Outcome of Treatment for Septic Knee Arthritis Comparison of

 ‘∑∏‘ ™—¬∫ÿμ√ æ.∫. ««. »—≈¬»“ μ√åÕÕ√å‚∏ªî¥‘° å
°≈ÿà¡ß“π»—≈¬°√√¡ÕÕ√å‚∏ªî¥‘° å ‚√ß欓∫“≈™—¬¿Ÿ¡‘
There was many methods of Treatment for septic knee arthritis, included needle aspiration
and arthrotomy. The aim of this study was to present our data comparing clinical results between
needle aspiration debridement and open arthrotomy for the treatment of septic arthritis of the
knee.
Methods : The retrospective study was performed in 82 patients who had septic arthritis of
their knees and were treated at the Department of Orthropaedic Surgery, Chaiyaphum Hospital
during 2012 to 2113. Medical records of patientûs demographic data and clinical findings and
the information of all investigation were reviewed. The early results of the treatment between
the patients who underwent needle aspiration and the patients who underwent arthrotomy
were analyzed.
Results : There were 82 patients included the study. Thirty seven patients were in the
needle aspiration group and 45 patients were in the open arthrotomy group. Culture fluid
from arthrocentesis were Staphylococcus aureus (47.6%. 31.2%) No differences between the
two groups were Length of stay, Complete recovery readmitted and dead form aspiration to
arthrotomy were statistically significant (p value>0.05)
Conclusion : The treatment of septic knee arthritis with needle aspiration was no different from
open arthrotomy.
40
............................................................................
™—¬¿Ÿ¡‘‡«™ “√
V.34 No.2 : 2014
Abstract
chaiyaphum medical journal
Outcome of Treatment for Septic Knee Arthritis Comparison of
Needle Aspiration and Arthrotomy Treatment in
Chaiyaphum Hospital
¿Ÿ¡‘À≈—ß ·≈–‡Àμÿº≈
™—¬¿Ÿ¡‘‡«™ “√
‡æ◊ËÕ»÷°…“∂÷ߺ≈≈—æ∏å°“√√—°…“¢âÕ‡¢à“Õ—°‡ ∫
μ‘¥‡™◊ÈÕ ¥â«¬«‘∏’°“√‡®“–¥Ÿ¥®“°¢âÕ‡ª√’¬∫‡∑’¬∫°—∫
°“√ºà“μ—¥‡ªî¥≈â“ߢâÕ‡¢à“ „π‚√ß欓∫“≈™—¬¿Ÿ¡‘
«‘∏’°“√»÷°…“
‡ªìπ°“√»÷°…“·∫∫ Retrospective Cohort
study „πºŸªâ «É ¬¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊ÕÈ (Medical records
