Çocukluk Çağı İzole Diz Septik Artritinde Yaşın Prognoza Etkisi

Öz

Septik artrit(SA), yıkıcı eklem hastalığı olup erken ve yeterli tedavi edilmediğinde kronik deformiteye ve sekellere yol açabilmektedir. Uzun yaşam beklentisi nedeniyle pediatrik SA’ler daha fazla dikkat gerektirmektedir. Çalışmanın amacı, izole diz SA nedeniyle opere edilen beş yaş altı ve üstü çocukların klinik sonuçlarını değerlendirerek yaşın prognoza etkisini araştırmaktır. 01.01.2017-01.112023 arasında kurumumuzda diz SA nedeniyle opere edilen pediatrik hasta verileri retrospektif olarak tarandı. İzole diz SA olan, 0-18 yaş, minimum 12 ay takipli hastalar çalışmaya dahil edildi. Yaş, cinsiyet, ek hastalık, cerrahi taraf, preoperatif fizik muayene bulguları, ESH, CRP, WBC, sinoviyal sıvı aspiratı hücre sayımı ve kültürü, şikayet başlamasından cerrahiye kadar süre kaydedildi. Postoperatif fizik muayene bulguları, ESH, CRP, WBC, kan kültürü, antibiyoterapi ve süresi, hastanede yatış süresi, takip süresi, reoperasyon ve komplikasyon kaydedildi. Hastalar ≤5 yaş ve >5 yaş olacak şekilde 2 gruba ayrıldı. SA ön tanısıyla opere edilen 67 hastadan; 23 hasta kalça SA, 3 hasta başka eklem SA ve 5 hasta 12 aydan az takip nedeniyle çalışma dışı bırakıldı. 36 hasta çalışmaya dahil edildi. Preoperatif WBC, CRP, sinoviyal hücre sayımı, postoperatif ESH, WBC ve CRP değerlerinde gruplar arasında anlamlı fark saptanmadı (sırasıyla; p=0,315, p=0,853, p=0,142, p=0,064, p=0,693, p=0,258). Preoperatif ESH ≤5 yaş grupta daha yüksekti (p=0,003). ≤5 yaş grupta %47,4 sinoviyal kültür pozitifliği saptandı (p=0,322). Preoperatif kan kültüründe üreme, hastane yatış süresi, antibiyotik süresi ve re-operasyon uygulanmasında gruplar arasında anlamlı fark izlenmedi (sırasıyla; p=0,684, p=0,231, p=0,483, p=0,732). Komplikasyonların gruplar arasında dağılımı homojendi ve anlamlı bir fark gözlenmedi (p>0,05). Yaşın pediatrik SA vakalarında komplikasyonların oluşumu üzerinde bağımsız bir etkisi olduğu görülmemektedir.

Anahtar Kelimeler

• Septik artrit
• Çocuk
• Diz
• Kas iskelet infeksiyonları

The Effect of Age on Prognosis in Childhood with Isolated Septic Arthritis of the Knee

Öz

Septic arthritis (SA) is a destructive joint disease that, if not treated promptly and adequately, can lead to chronic deformities and long-term sequelae. Due to the longer life expectancy of pediatric patients, SA in children requires greater attention. This study aims to investigate the impact of age on prognosis by evaluating the clinical outcomes of children under and over five years of age who underwent surgery for isolated knee SA. Data from pediatric patients who underwent surgery for knee SA at our institution between January 1, 2017, and November 1, 2023, were retrospectively reviewed. Patients aged 0–18 years with isolated knee SA and a minimum follow-up period of 12 months were included in the study. Collected data included age, sex, comorbidities, affected side, preoperative physical examination findings, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC), synovial fluid cell count and culture results, and the time from symptom onset to surgery. Postoperative data included physical examination findings, ESR, CRP, WBC, blood culture results, antibiotic therapy and duration, hospital stay duration, follow-up period, reoperation, and complications. Patients were divided into two groups: ≤5 years and >5 years. Of 67 patients operated on with a preliminary diagnosis of SA, 23 with hip SA, 3 with SA in other joints, and 5 with less than 12 months of follow-up were excluded. A total of 36 patients were included in the study. No significant differences were found between the groups in preoperative WBC, CRP, synovial cell count, or postoperative ESR, WBC, and CRP values (p=0.315, p=0.853, p=0.142, p=0.064, p=0.693, and p=0.258, respectively). Preoperative ESR was significantly higher in the ≤5 years group (p=0.003). Synovial culture positivity was observed in 47.4% of the ≤5 years group (p=0.322). There were no significant differences between the groups in preoperative blood culture positivity, hospital stay duration, antibiotic therapy duration, or reoperation rates (p=0.684, p=0.231, p=0.483, and p=0.732, respectively). The distribution of complications across the groups was homogeneous, with no significant differences observed (p>0.05). Age does not appear to have an independent effect on the occurrence of complications in pediatric septic arthritis cases

Anahtar Kelimeler

• Septic arthritis
• Children
• Knee
• Musculoskeletal infections

Kaynakça

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