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頁籤選單縮合
題名 | Septic arthritis in early infancy=嬰兒化膿性關節炎 |
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作者 | 王清虹; 黃富源; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 31:2 民79.03-04 |
頁次 | 頁69-75 |
分類號 | 417.62631 |
關鍵詞 | 嬰兒; 化膿性關節炎; |
語文 | 英文(English) |
中文摘要 | 發生在小於二個月大之嬰兒的化膿性關節炎,是一種少見的疾病。正確的診斷常被延誤,而延誤治療可能會造成嚴重的後遺症。在過去的七年中,馬偕醫院小兒科共經歷18例二個月大以內罹患化膿性關節炎的病例。其中男與女的比例為1.6:1。最常見的症狀為母親為寶寶換尿布時發現牽動患肢會引起哭嚎,且可見被感染關節周圍浮腫、患肢活動減少。發高燒、食慾差、嗜睡等症狀則少見。16例(89%)僅單一關節被感染。被感染關節以髖關節為最多,佔12例;其次為膝關節,佔4例。10例(55%)同時有鄰近骨之骨髓炎。16例(89%)可確定其致病菌種。致病菌以S.aureus為最多(5例),其次為group B streptococcus (4例)。其他的致病菌為streptococcus pneumonia、Non-group D streptococcus、Neisseria gonorrhea、Candida albicans、E-Coli、salmonella enteritidis及Bacter-oides fragilis,各佔一例。由S.aureus引起之5例中,有4例其感染認為和全靜脈營養有關。9例曾接受關節切開術(8例為髖關節感染)。治療時間為21至44天不等。在13位有繼續追蹤的患者中,有二例髖關節感染者發生二腿不等長及跛行的後遺症。還有二例,分別為髖關節和肩關節感染,皆未接受開刀引流,但臨床上無後遺症發生。此二例皆為group B streptococcus引起之關節炎且都無伴隨之骨髓炎。作者由此推想,group B streptococcus關節炎可能是屬較良性的感染,但其治療是否一定需接受關節切開術仍需更多的經驗。對於嬰兒之化膿性關節炎,醫師應提高警覺期能早期診斷並儘早使用有效之抗生素,在髖關節或肩關節感染時並應趁早作開刀引流,以減少後遺症的發生。 |
英文摘要 | Septic arthritis in infants who are less than two months of age is a rare condition. During a recent seven-year period, eighteen cases of infantile septic arthritis were diagnosed at Mackay Memorial Hospital. The ratio of males to females was 1.6: 1. The most common symptoms were crying during diaper change, and an immobile and swollen joint. Nonspecific symptoms such as fever, poor appetite and lethargy were uncommon. The hip was the most commonly affected joint with the knee taking second place. Ten cases (55%) demonstrated concomitant osteomyelitis. A bacterial etiology was established in 16 cases (88%). The predominant pathogens were S. aureus (5 cases) followed by group B streptococcus (4 cases). Total parenteral nutrition was the predisposing factor of infection in 4 of the 5 S. aureus arthritis cases. The duration of treatment ranged from 21 to 44 days. Two patients developed sequelae: namely discrepancies in leg length, and a limping gait. Early diagnosis and prompt antibiotic treatment are crucial elements in the prevention of disabling and catastrophic sequelae in young infants who have septic arthritis. In addition, open drainage is highly recommended in hip and shoulder arthritis. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。