for septic knee arthritis ICD-10 [International
V.34 No.2 : 2014
41
............................................................................
«—μ∂ÿª√– ߧå¢Õß°“√»÷°…“
chaiyaphum medical journal
‚√§¢â Õ Õ— ° ‡ ∫μ‘ ¥ ‡™◊È Õ ‡ªì π ¿“«–©ÿ ° ‡©‘ π ∑“ß
»— ≈ ¬°√√¡°√–¥Ÿ ° ·≈–¢â Õ ∑’Ë √ÿ π ·√߇°’Ë ¬ «¢â Õ ß°— ∫ °“√
‡®Á∫ªÉ«¬ °“√쓬1-2 ´÷ßË °“√μ‘¥‡™◊ÕÈ ∑’‡Ë ¢à“®–æ∫‰¥â∫Õà ¬∂÷ß
50% ·≈–¡’ Õ— μ √“쓬 5-20% 3-4 ‚¥¬‡©æ“–°≈ÿà ¡
non-gonococcal arthritis À√◊Õ pyogenic arthritis
‡ªì π ‚√§¢â Õ Õ— ° ‡ ∫∑’Ë ”§— ≠ ∑’Ë ÿ ¥ „π°≈ÿà ¡ acute
monoarticular arthritis ·¡â „ πªí ® ®ÿ ∫— π ®–¡’ ¬ “
ªØ‘™’«π–∑’Ë¥’¡“°‚√§π’Ȭ—ß¡’Õ—μ√“쓬·≈–Õ—μ√“°“√‡°‘¥
¿“«–∑ÿææ≈¿“æ Ÿß º≈°“√√—°…“¢÷Èπ°—∫§«“¡√«¥‡√Á«
·≈–§«“¡∂Ÿ°μâÕß„π°“√«‘π‘®©—¬·≈–°“√√—°…“ ‚√§¢âÕ
Õ—°‡ ∫μ‘¥‡™◊ÈÕ5 ”À√—∫°“√√—°…“π—Èπ¡’À≈“¬«‘∏’¥â«¬°—π
§◊Õ °“√√—°…“¥â«¬¬“ªØ‘™’«π– °“√√—°…“¥â«¬°“√∑”
À—μ∂°“√‰¥â·°à (1) °“√‡®“–¥Ÿ¥ÀπÕß√–∫“¬ÕÕ°∫àÕ¬ Ê
(repeated needle aspiration) (2) °“√√–∫“¬ÀπÕß
ÕÕ°¥â«¬°“√ àÕß°≈âÕß (arthroscopic debridement)
·≈– (3) °“√ºà “ μ— ¥ ‡æ◊Ë Õ √–∫“¬ÀπÕßÕÕ° (open
arthrotomy with debridement) 6-10 ·≈– (4)
°“√√–∫“¬ÀπÕßÕÕ°¥â«¬°“√ àÕß°≈âÕß ·≈–°“√¥Ÿ¥≈â“ß
Õ¬à“ßμàÕ‡π◊ËÕß (arthroscopic debridement with
continuous irrigation suction)11 ·μà‰¡à‰¥â¡’¢âÕ∫àß™’È
«à“°“√√—°…“·∫∫„¥¥’∑’Ë ÿ¥ ¡’ºŸâ«‘®—¬∫“ߧπ·π–π”„Àâ„™â
«‘∏’°“√‡®“–¥Ÿ¥√–∫“¬ÀπÕßÕÕ°„π√–¬–·√°¢Õß°“√
μ‘ ¥ ‡™◊È Õ 12-13 ·≈–¡’ √ “¬ß“π°“√»÷ ° …“¡“°°«à “ 90
√“¬ß“π°≈à“««à“ °“√√—°…“¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊ÈÕ∑’ˉ¥â
º≈¥’ ∑’Ë ÿ ¥ ‰¥â · °à °“√√–∫“¬‡Õ“ÀπÕßÕÕ°¥â « ¬°“√
àÕß°≈âÕ߇π◊ËÕß®“°¡’·º≈∑’ˇ≈Á° ¡’§«“¡‡®Á∫ª«¥πâÕ¬
º≈≈—æ∏å§◊Õ¢âÕ‡¢à“¬—ß∑”Àπâ“∑’ˉ¥â¥’°«à“ ·≈–¡’§«“¡
æ‘°“√μË” 14-15
°≈ÿ¡à ß“π»—≈¬°√√¡°√–¥Ÿ°·≈–¢âÕ ‚√ß欓∫“≈
™—¬¿Ÿ¡‘ „Àâ°“√√—°…“ºŸâªÉ«¬¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊Èե⫬
«‘∏’°“√‡®“–¥Ÿ¥®“°¢âÕ ·≈–°“√ºà“μ—¥¢âÕ‡¢à“‡æ◊ËÕ≈â“ß
√–∫“¬‡Õ“ÀπÕßÕÕ° ¡’ √ “¬ß“π°“√»÷ ° …“¢Õß
‚™μ‘ ¿“«»ÿ∑∏‘°ÿ≈ 16 (2556) ∑’Ë»÷°…“¬âÕπÀ≈—ß 10 ªï
∂÷ß°“√√—°…“¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊Èե⫬°“√‡®“–¥Ÿ¥®“°
¢âÕ‡ª√’¬∫‡∑’¬∫°—∫°“√ºà“μ—¥‡ªî¥≈â“ߢâÕ„π‚√ß欓∫“≈
«√√§åª√–™“√—°…å ´÷Ëßæ∫«à“°“√√—°…“‰¡à·μ°μà“ß°—π
