儿童化脓性髋关节炎预后不良的危险因素分析

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Abstract Objective To analyze the clinical features, treatment, and outcome of patients with septic hip arthritis, and to explore the risk factors for poor prognosis of children with septic hip arthritis. Methods Clinical data of patients with septic hip arthritis admitted to the Department of Orthopedics of Beijing Children's Hospital from January 2010 to December 2020 were retrospectively analyzed. All patients received empirical broad-spectrum antibiotics and joint incision and drainage surgery, followed by antibiotic adjustments based on bacterial culture results. Evaluation indicators included Choi classification, laboratory tests, imaging data, bacteriological examinations, and prognosis. Data were statistically analyzed using SPSS 26.0, with binary logistic regression employed to identify independent risk factors for poor prognosis. ROC curves were constructed to determine optimal cutoff value. Results A total of 76 cases of septic hip arthritis were included, the positive rate of bacterial culture was 48.7%(37 cases), among which Staphylococcus aureus was the most common, accounting for 70.3% of positive group. There were statistically significant differences between the poor prognosis group (Choi type Ⅱ-Ⅳ) and the good prognosis group (Choi type Ⅰ) in terms of CRP levels, time from onset to surgery, hip dislocation, osteomyelitis, and pyomyositis (P<0.05). The median CRP in the poor prognosis group was 87.00 (25.3, 107.5), significantly higher than that in the good prognosis one, which was 42.0 (17.0, 96.0) (P=0.029). The median time from onset to surgery in the poor prognosis group was 22.0 (15.0, 32.0) days, significantly longer than the 12.5 (9.0, 16.8) days in the good prognosis group (P<0.001). Binary logistic regression analysis indicated that elevated CRP (OR=1.017, 95%CI: 1.004, 1.031, P=0.010) and prolonged time from onset to surgery (OR=1.229, 95%CI: 1.081, 1.397, P=0.002) were independent risk factors for poor prognosis. ROC curve analysis showed that when CRP>93 mg/L, the sensitivity and specificity for poor prognosis were 70.8% and 82.7%, respectively; when the time from onset to surgery was >13.5 days, the sensitivity and specificity were 88.3% and 61.5%, respectively. Conclusions The prognosis of septic hip arthritis is closely related to CRP levels and the time from onset to surgery. Early diagnosis, timely surgery and active anti-infection treatment are the keys to improve the prognosis of patients.

Key words： septic hip arthritis children surgical treatment risk factors poor prognosis

Received: 01 February 2024

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	FENG Wei
	ZHU Danjiang
	SONG Baojian
	WANG Qiang

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FENG Wei,ZHU Danjiang,SONG Baojian等. Analysis of risk factors for poor prognosis of septic hip arthritis in children[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(11): 965-970.

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https://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR https://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2024/V35/I11/965

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