細菌性關節炎

Bacterial Arthritis

自1978年12月迄1986年7月，7年半中，長庚醫院共經驗了178人，181個細菌性關節炎，臨床追蹤最少一年，其中大人112人，114個關節；兒童66人，67個關節；117例接受手術，64例採保守療法。我們使用修正過的Rosenthal評估標準法（表一）。培養出的細菌中，Staphylococcus aureus（金黃色葡萄球菌）占首位(43.3％)，其次為Streptococcus（鏈球菌）(8.4％)，第三為 Pseudomonas aeruginosa（綠膿桿菌）(5.9％)。兒童的細菌性關節炎以髖關節為主，有38個，其次是膝關節，有20個；在大人則以膝關節為主，有56個，而髖關節居次，有29個。外科療法後，60個關節(51％)得到良好(good)的結果，有50個(43％)結果很差(poor)。內科療法後，31個關節(48％)結果良好，25個(39％)很差。若依年齡和解剖位置來區分結果：大人膝關節50％很差(poor)，兒童膝關節19％很差；大人髖關節86％很差，兒童髖關節21％很差。很顯然的，在大人的髓和膝關節及兒童髓關節的細菌性關節炎，外科療法比內科療法還佳；單以髖和膝關節來看，兒童的結果又優於大人。延遲治療會大大影響預後的好壞。

One hundred and seventy-eight patients, 181 joints, with bacterial arthritis aged 15 days to 85 years were treated conservatively or surgically. The follow-up period ranged from one year to 8.5 years (Avg. 3Y2M). The positive diagnostic criteria was modified from Rosenthal [1] and Morrey [20] (Table 2). The assessment of results was also modified from Rosenthal [1] (Table 1) and four principles of treatment were followed. One hundred and seventeen joints were treated with parenteral antibiotics and open surgical drainage. Of them, sixty jioints (51%) have good results; seven (6%) are fair, and fifty (43%) are poor. Sixty-four joints (51%) have good results; seven (6%) arc fair, and fifty (43%) are poor. Sixty-four joints were treated with parenteral abtibiolics and repeated arthrocentesis. 31 joints (48%) have good results, 8 joints (13%) are fair, and 25 joints (39%) arc poor. If the clinical outcome was classified according to the age and the anatomic distribution. There were 50% poor in the adult knee, 19% poor in the children knee, 86% poor in the adult hip, and 21% poor in the children hip. In the past 8.5 years, various methods have been used in the treatment of the bacterial arthritis in our hospital. It appeared that the surgical management was better than medical treatment in the bacterial arthritis of the hip and knee in adult and also the hip of the children. The clinical outcomc of bacterial arthritis of hip and knee in children was better than that of the adult. Periods of delayed treatment had significantly related to the end results of the above joints (Table 5).