·μà ¥â « ¬∫√‘ ∫ ∑∑’Ë · μ°μà “ ß°— π ·≈–°“√»÷ ° …“¬— ß ‰¡à
§√Õ∫§≈ÿ ¡ ∂÷ ß ¢â Õ ¡Ÿ ≈ ¥â “ π√–¬–‡«≈“‡√‘Ë ¡ μâ 𠇮Á ∫ ªÉ « ¬
®π°√–∑—Ëß¡“√—∫°“√√—°…“ (Onset) º≈°“√μ√«®∑“ß
ÀâÕߪؑ∫—μ‘°“√ ‰¥â·°à ®”π«π‡¡Á¥‡≈◊Õ¥¢“« (White
blood cell count) °“√«— ¥ °“√Õ— ° ‡ ∫„π‡≈◊ Õ ¥
(Inflammatory marker) ‰¥â·°à °“√μ°μ–°Õπ¢Õß
‡¡Á¥‡≈◊Õ¥·¥ß (ESR) §à“√—°…“欓∫“≈ °“√π—¥μ‘¥μ“¡
°“√√—°…“‡æ◊ËÕ¿“«–·∑√°´âÕπÀ≈—ß°“√ºà“μ—¥ ¥—ßπ—Èπ
ºŸâ«‘®—¬®÷ßμâÕß°“√»÷°…“‚¥¬§√Õ∫§≈ÿ¡ªí®®—¬¥—ß°≈à“«
„Àâ ∑ √“∫∂÷ ß º≈≈— æ ∏å ° “√√— ° …“¢â Õ ‡¢à “ Õ— ° ‡ ∫μ‘ ¥ ‡™◊È Õ
¥â « ¬«‘ ∏’ ° “√√— ° …“¢â Õ ‡¢à “ Õ— ° ‡ ∫μ‘ ¥ ‡™◊È Õ ¥â « ¬«‘ ∏’ ° “√
‡®“–¥Ÿ ¥ ‡ª√’ ¬ ∫‡∑’ ¬ ∫°— ∫ °“√ºà “ μ— ¥ ‡ªî ¥ ≈â “ ߢâ Õ ‡¢à “
„π‚√ß欓∫“≈™—¬¿Ÿ¡‘
™—¬¿Ÿ¡‘‡«™ “√
º≈°“√»÷°…“
„π™à«ß∑’Ë»÷°…“¡’ºŸâªÉ«¬¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊ÈÕ
®”π«π 92 √“¬ ¡’¢âÕ¡Ÿ≈§√∫∂â«π®”π«π 82 √“¬
·∫à߇ªìπ°≈ÿࡉ¥â√—∫°“√√—°…“¥â«¬«‘∏’‡®“–¥Ÿ¥ÀπÕß„π
‡¢à“μàÕ‡π◊ÕË ß ®”π«π 37 √“¬ ·≈–°≈ÿ¡à ∑’ºË “à μ—¥‡ªî¥≈â“ߢâÕ
®”π«π 45 √“¬ ºŸªâ «É ¬∑’‰Ë ¥â√∫— °“√‡®“–¥Ÿ¥ÀπÕß®“°¢âÕ
(Needle aspiration) Õ“¬ÿ‡©≈’ˬ 63.4+5.3 ªï ‡ªìπ
‡æ»À≠‘ß 67.6% πÈ”Àπ—°‡©≈’ˬ 64.4+6.3 °‘‚≈°√—¡
à«π Ÿß‡©≈’ˬ 164.2+5.7 ‡´π쑇¡μ√ §à“¥—™π’¡«≈°“¬
(BMI) ‡©≈’¬Ë 23.8+2.0 ‡ªìπ‚√§¢âÕ‡¢à“ 29.7% °“√»÷°…“
à«π¡“°√–¥—∫¡—∏¬¡»÷°…“ 51.4% à«π°≈ÿà¡∑’ˉ¥â√—∫
°“√√—°…“¥â«¬°“√ºà“μ—¥‡ªî¥≈â“ߢâÕ‡¢à“ Õ“¬ÿ‡©≈’ˬ
62.2 + 5.4 ªï ‡ªìπ‡æ»™“¬ 57.8% πÈ”Àπ—°‡©≈’ˬ
63.4+5.2 °‘‚≈°√—¡ à«π Ÿß‡©≈’¬Ë 163.5+5.7 ‡´π쑇¡μ√
§à“¥—™π’¡«≈°“¬ (BMI) ‡©≈’ˬ 23.8+2.1 ‡ªìπ‚√§¢âÕ
‡¢à“ 29.4% °“√»÷°…“ à«π¡“°√–¥—∫¡—∏¬¡»÷°…“ 44.4%
(μ“√“ß∑’Ë 1) º≈°“√‡æ“–‡™◊ÈÕ®“°πÈ”¢âÕ‡¢à“„πºŸâªÉ«¬∑—Èß
2 °≈ÿ¡à æ∫«à“‡ªìπ‡™◊ÕÈ Staphylococcus aureus 47.6%,
31.2% (μ“√“ß∑’Ë 3)
V.34 No.2 : 2014
42
............................................................................
Àâ Õ ßªØ‘ ∫— μ‘ ° “√ [white blood cell count,
haemoculture and erythrocyte sedimentation
rate (ESR) microbiological findings], √–¬–‡«≈“
πÕπ‚√ß欓∫“≈ (length of stay) °“√À“¬®“°°“√
‡®Á∫ªÉ«¬ (Complete recovery) °“√°≈—∫‡¢â“√—∫
°“√√—°…“´È” ·≈–°“√‡ ’¬™’«‘μ ‚¥¬«‘‡§√“–Àå¢âÕ¡Ÿ≈
ºà“π‚ª√·°√¡ ”‡√Á®√Ÿª SPSS version 16 „™â ∂‘μ‘
∫√√¬“¬ À“§à“ mean + standard deviation (SD).
