏伟, 何学智, 黄兵旋, 许娜, 夏焙. 新生儿及小婴儿化脓性髋关节炎的超声诊断:病例系列研究[J/OL]. 中华医学超声杂志(电子版), 2022, 19(12): 1377-1382.

Yanhua Xie, Weiling Chen, Zijian Tang, Hongwei Tao, Xuezhi He, Bingxuan Huang, Na Xu, Bei Xia. Ultrasound diagnosis of septic hip arthritis in neonates and small infants: a case series[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(12): 1377-1382.

目的

探讨新生儿及小婴儿化脓性髋关节炎的超声表现,评估其在早期诊断、治疗及随访中的作用。

方法

选取2015年1月至2021年1月经深圳市儿童医院确诊为化脓性髋关节炎,年龄<6个月的婴儿及新生儿患者22例,回顾性分析化脓性髋关节炎的临床资料、主要超声表现及影像学特征,以及治疗结局和超声随访复查结果。

结果

22例化脓性髋关节炎患儿,其中男8例,女14例;年龄中位数52 d(1~180 d)。累及单侧髋关节21例、双侧1例。髋关节超声表现:髋关节滑膜增厚、关节腔积液21例(22个髋关节),其中14例(15个髋关节)积液伴点状回声、1例积液呈絮状回声;髋关节周围软组织增厚、回声增强22例;股骨头关节面软骨回声欠光滑9例;股骨头髋臼关系异常5例(3例髋关节不稳定、2例脱位)。患儿经保守治疗10例,行手术治疗12例。最终治愈18例,超声复查显示股骨头变小1例,3例仍存在关节腔积液伴点状回声,其中进展为股骨头坏死2例,异位骨化1例。

结论

新生儿及小婴儿化脓性髋关节炎超声声像图以关节腔积液伴髋关节脱位为主要表现。髋关节超声有助于化脓性髋关节炎的诊断、随访复查以及改善患儿预后。

Objective

To explore the ultrasound manifestations of septic hip arthritis in neonates and infants, and evaluate its role in early diagnosis, treatment, and follow-up.

Methods

Twenty-two cases of neonates or infants less than 6 months old who were diagnosed as having septic hip arthritis at Shenzhen Children's Hospital from January 2015 to January 2021 were selected to retrospectively analyze the clinical data, main ultrasonic manifestations, and imaging characteristics of septic hip arthritis, as well as the treatment outcome and ultrasonic follow-up results.

Results

A total of 22 patients with septic hip arthritis were analyzed, including 8 males and 14 females, with a median age of 52 days (range, 1-180 days). Ultrasonic findings of the hip joint included hip joint synovial thickening and joint cavity effusion in 21 cases (22 hip joints) , including 14 cases (15 hip joints) of effusion with punctate echo, and 1 case of effusion with flocculent echo; thickening and echo enhancement of soft tissue around the hip joint in 22 cases; unsmooth echo of articular cartilage of the femoral head in 9 cases; abnormal positional relationship between the femoral head and acetabulum in 5 cases (3 cases of hip joint instability and 2 cases of dislocation). Ten cases were treated conservatively and 12 cases received surgical treatment. Eighteen cases were cured. In the follow-up review, ultrasound showed 1 case of femoral head reduction, 2 cases of femoral head necrosis, and 1 case of heterotopic ossification.

Conclusion

The ultrasound findings of septic hip arthritis in neonates and infants are mainly joint cavity effusion with hip dislocation. Hip ultrasound is helpful for the diagnosis and follow-up of septic hip arthritis, which can improve the prognosis of children.

