Avaliação do tratamento da artrite séptica do quadril

Abstract

Objective: Presenting a retrospective review of the results of treatment of children with septic arthritis of the hip and the investigation of the relationship between prognostic factors and the clinical results obtained. Methods: The patients evaluated (46) comprising 47 hips, who attended Orthopedics HIJG´s ambulatory clinic, answered a questionnaire, underwent physical examinations and radiographs of the pelvis, as well as the review of data from medical records. The patients were classified in terms of clinical and radiographic point of view according to both the classifications of Hunka and Choi, and were divided into groups for statistical comparison. Group 1 consisted of patients classified as Type IA and group 2 consisted of patients classified as Type IB to Type IVB. Results: The disease affected 30 boys, affecting the right hip in 26 children and both sides in one child. The average age at the presentation was 50 months, being higher in group 1 (p = 0.023). The synovial fluid culture was positive in 23 patients and Staphylococcus aureus grew in 18 of them. Symptoms lasted on average for 3.5 days before surgery, the wait being shorter in group 1 (p = 0.03). The treatment outcome was satisfactory in most cases. Conclusion: Young patients, who did not limp during the initial medical exam, with synovial fluid culture positive for Staphylococcus aureus and delay in undergoing surgical treatment, were associated with poor outcomes. Objetivo: Revis{ã}o dos resultados do tratamento de 46 crian{ç}as, 47 quadris, com artrite s{é}ptica do quadril e a investiga{ç}{ã}o da rela{ç}{ã}o entre os fatores progn{ó}sticos e os resultados cl{í}nicos obtidos. M{é}todos: Foram classificados, do ponto de vista cl{í}nico e radiogr{á}fico, de acordo com as classifica{ç}{õ}es de Hunka e a de Choi, e distribu{í}dos em grupos para estudo estat{í}stico. O grupo 1 foi formado por pacientes classificados como tipo IA, e o grupo 2 pelos pacientes tipos IB ao IVB. A doen{ç}a acometeu 30 meninos, sendo o lado direito comprometido em 26 crian{ç}as e uma delas com acometimento bilateral. A m{é}dia de idade na apresenta{ç}{ã}o foi de 50 meses, sendo maior no grupo 1 (p = 0,023). A cultura do l{í}quido sinovial foi positiva em 23 pacientes e, dentre elas, em 18 cresceram Staphylococcus aureus. O tempo de sintomas at{é} o tratamento cir{ú}rgico teve m{é}dia de 3,5 dias, sendo a espera no grupo 1 menor (p = 0,03). Resultados: Quarenta e seis pacientes, 47 quadris, que compareceram ao Ambulat{ó}rio da Ortopedia do HIJG, e responderam ao protocolo, submetidos a exame f{í}sico e radiografias da bacia, al{é}m da revis{ã}o de dados do prontu{á}rio. O resultado do tratamento foi satisfat{ó}rio na grande maioria dos casos. Conclus{ã}o: Pacientes jovens, que, na apresenta{ç}{ã}o, n{ã}o claudicavam, com cultura do l{í}quido sinovial positiva para Staphylococcus aureus e demora na institui{ç}{ã}o do tratamento cir{ú}rgico constitu{í}ram fatores de pior progn{ó}stico nos resultados.