À“§«“¡ —¡æ—π∏å‚¥¬„™â Chi-square tests, p-value
< 0.05
chaiyaphum medical journal
Classification of Diseases, Tenth Revision] codes
M0095 to M0097) ∑’ˇ¢â“√—∫°“√√—°…“„π°≈ÿà¡ß“π
»—≈¬°√√¡°√–¥Ÿ°·≈–¢âÕ ‚√ß欓∫“≈™—¬¿Ÿ¡‘ μ—Èß·μà
‡¥◊Õπ¡°√“§¡ 2554 - ‡¥◊Õπ∏—𫓧¡ 2556 ·≈–
·æ∑¬åπ—¥μ‘¥μ“¡°“√√—°…“À≈—ß®”Àπà“¬ 1 ‡¥◊Õπ ‚¥¬
¡’‡°≥±å§—¥‡¢â“°“√»÷°…“ (The inclusion criteria)
¥—ßπ’ȧ◊Õ (1) ºŸâªÉ«¬¡’Õ“¬ÿ 15 ªï¢÷Èπ‰ª (2) ¡’°“√Õ—°‡ ∫
μ‘¥‡™◊ÈÕ∑’Ë¢âÕ‡¢à“„π√–¬–·√° (3) ¡’º≈°“√‡æ“–‡™◊ÈÕ®“°
πÈ”‡®“–‡¢à“„Àâº≈∫«°À√◊Õæ∫ÀπÕß (4) ¡’‚√§ª√–®”μ—«
‰¥â·°à ‡∫“À«“𠧫“¡¥—π‚≈À‘μ Ÿß∑’¡Ë °’ “√§«∫§ÿ¡‚√§‰¥â¥’
‡°≥±å§¥— ÕÕ°®“°°“√»÷°…“ (The exclusion critria)
¡’¥ß— π’§È Õ◊ (1) ºŸªâ «É ¬¡–‡√Á߇¡Á¥‚≈À‘μ¢“« ºŸªâ «É ¬‚√§ SLE
À√◊Õ ºŸâªÉ«¬∑’ˇªìπ‚√§¢âÕÕ—°‡ ∫√Ÿ¡“μÕ¬¥å (2) ºŸâªÉ«¬
¡’°“√μ‘¥‡™◊ÈÕ∑’Ë°√–¥Ÿ° √à«¡¥â«¬ (osteomyelitis of
the distal femur or proximal tibia) (3) ºŸâªÉ«¬ periprosthetic septic arthritis (4) ºà“μ—¥„ à¢âÕ‡¢à“‡∑’¬¡
·≈– (5) ºŸâªÉ«¬∑’Ë¡’¢âÕ¡Ÿ≈‰¡à§√∫∂â«π
‚¥¬·∫àߺŸâªÉ«¬ÕÕ°‡ªìπ 2 °≈ÿà¡ °≈ÿà¡∑’Ë 1 §◊Õ
°≈ÿà¡∑’ˉ¥â√—∫°“√√—°…“¥â«¬°“√«‘∏’°“√‡®“–¥Ÿ¥®“°¢âÕ
(Needle Aspiration) °≈ÿà¡∑’Ë 2 §◊Õ °≈ÿà¡∑’ˉ¥â√—∫°“√
√—°…“¥â«¬°“√∑”ºà“μ—¥√–∫“¬‡Õ“ÀπÕßÕÕ° (arthrotomy and debridement) ‚¥¬∑—Èß 2 °≈ÿà¡®–‰¥â√—∫
¬“ªØ‘™«’ π–„π§√—ßÈ ·√°∑’¡Ë Õ’ “°“√· ¥ß∑“ߧ≈‘π°‘ ‡ªìπ‡«≈“
7 «—π ·≈–‰¥â√—∫°“√μ√«®∑“ßÀâÕߪؑ∫—μ‘°“√°àÕπ°“√
ºà“μ—¥ ‡°Á∫¢âÕ¡Ÿ≈‡°’ˬ«°—∫¢âÕ¡Ÿ≈∑—Ë«‰ª (demographic
data) ‰¥â·°à ‡æ» Õ“¬ÿ πÈ”Àπ—° à«π Ÿß ¥—™π’¡«≈°“¬
(BMI) μ”·ÀπàߢâÕ‡¢à“∑’ÕË °— ‡ ∫, Õ“°“√· ¥ß∑“ߧ≈‘π°‘
(clinical presentation: onset, affected knee),
ªí®®—¬‡ ’Ë¬ß ‰¥â·°à ‚√§‡∫“À«“π ‚√§§«“¡¥—π‚≈À‘μ Ÿß
·≈– systemic disease, “‡Àμÿ¢Õß°“√μ‘¥‡™◊ÈÕ
(etiology of the infection), º≈°“√μ√«®∑“ß
43
............................................................................
™—¬¿Ÿ¡‘‡«™ “√
V.34 No.2 : 2014
ºà“μ—¥‡ªî¥≈â“ß (arthrotomy) μ‘¥μ“¡°“√√—°…“‰ª
2 ªï æ∫«à“º≈°“√√—°…“∑—Èß 2 «‘∏’π—Èπ‰¡à·μ°μà“ß°—π
·π–π”„Àℙ⫑∏’°“√√—°…“¥â«¬°“√‡®“–¥Ÿ¥‡π◊ËÕß®“°
ªØ‘∫—쑉¥âßà“¬ ·≈–ª≈Õ¥¿—¬®÷߇ªìπ∑“߇≈◊Õ°Àπ÷ËߢÕß
°“√√—°…“ πÕ°®“°π’Ȭ—ßæ∫«à“°“√ ≈“¬º—ߺ◊¥ ·≈–
°“√√–∫“¬‡Õ“ÀπÕß∫√‘‡«≥√Õ∫ Ê ÕÕ°„ÀâÀ¡¥π—Èπ
‰¡à “¡“√∂∑”‰¥â „ π«‘ ∏’ ° “√√— ° …“¥â « ¬°“√‡®“–¥Ÿ ¥
(Closed needle aspiration) 20-22 ®“°°“√»÷°…“¢Õß
Ravindran V ·≈–§≥– 23 æ∫«à“°“√‡®“–¥Ÿ¥®“°
¢â Õ ‡ª√’ ¬ ∫‡∑’ ¬ ∫°— ∫ °“√ºà “ μ— ¥ π—È π æ∫«à “ °“√‡®“–¥Ÿ ¥
®“°¢âÕ (needle aspiration) π—Èπ∂÷ß·¡â«à“®–‡ªìπ
«‘∏’°“√√—°…“·∫∫¥—È߇¥‘¡‰¥âº≈≈—æ∏å¢Õß°“√√—°…“∑’Ë¥’
‰¡à · μ°μà “ ß®“°°“√ºà “ μ— ¥ √— ° …“ (arthrotomy)
Õ¿‘ª√“¬º≈
¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊ÕÈ ‡ªìπ¿“«–©ÿ°‡©‘π∑’μË Õâ ߉¥â√∫— Õ’°∑—È߇ªìπÀ—μ∂°“√∑’˪ؑ∫—쑉¥âßà“¬·μ°μà“ß®“°°“√
°“√«‘π®‘ ©—¬·≈–„Àâ°“√√—°…“Õ¬à“ß√«¥‡√Á«‡æ◊ÕË À≈’°‡≈’¬Ë ß ºà“μ—¥´÷ËßμâÕß„™â§«“¡√–¡—¥√–«—ß Ÿß°«à“
°“√§«“¡æ‘°“√·≈–°“√‡ ’¬™’«‘μ ¡—°æ∫„πºŸâªÉ«¬°≈ÿà¡∑’Ë √ÿª
¡’¢âÕÕ—°‡ ∫Õ¬Ÿà°àÕπ·≈â«®“°°“√»÷°…“„πÕ‡¡√‘°“æ∫«à“
°“√√—°…“ºŸâªÉ«¬¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊Èե⫬«‘∏’
‡™◊È Õ ∑’Ë ‡ ªì 𠓇Àμÿ à « π¡“°‰¥â · °à Staphylococcus ‡®“–¥Ÿ ¥ ®“°¢â Õ ·≈–«‘ ∏’ ° “√ºà “ μ— ¥ ‡ªî ¥ ¢â Õ ‡¢à “ ≈â “ ß
aureus17 ·≈–®“°°“√»÷°…“æ∫«à“ °“√√—°…“¢âÕ‡¢à“ „Àâº≈≈—æ∏å∑’ˉ¡à·μ°μà“ß°—π
Õ—°‡ ∫μ‘¥‡™◊Èե⫬«‘∏’‡®“–¥Ÿ¥ÀπÕß À√◊Õ°“√√—°…“¥â«¬ ¢âÕ‡ πÕ·π–®“°°“√»÷°…“
°“√ºà “ μ— ¥ ‡ªî ¥ ≈â “ ߢâ Õ ‡¢à “ π—È π ¡’ º ≈≈— æ ∏å ° “√√— ° …“∑’Ë
®“°°“√»÷ ° …“¡’ ¢â Õ ®”°— ¥ §◊ Õ ‡ªì π °“√»÷ ° …“
‰¡à · μ°μà “ ß°— π Õ¥§≈â Õ ß°— ∫ °“√√— ° …“¢Õß ‚™μ‘ ¬â Õ πÀ≈— ß ¥— ß π—È π ¢â Õ ¡Ÿ ≈ ∫“ßÕ¬à “ ß®÷ ß ¡’ ‰ ¡à § √∫∂â « π
¿“«–»ÿ∑∏‘°ÿ≈ (2556) ∑’Ë»÷°…“∂÷ß°“√√—°…“¢âÕ‡¢à“Õ—°‡ ∫ ‰¥â · °à °“√ª√–‡¡‘ π º≈∑“ߧ≈‘ π‘ ° ¢Õß√“¬≈–‡Õ’ ¬ ¥
μ‘ ¥ ‡™◊È Õ ¥â « ¬«‘ ∏’ ‡ ®“–¥Ÿ ¥ ®“°¢â Õ ‡ª√’ ¬ ∫‡∑’ ¬ ∫°— ∫ °“√ °à Õ πºà “ μ— ¥ ·≈–À≈— ß ºà “ μ— ¥ °“√∑”ß“π¢ÕßÀ— « ‡¢à “
ºà“μ—¥‡ªî¥≈â“ߢâÕ „π‚√ß欓∫“≈ «√√§åª√–™“√—°…å16 ‡™à π °“√„Àâ § –·π𧫓¡‡®Á ∫ ª«¥„π™à « ߢÕß°“√
·≈–°“√»÷ ° …“¢Õß Goldenberg DL ·≈–§≥– ‡§≈◊Ë Õ π‰À«·≈–º≈°“√∑”ß“π §«“¡æ÷ ß æÕ„®¢Õß
(1975)18 πÕ°®“°π’È®“°°“√»÷°…“¢Õß Smith SP ·≈– ºŸâªÉ«¬ √«¡∂÷ߧà“√—°…“欓∫“≈ ¥—ßπ—ÈπÀ“°¡’°“√
§≥– (1975)19 ∑’»Ë °÷ …“‰ª¢â“ßÀπâ“„π°“√√—°…“ºŸªâ «É ¬‡¥Á° »÷°…“§√—ÈßμàÕ‰ª§«√‰¥â¡’°“√»÷°…“„πª√–‡¥Áπ‡À≈à“π’È
∑’ˉÀ≈àÕ—°‡ ∫μ‘¥‡™◊ÈÕ®”π«π 61 √“¬ ∑’ˉ¥â√—∫°“√√—°…“
¥â«¬«‘∏’‡®“–¥Ÿ¥ (closed needleaspiration) ·≈–
chaiyaphum medical journal
‡æ» Õ“¬ÿ √–¥—∫°“√»÷°…“ à«π Ÿß πÈ”Àπ—°
§à“¥—™π’¡«≈°“¬ (Table1) √–¬–‡«≈“‡√‘Ë¡°“√‡®Á∫ªÉ«¬
μ”·Àπàß∑’Ë¢âÕ‡¢à“Õ—°‡ ∫ §à“‡¡Á¥‡≈◊Õ¥¢“«, §à“ ESR,
®”π«π‡¡Á¥‡≈◊Õ¥¢“« ·≈– Polymorphonuclear cell
À√◊Õ Neutrophil (μ“√“ß∑’Ë 2) ‰¡à¡’§«“¡ —¡æ—π∏åÕ¬à“ß
¡’π—¬ ”§—≠∑“ß ∂‘μ‘ (p<0.05) à«π Pre-existing joint
diseases π—Èπ¡’§«“¡ —¡æ—π∏åÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘
(p<0.05)
º≈≈— æ ∏å ° “√√— ° …“„π‡√◊Ë Õ ß √–¬–‡«≈“πÕπ
‚√ß欓∫“≈, À“¬®“°°“√‡®Á ∫ ªÉ « ¬, °“√‡ ’ ¬ ™’ «‘ μ
°“√°≈—∫‡¢â“√—∫°“√√—°…“μàÕ„π‚√ß欓∫“≈ ∑—Èß 2 °≈ÿà¡
æ∫«à“‰¡à·μ°μà“ßÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘ (p>0.05)
TABLE 1 Patientûs characteristics and demographic data
TABLE 2 Clinical presentation and laboratory investigations
44
............................................................................
™—¬¿Ÿ¡‘‡«™ “√
