Wang Huaikeng,Huang Shaomin,Liang Longfang,et al.Application of continuous douche plus vacuum drainage for acute hematogenous osteomyelitis in children with fenestration decompression and lesion clearance[J].Journal of Clinical Pediatric Surgery,,():757-762.[doi:10.3760/cma.j.cn101785-202309018-010]
Application of continuous douche plus vacuum drainage for acute hematogenous osteomyelitis in children with fenestration decompression and lesion clearance
- Keywords:
- Osteomyelitis; Debridement; Drainage; Child
- Abstract:
- Objective To explore clinical value of continuous douche plus vacuum drainage in children with acute hematogenous osteomyelitis (AHO) after operation.Methods From July 2015 to December 2022,the relevant clinical data were retrospectively reviewed for AHO children hospitalized into Xiamen Children’s Hospital.They were divided into two groups of fenestration decompression+lesion clearance+continuous douche plus vacuum drainage (Ⅰ,n=17) and fenestration decompression+lesion clearance (Ⅱ,n=18) according to whether or not continuous douche plus vacuum drainage post-operation was performed.The differences in duration of fever,length of hospitalization stay,indwelling time of drainage tube,postoperative time for white blood cell (WBC),C-reactive protein (CRP),procalcitonin (PCT) and erythrocyte sedimentation rate (ESR) to normalize,postoperative recurrence rate of osteomyelitis,chronic osteomyelitis,pathological fracture,incision infection rate and postoperative efficacy were compared between two groups.Results Indwelling time of drainage tube was longer in group Ⅰ than that in group Ⅱ[(8.59±1.33) vs.(6.28±1.27) day]and the difference was statistically significant (t=5.256,P=0.000).No significant differences existed in duration of fever [(5.20±5.11) vs.(4.06±5.79) day,t=0.616],length of hospitalization stay [(21.32±9.12) vs.(23.11±10.30) day,t=-0.543],postoperative time for WBC to normalize (5.21±4.93 vs. 4.78±4.67 day,t=0.265),time for CRP to normalize (6.23±4.15 vs. 5.61±3.37 day,t=0.486),postoperative time for PCT to normalize [(8.15±7.25) vs. 10.89±10.25 days,t=-0.908),postoperative time for ESR to normalize [(23.87±12.56) vs.(21.00±13.33) day,t=0.655],postoperative recurrence rate of osteomyelitis (1/17,5.89% vs. 2/18,11.11%) and incision infection rate (1/17,5.89% vs. 1/18,5.56%)(P>0.05).There was no instance of chronic osteomyelitis or pathological fracture.No significant inter-group difference in excellent/decent rate of efficacy evaluation [(16/17,94.12%) vs. (16/18,88.89%),P=1.000].Conclusions Continuous douche plus vacuum drainage fails to improve the postoperative efficacy of AHO children.It prolongs the retention time of drainage tube.Fenestration decompression plus lesion clearance is indicated for AHO children with reliable efficacy and simple procedures.
References:
[1] Yeo A,Ramachandran M.Acute haematogenous osteomyelitis in children[J].BMJ,2014,348:g66.DOI:10.1136/bmj.g66.
[2] Martin AC,Anderson D,Lucey J,et al.Predictors of outcome in pediatric osteomyelitis: five years experience in a single tertiary center[J].Pediatr Infect Dis J,2016,35(4):387-391.DOI:10.1097/INF.0000000000001031.
[3] Thakolkaran N,Shetty AK.Acute hematogenous osteomyelitis in children[J].Ochsner J,2019,19(2):116-122.DOI:10.31486/toj.18.0138.
[4] 宋宝健,王强,冯伟,等.持续冲洗结合负压封闭引流治疗儿童急性血源性骨髓炎[J].临床小儿外科杂志,2017,16(3):238-241.DOI:10.3969/j.issn.1671-6353.2017.03.009. Song BJ,Wang Q,Feng W,et al.Efficacy of continuous douche plus vacuum sealing drainage for acute hematogenous osteomyelitis in children[J].DOI:10.3969/j.issn.1671-6353.2017.03.009.
[5] 化昊天,王新卫,张磊,等.骨皮质开窗病灶清除联合抗生素硫酸钙治疗儿童急性血源性骨髓炎29例[J].中国中医骨伤科杂志,2022,30(4):38-42. Hua HT,Wang XW,Zhang L,et al.Fenestration of bone cortex plus antibiotics calcium sulfate for acute hematogenous osteomyelitis: a report of 29 cases[J].Chin J Tradit Med Traumatol Orthop,2022,30(4):38-42.
[6] Vaughan PA,Newman NM,Rosman MA.Acute hematogenous osteomyelitis in children[J].J Pediatr Orthop,1987,7(6):652-655.
[7] Harris JC,Caesar DH,Davison C,et al.How useful are laboratory investigations in the emergency department evaluation of possible osteomyelitis?[J].Emerg Med Australas,2011,23(3):317-330.DOI:10.1111/j.1742-6723.2011.01413.x.
