Clinical Application of Ultrasonography for Detection of Septic Arthritis in Children

為能早期偵測感染性關節炎之關節腔積水，四十名被懷疑有感染性關節炎的兒童，接受了超音波掃瞄檢查，結果三十一名被發現有關節腔積水，這些病人在進一步接受針吸關節液後，有二十二名被證實有感染性關節炎。其中三名病人，除了關節腔積水外，超音波掃瞄亦顯示有骨膜下膿瘍及骨壁凹蝕，因此，也被診斷具有併發性骨髓炎。有二名病人超音波掃瞄只顯現了臀部肌肉層的膿瘍而髖關節並沒有積水，排除了感染性關節炎的可能性，因此，得以壁免再作無必要的針檢查。有一名病人超音波掃瞄只顯現了腕部曲腱鞘膜炎而沒有腕關節積水，因此得以避免了腕關節切開引流術，而給予肌腱滑囊膜切除手術，之後病理報告為結核性鞘膜炎。從這些臨床上的經驗，我們發現超音波在診斷感染關節炎的使用有下列優點：(1)超音波在偵測關節腔積水具有高度敏感度。(2)超音波可同時清楚地偵測關節感染是否已超越關節囊並已有併發性骨髓炎。(3)超音波可清楚將肌肉膿瘍和感染性關節炎做出鑑別診斷而避免再作進一步無必要的關節腔針吸檢查。

關鍵字

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並列摘要

For early detection of the effusion of infected joint, 40 children were examined by ultrasound scanner for suspected septic arthritis. Thirty-one patients were found with joint effusion, and the needle aspirations of these 31 joints confirmed septic arthritis in 22 patients. In 3 patients, in addition to the joint effusion, the joint surrounding subperiosteal abscess and cortical erosion also were found on sonography, resulting in a diagnosis of concurrent osteomyelitis. In two patients, sonography confirmed only soft tissue swelling and abscess formation on the buttock, but without hip joint effusion. These findings excluded the diagnosis of septic arthritis and helped us obviate the unnecessary attempts at joint aspiration. In one patient, sonography revealed only flexor tenosynovitis without wrist joint effusion. This case was later treated by tenosynovectomy rather than wrist arthrotomy and the pathological examination showed to be a tuberculous tenosynovitis. From the preliminary results, we find ultrasonography has the following advantages for the diagnosis of septic arthritis: 1.)ultrasonography is verysensitive in detecting the joint effusion of septic arthritis; 2.) ultrasonography can clearly define the pathological extent of septic arthritis and help clinicians to treat the concurrent osteomyelitis by appropriate surgical debridement; and 3.) ultrasonography can differentiate soft tissue abscess or tenosynovitis from septic arthritis and help clinicians obviate unnecessary needle joint aspiration.

並列關鍵字

ultrasonography ； septic arthritis ； joint effusion

國際替代計量

Clinical Application of Ultrasonography for Detection of Septic Arthritis in Children

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