V.34 No.2 : 2014
chaiyaphum medical journal
*Data expressed mean + standard deviation, a p-value derived using unpaired studentûs t-test :
b p-value derived using Fisherûs exact test, BMI: body mass index
TABLE 3 Causative organisms isolated from knee joint fluid.
45
............................................................................
™—¬¿Ÿ¡‘‡«™ “√
V.34 No.2 : 2014
TABLE 4 Outcome of septic knee arthritis patients based on treatment
chaiyaphum medical journal
*Data expressed mean + standard deviation, a p-value derived using unpaired studentûs t-test:
b p-value derived using Fisherûs exact test, WBC: White blood cell, ESR: Erythrocyte
sedimentation rate, PMN: Polymorphonuclears cells.
‡Õ° “√Õâ“ßÕ‘ß
™—¬¿Ÿ¡‘‡«™ “√
V.34 No.2 : 2014
46
............................................................................
chaiyaphum medical journal
1. Mehta P, Schnall SB, Zalavras CG. Septic
arthritis of the shoulder, elbow and wrist.
Clin Orthop Relat Res. 2006 ; 451 : 42-5.
2. Shirtliff ME, Mader JT. Acute septic arthritis. Clin Microbiol Rev. 2002 ; 15 : 527-44.
3. Carpenter CR, Schuur JD, Everett WW, Pines
JM. Evidence-based diagnostics: adult
septic arthritis. Academic Emergency
Medicine 2011 ; 18 : 781-96.
4. Nilganuwong S, Jindabunjerd Y. Clinical Study
of Non-Gonococcal Bacterial Septic Siriraj
Hospital, Thailand. Siriraj Med J. 2006 ;
58 (11) : 1095-102.
5. √—μπ«¥’ ≥ π§√, »‘√¿æ ÿ«√√≥‚√®πå : Approach
to acute monoarthritis. „π : ∑«’ »‘√‘«ß»å, ∫°.
Focus on practical medicine. °√ÿ߇∑æœ :
‡¥Õ– ¬“¡‡ŒÕ√‘‡∑® ®”°—¥ 2538 : 29-44.
6. Lane JG, Falahee MH, Wojtys EM, Hankin
FM, Kaufer H. Pyarthrosis of the knee.
Treatment considerations. Clin Orthop Relat
Res. 1990 Mar (252) : 198-204.
7. Shulman G, Waugh TR. Acute bacterial
arthritis in the adult. Orthop Rev. 1988 Oct;
17(10) : 955-60.
8. Stanitski CL, Harvell JC, Fu FH. Arthroscopy
in acute septic knees. Management in
pediatric patients. Clin Orthop Relat Res. 1989
Apr (241) : 209-12.
9. Thiery JA. Arthroscopic drainage in septic
arthritides of the knee: a multicenter study.
Arthroscopy. 1989 ; 5(1) : 65-9.
10. Wirtz DC, Marth M, Miltner O, Schneider U,
Zilkens KW. Septic arthritis of the knee in
adults: treatment by arthroscopy or arthrotomy. Int Orthop. 2001 ; 25(4) : 239-41.
11. Mathews CJ, Weston VC, Jones A, Field M,
Coakley G. Bacterial septic arthritis in
adults.Lancet 2010 ; 375 : 846-55.