[8] DeRonde KJ,Girotto JE,Nicolau DP.Management of pediatric acute hematogenous osteomyelitis,part I: antimicrobial stewardship approach and review of therapies for methicillin-susceptible Staphylococcus aureus,Streptococcus pyogenes,and Kingella kingae[J].Pharmacotherapy,2018,38(9): 947-966.DOI:10.1002/phar.2160.
[9] McCarthy JJ,Dormans JP,Kozin SH,et al.Musculoskeletal infections in children: basic treatment principles and recent advancements[J].Instr Course Lect,2005,54: 515-528.DOI:10.2106/00004623-200404000-00028.
[10] Zhorne DJ,Altobelli ME,Cruz AT.Impact of antibiotic pretreatment on bone biopsy yield for children with acute hematogenous osteomyelitis[J].Hosp Pediatr,2015,5(6):337-341.DOI:10.1542/hpeds.2014-0114.
[11] 中华医学会儿科学分会感染学组,中华儿科杂志编辑委员会.儿童急性血源性骨髓炎治疗专家共识[J].中华儿科杂志,2022,60(8):745-750.DOI:10.3760/cma.j.cn112140-20220214-00118. Subspecialty Group of Infectious Diseases,Branch of Pediatrics,Chinese Medical Association;Editorial Board,Chinese Journal of Pediatrics: Expert Consensus on Managing Acute Hematogenous Osteomyelitis in Children[J].Chin J Pediatr,2022,60(8):745-750.DOI:10.3760/cma.j.cn112140-20220214-00118.
[12] 胡付品,郭燕,朱德妹,等.2020年CHINET中国细菌耐药监测[J].中国感染与化疗杂志,2021,21(4):377-387.DOI: 10.16718/j.1009-7708.2021.04.001. Hu FP,Guo Y,Zhu DM,et al.CHINET surveillance of bacterial resistance: results of 2020[J].Chin J Infect Chemother,2021,21(4):377-387.DOI: 10.16718/j.1009-7708.2021.04.001.
[13] 胡付品,郭燕,朱德妹,等.2019年CHINET三级医院细菌耐药监测[J].中国感染与化疗杂志,2020,20(3):233-243.DOI:10.16718/j.1009-7708.2020.03.001. Hu FP,Guo Y,Zhu DM,et al.CHINET surveillance of bacterial resistance across tertiary hospitals in 2019[J].Chin J Infect Chemother,2020,20(3):233-243.DOI: 10.16718/j.1009-7708.2020.03.001.
[14] Hu FP,Guo Y,Yang Y,et al.Resistance reported from China antimicrobial surveillance network (CHINET) in 2018[J].Eur J Clin Microbiol Infect Dis,2019,38(12):2275-2281.DOI:10.1007/s10096-019-03673-1.
[15] Peltola H,Unkila-Kallio L,Kallio MJ.Simplified treatment of acute staphylococcal osteomyelitis of childhood.The Finnish Study Group[J].Pediatrics,1997,99(6):846-850.DOI:10.1542/peds.99.6.846.
[16] Whyte NS,Bielski RJ.Acute hematogenous osteomyelitis in children[J].Pediatr Ann,2016,45(6):e204-e208.DOI:10.3928/00904481-20160428-01.
[17] Peltola H,P??kk?nen M.Acute osteomyelitis in children[J].N Engl J Med,2014,370(4):352-360.DOI:10.1056/NEJMra1213956.
[18] Iliadis AD,Ramachandran M.Paediatric bone and joint infection[J].EFORT Open Rev,2017,2(1):7-12.DOI:10.1302/2058-5241.2.160027.
[19] Saavedra-Lozano J,Falup-Pecurariu O,Faust SN,et al.Bone and joint infections[J].Pediatr Infect Dis J,2017,36(8):788-799.DOI:10.1097/INF.0000000000001635.
[20] Chiappini E,Mastrangelo G,Lazzeri S.A case of acute osteomyelitis: an update on diagnosis and treatment[J].Int J Environ Res Public Health,2016,13(6):539.DOI:10.3390/ijerph13060539.
[21] Street M,Puna R,Huang M,et al.Pediatric acute hematogenous osteomyelitis[J].J Pediatr Orthop,2015,35(6):634-639.DOI:10.1097/BPO.0000000000000332.
[22] Copley LAB.Pediatric musculoskeletal infection: trends and antibiotic recommendations[J].J Am Acad Orthop Surg,2009,17(10):618-626.DOI:10.5435/00124635-200910000-00004.
[23] Qin CH,Zhang HA,Chee YH,et al.Comparison of the use of antibiotic-loaded calcium sulphate and wound irrigation-suction in the treatment of lower limb chronic osteomyelitis[J].Injury,2019,50(2):508-514.DOI:10.1016/j.injury.2018.10.036.
Memo
收稿日期:2023-9-10。
基金项目:厦门市医疗卫生指导性项目(3502Z202142ZD1246)
通讯作者:裴新红,Email:peizane@163.com