图1 患儿,男性,53 d,左侧化脓性髋关节炎合并股骨头坏死、髋关节脱位。图a,b为髋关节超声图像,其中图a为左侧髋关节冠状切面图,显示股骨头变小,向外上方脱出髋臼,周围显示积液(箭头),伴絮状回声;图b为左侧髋关节横切面图,显示股骨头与耻骨(P)、坐骨(I)间距增大(黄色虚线),股骨头周围显示积液(箭头)。图c为髋关节X线平片,显示左侧髋臼浅斜(黄色虚线),左侧股骨近端向外上方移位(箭头),左侧股骨近端局部骨质破坏。图d、g为MRI平扫冠状面和横断面,显示左髋关节脱位,关节腔高信号影、关节腔积液(箭头)。图e,f为术后4个月髋关节超声图像,图e示左侧股骨头小,形态不规则(箭头);图f示左侧股骨头略向外上方脱出髋臼(黄色虚线)
图2 患儿,女性,19 d,双侧化脓性髋关节炎合并股骨头坏死、左髋关节脱位。图a,b分别为髋关节超声左侧髋关节冠状切面和右侧髋关节外侧横切面图,均显示关节腔内积液(箭头),伴点状回声;图c为骨盆X线平片,未显示明显异常;图d为MRI平扫,显示双侧髋关节周围肌肉、肌间隙水肿信号(箭头);图e~g为出院后5个月复查髋关节超声图像,图e、f分别显示右侧和左侧股骨头变小(箭头),形态不规则,左侧股骨头脱至髋臼上方(黄色虚线);图g显示右侧股骨头回声不均匀,内部显示坏死液化(箭头)
图3 患儿,男性,21 d,右侧化脓性髋关节炎合并异位骨化性肌炎。图a~d为髋关节超声图像,图a,b为右侧髋关节冠状切面图,图c,d为右侧髋关节外侧横切面图,均显示右侧髋关节滑膜增厚,滑膜腔内显示积液回声伴密集点状回声(箭头),增厚滑膜血流信号稍丰富。图e~h为术后髋关节影像学检查图像,图e为术后第29天髋关节超声图像示右侧关节囊表面肌间显示不规则片状骨块样强回声,伴后方声影(箭头);图f为术后第29天髋关节X线平片示右髋软组织内见高密度影(箭头);图g为术后第30天骨盆CT示右髋关节前外侧关节囊表面高密度影(箭头);图h为CT三维重建图像示右髋外侧骨化团块(箭头)
1
Agarwal A, Aggarwal AN. Bone and joint infections in children: septic arthritis[J]. Indian J Pediatr, 2016, 83(8): 825-833.
2
Xu N, Xia B, Tao H, et al. Chinese expert consensus on ultrasonographic acquisition, measurement, and reporting system for developmental dysplasia of the hip[J]. AUDT, 2020, 4(1):1-8.
3
黄兵旋, 夏焙, 许娜, 等. 健康婴儿髋关节超声测量分析的多中心研究[J]. 中华超声影像学杂志, 2018, 27(5): 417-422.
4
Kotlarsky P, Shavit I, Kassis I, et al. Treatment of septic hip in a pediatric ED: a retrospective case series analysis[J]. Am J Emerg Med, 2016, 34(3): 602-605.
5
Sukswai P, Kovitvanitcha D, Thumkunanon V, et al. Acute hematogenous osteomyelitis and septic arthritis in children: clinical characteristics and outcomes study[J]. J Med Assoc Thai, 2011, 94(3): S209- S216.
6
Plumb J, Mallin M, Bolte RG. The role of ultrasound in the emergency department evaluation of the acutely painful pediatric hip[J]. Pediatr Emerg Care, 2015, 31(1): 54-58.
7
Zamzam MM. The role of ultrasound in differentiating septic arthritis from transient synovitis of the hip in children[J]. J Pediatr Orthop B, 2006, 15(6): 418-422.
8
Clausen S, Kjær S, Fredberg U, et al. Ultrasound imaging in patients with hip pain and suspected hip osteoarthritis: an inter-rater and intra-rater reliability study[J]. BMJ Open, 2020, 10(11): e038643.
9
Laine JC, Denning JR, Riccio AI, et al. The use of ultrasound in the management of septic arthritis of the hip[J]. J Pediatr Orthop B, 2015, 24(2): 95-98.
10
Barbuto L, Di Serafno M, Della Vecchia N, et al. Pediatric musculoskeletal ultrasound: a pictorial essay[J]. J Ultrasound, 2019, 22(4): 491-502.
[1] 章建全, 程杰, 陈红琼, 闫磊. 采用ACR-TIRADS评估甲状腺消融区的调查研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 966-971.
[2] 罗辉, 方晔. 品管圈在提高甲状腺结节细针穿刺检出率中的应用[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 972-977.
[3] 杨忠, 时敬业, 邓学东, 姜纬, 殷林亮, 潘琦, 梁泓, 马建芳, 王珍奇, 张俊, 董姗姗. 产前超声在胎儿22q11.2 微缺失综合征中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 852-858.
[4] 孙佳丽, 金琳, 沈崔琴, 陈晴晴, 林艳萍, 李朝军, 徐栋. 机器人辅助超声引导下经皮穿刺的体外实验研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 884-889.
[5] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[6] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 563-570.
[7] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[8] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 470-476.
[9] 胡可, 鲁蓉. 基于多参数超声特征的中老年女性压力性尿失禁诊断模型研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 477-483.
[10] 张妍, 原韶玲, 史泽洪, 郭馨阳, 牛菁华. 小肾肿瘤超声漏诊原因分析新思路[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 500-504.
[11] 席芬, 张培培, 孝梦甦, 刘真真, 张一休, 张璟, 朱庆莉, 孟华. 乳腺错构瘤的临床与超声影像学特征分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 505-510.
[12] 钱警语, 郑明明. 《2024意大利妇产科学会非侵入性和侵入性产前诊断指南》解读[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 486-492.
[13] 张琛, 秦鸣, 董娟, 陈玉龙. 超声检查对儿童肠扭转缺血性改变的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 565-568.
[14] 李茂军, 唐彬秩, 吴青, 阳倩, 梁小明, 邹福兰, 黄蓉, 陈昌辉. 新生儿呼吸窘迫综合征的管理:多国指南/共识及RDS-NExT workshop 共识陈述简介和评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 607-617.
[15] 陈秀晓, 隋文倩, 王珉鑫, 吴圆圆. 腹股沟斜疝并腹腔游离体超声表现一例[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 516-517.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?