12. Balabaud L, Gaudias J, Boeri C, Jenny JY,
Kehr P. Results of treatment of septic knee
arthritis: a retrospective series of 40 cases.
Knee Surg Sports Traumatology Arthroscopy
2007 ; 15 : 387-92.
13. Goldenberg DL, Brandt KD, Cohen AS,
Cathcart ES. Treatment of septic arthritis
comparison of needle aspiration and
surgery as initial modes of joint drainage.
Arthritis Rheum 1975 ; 18 : 83-90.
14. Wirtz DC, Marth M, Miltner O, Schneider U,
Zilkens KW. Septic arthritis of the knee in
adults: treatment by arthroscopy or arthrotomy. Int Orthop. 2001 ; 25(4) : 239-41.
15. Balabaud L, Gaudias J, Boeri C, Jenny JY,
Kehr P. Results of treatment of septic knee
arthritis: a retrospective series of 40 cases.
Knee Surg Sports Traumatol Arthrosc. 2007
Apr ; 15(4) : 387-92.
™—¬¿Ÿ¡‘‡«™ “√
V.34 No.2 : 2014
47
............................................................................
21. Sammer DM, Shin AY. Comparison of
arthroscopic and open treatment of septic
arthritis of the wrist. J Bone Joint Surg Am.
2009 ; 91 : 1387-93.
22. Abdel MP, Perry KI, Morrey ME, et al.
Arthroscopic management of native
shoulder septic arthritis. J Shoulder Elbow
Surg. 2012.
23. Ravindran V, Logan I, Bourke BE. Medical
vs surgical treatment for the native joint in
septic arthritis: a 6-year, single UK academic
centre experience. Rheumatology (Oxford).
2009 ; 48 : 1320-2.
24. Butt U, Amissah-Arthur M, Khattak F, et al.
What are we doing about septic arthritis?
A survey of UK-based rheumatologists
and orthopedic surgeons. Clin Rheumatol.
2011 ; 30 : 707-10.
chaiyaphum medical journal
16. Chote Pawasuttikul. Comparison of Needle
Aspiration and Arthrotomy Treatment for
Septic Knee Arthritis : A 10-year retrospective study. JRCOST 2013 : VOL.37 NO.2-4
April-October : 29-33.
17. Katie A. Sharff Eric P. Richards John M.
Townes. Clinical Management of Septic Arthritis. Curr Rheumatol Rep (2013) 15 : 332.
18. Goldenberg DL, Brandt KD, Cohen AS,
Cathcart ES. Treatment of septic arthritis :
comparison of needle aspiration and surgery
as initial modes of joint drainage. Arthritis
Rheum 1975 ; 18 : 83-90.
19. Smith SP, Thyoka M, Lavy CB, Pitani A.
Septic arthritis of the shoulder in children in
Malawi. A randomised, prospective study of
aspiration versus arthrotomy and washout. J
Bone Joint Surg Br 2002 ; 84 : 1167-1172.
20. Goldenberg DL, Brandt KD, Cohen AS, et al.
Treatment of septic arthritis : comparison of
needle aspiration and surgery as initial modes
of joint drainage. Arthritis Rheum. 1975 ;
18 : 83-90.
∫∑§—¥¬àÕ
°“√√—°…“¢âÕ‡¢à“Õ—°‡ ∫®“°°“√μ‘¥‡™◊ÕÈ ¡’À≈“¬«‘∏’ ‚¥¬‚√ß欓∫“≈™—¬¿Ÿ¡„‘ Àâ°“√√—°…“¥â«¬«‘∏‡’ ®“–¥Ÿ¥®“°
¢âÕ‡¢à“Õ¬à“ßμàÕ‡π◊ÕË ß ·≈–«‘∏°’ “√ºà“μ—¥‡ªî¥≈â“ߢâÕ‡¢à“ ·μà¬ß— ‰¡à¡¢’ Õâ √ÿª«à“°“√√—°…“·∫∫„¥‰¥âº≈°“√√—°…“∑’¥Ë °’ «à“
¥—ßπ—ÈπºŸâ«‘®—¬®÷ßμâÕß°“√»÷°…“‚¥¬¡’«—μ∂ÿª√– ߧå‡æ◊ËÕ»÷°…“º≈≈—æ∏å°“√√—°…“¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊Èե⫬«‘∏’°“√‡®“–
¥Ÿ¥®“°¢âÕ ‡ª√’¬∫‡∑’¬∫°—∫°“√√—°…“¥â«¬°“√ºà“μ—¥‡ªî¥≈â“ߢâÕ „π‚√ß欓∫“≈™—¬¿Ÿ¡‘
«‘∏’°“√»÷°…“ ‡ªìπ°“√»÷°…“ ¬âÕπÀ≈—ß„πºŸâªÉ«¬∑’ˇ¢â“√—∫°“√√—°…“¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊ÈÕ ∑’ˇ¢â“√—∫°“√√—°…“„π°≈ÿà¡
ß“π»—≈¬°√√¡°√–¥Ÿ°·≈–¢âÕ ‚√ß欓∫“≈™—¬¿Ÿ¡‘ μ—Èß·μà‡¥◊Õπ¡°√“§¡ 2554 - ‡¥◊Õπ∏—𫓧¡ 2556 ®”π«π
82 √“¬ ‚¥¬»÷°…“∂÷ß°“√√—°…“ ¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊ÕÈ ¥â«¬«‘∏°’ “√‡®“–¥Ÿ¥‡¢à“‡ª√’¬∫‡∑’¬∫°—∫°“√ºà“μ—¥‡ªî¥≈â“ߢâÕ‡¢à“
‡æ◊ËÕ¥Ÿ§«“¡·μ°μà“ß„π¥â“π√–¬–‡«≈“„π°“√πÕπ‚√ß欓∫“≈ °“√À“¬¢“¥®“°‚√§ °“√‡ ’¬™’«‘μ ·≈–°“√
°≈—∫‡¢â“√—∫°“√√—°…“´È”„π‚√ß欓∫“≈ «‘‡§√“–Àå¢âÕ¡Ÿ≈‚¥¬„™â ∂‘μ‘∫√√¬“¬ À“§à“ mean + standard deviation
(SD). À“§«“¡ —¡æ—π∏å‚¥¬„™â Chi-square tests, p-value < 0.05
º≈°“√»÷°…“ „π™à«ß∑’Ë»÷°…“¡’ºŸâªÉ«¬¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊ÈÕ®”π«π 92 √“¬ ¡’¢âÕ¡Ÿ≈§√∫∂â«πμ“¡‡°≥±å∑’Ë°”Àπ¥
®”π«π 82 √“¬ ·∫àßÕÕ°‡ªìπ°≈ÿࡉ¥â√—∫°“√√—°…“¥â«¬«‘∏’‡®“–¥Ÿ¥ÀπÕß„π‡¢à“μàÕ‡π◊ËÕß ®”π«π 37 √“¬ ·≈–
°≈ÿà¡∑’ˉ¥â√—∫°“√ºà“μ—¥‡ªî¥≈â“ߢâÕ ®”π«π 45 √“¬ ≈—°…≥–∑—Ë«‰ª¢ÕߺŸâªÉ«¬∑—Èß 2 °≈ÿࡉ¥â·°à ‡æ» Õ“¬ÿ √–¥—∫°“√»÷°…“
à«π Ÿß πÈ”Àπ—° §à“¥—™π’¡«≈°“¬ √–¬–‡«≈“‡√‘Ë¡‡®Á∫ªÉ«¬ μ”·Àπàß∑’Ë¢âÕ‡¢à“Õ—°‡ ∫ ≈—°…≥–∑“ߧ≈‘π‘° ·≈–
º≈°“√μ√«®∑“ßÀâÕߪؑ∫—μ‘ ‚¥¬‰¡à¡’§«“¡·μ°μà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘ (p<0.05) ¬°‡«âπ Pre-existing
joint disease ∑’Ë¡’§«“¡·μ°μà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘ (p=0.004) à«πº≈°“√‡æ“–‡™◊ÈÕ®“°πÈ”¢âÕ‡¢à“
à«π¡“°‡ªìπ‡™◊ÈÕ Staphylococcus aureus ¡“°∑’Ë ÿ¥∑—Èß 2 °≈ÿà¡ (47.6% ·≈– 31.2%) ‡¡◊ËÕ«‘‡§√“–Àå
º≈≈—æ∏å°“√√—°…“„π‡√◊ËÕß √–¬–‡«≈“πÕπ‚√ß欓∫“≈, À“¬®“°°“√‡®Á∫ªÉ«¬, °“√°≈—∫‡¢â“√—∫°“√√—°…“μàÕ„π
‚√ß欓∫“≈°“√‡ ’¬™’«‘μ∑—Èß 2 °≈ÿà¡ æ∫«à“‰¡à·μ°μà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘ (p>0.05)
√ÿª °“√√—°…“ºŸâªÉ«¬¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊Èե⫬«‘∏’‡®“–¥Ÿ¥®“°¢âÕ ·≈–«‘∏’°“√ºà“μ—¥‡ªî¥¢âÕ‡¢à“≈â“ß „Àâº≈≈—æ∏å
∑’ˉ¡à·μ°μà“ß°—π
48
............................................................................
™—¬¿Ÿ¡‘‡«™ “√
V.34 No.2 : 2014
‘∑∏‘ ™—¬∫ÿμ√ æ.∫. ««. »—≈¬»“ μ√åÕÕ√å‚∏ªî¥‘° å
°≈ÿà¡ß“π»—≈¬°√√¡ÕÕ√å‚∏ªî¥‘° å ‚√ß欓∫“≈™—¬¿Ÿ¡‘
chaiyaphum medical journal
º≈≈—æ∏å°“√√—°…“¢âÕ‡¢à“Õ—°‡ ∫μ‘¥‡™◊Èե⫬«‘∏’°“√‡®“–¥Ÿ¥®“°¢âÕ
‡ª√’¬∫‡∑’¬∫°—∫°“√ºà“μ—¥‡ªî¥≈â“ߢâÕ „π‚√ß欓∫“≈™—¬¿Ÿ¡‘
(Outcome of Treatment for Septic Knee Arthritis Comparison of
Needle Aspiration and Arthrotomy Treatment in
Chaiyaphum Hospital)