Wen Yuwei,Jia Haiting,Wang Chunhua,et al.Treatment of osteomyelitis of short tubular and flat bones in children[J].Journal of Clinical Pediatric Surgery,,22():158-162.[doi:10.3760/cma.j.cn101785-202202018-012]
Treatment of osteomyelitis of short tubular and flat bones in children
- Keywords:
- Osteomyelitis; Short Tubular Bone; Treatment Outcome; Flat Bone; Child
- Abstract:
- Objective To explore the clinical characteristics,treatments and prognoses of osteomyelitis of short tubular and flat bones in children.Methods From September 2017 to July 2020,clinical data were retrospectively reviewed for 15 children with short tubular and flat bone osteomyelitis,including short tubular bone (n=12) and flat bone (n=3).There were 9 boys and 6 girls with an average age of 42.3(1-108) months.Negative pressure drainage of vacuum-assisted closure (VAC) was applied.Symptoms & signs,body temperature,inflammatory parameters,imaging examinations and functions of affected extremities were recorded.Results Clinical manifestations of 10 children were local redness,heat,pain and function limitation,fever (n=6) and elevations of leucocyte,erythrocyte sedimentation rate (ESR) and C-reactive protein (n=7).All operations were successful.After incision,debridement and VAC negative pressure drainage,inflammatory parameters normalized.Eleven children with short tubular bone and 2 children with flat bone recovered well.One case of patellar osteomyelitis recurred and normalized after reoperation and function of knee joint was restored.Extremity shortening occurred in a child with phalangeal bone osteomyelitis. Conclusion Osteomyelitis of short tubular and flat bones in children generally manifest locally with fewer systemic symptoms and no marked elevations of inflammatory parameters.A definite diagnosis is dependent upon magnetic resonance imaging (MRI) examination. mainly depends on MRI.No significant difference exists in the treatment of long tubular bone and clinical prognosis is decent.
References:
[1] Peltola H,P??kk?nen M.Acute osteomyelitis in children[J].N Engl J Med,2014,370(14):1364-1366.DOI:10.1056/NEJMc1402234.
[2] Keren R,Shah SS,Srivastava R,et al.Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children[J].JAMA Pediatr,2015,169(2):120-128.DOI:10.1001/jamapediatrics.2014.2822.
[3] Peltola H,P??kk?nen M.Acute osteomyelitis in children[J].N Engl J Med,2014,370(4):352-360.DOI:10.1056/NEJMra1213956.
[4] 张晓乐,赵国强,赵旭飞.18例儿童手和足骨髓炎诊治分析[J].临床小儿外科杂志,2020,19(10):921-925.DOI:10.3969/j.issn.1671-6353.2020.10.011. Zhang XL,Zhao GQ,Zhao XF.Analysis of diagnosis and treatment of hand and foot osteomyelitis in children:a report of 18 cases[J].J Clin Ped Sur,2020,19(10):921-925.DOI:10.3969/j.issn.1671-6353.2020.10.011.
[5] Dartnell J,Ramachandran M,Katchburian M.Haematogenous acute and subacute paediatric osteomyelitis:a systematic review of the literature[J].J Bone Joint Surg Br,2012,94(5):584-595.DOI:10.1302/0301-620X.94B5.28523.
[6] Taj-Aldeen SJ,Rammaert B,Gamaletsou M,et al.Osteoarticular infections caused by non-Aspergillus filamentous fungi in adult and pediatric patients:a systematic review[J].Medicine (Baltimore),2015,94(50):e2078.DOI:10.1097/MD.0000000000002078.
[7] Jaramillo D,Treves ST,Kasser JR,et al.Osteomyelitis and septic arthritis in children:appropriate use of imaging to guide treatment[J].AJR Am J Roentgenol,1995,165(2):399-403.DOI:10.2214/ajr.165.2.7618566.
[8] Beaman FD,von Herrmann PF,et al.Expert Panel on Musculoskeletal Imaging,ACR appropriateness criteria? suspected osteomyelitis,septic arthritis,or soft tissue infection (excluding spine and diabetic foot)[J].J Am Coll Radiol,2017,14(5S):S326-S337.DOI:10.1016/j.jacr.2017.02.008.
[9] Leone A,Cassar-Pullicino VN,Semprini A,et al.Neuropathic osteoarthropathy with and without superimposed osteomyelitis in patients with a diabetic foot[J].Skeletal Radiol,2016,45(6):735-754.DOI:10.1007/s00256-016-2339-1.
[10] Hara H,Akisue T,Kawamoto T,et al.Sequential MR images and radiographs of epiphyseal osteomyelitis in the distal femur of an infant[J].Case Rep Radiol,2013,2013:672815.DOI:10.1155/2013/672815.
[11] Warmann SW,Dittmann H,Seitz G,et al.Follow-up of acute osteomyelitis in children:the possible role of PET/CT in selected cases[J].J Pediatr Surg,2011,46(8):1550-1556.DOI:10.1016/j.jpedsurg.2010.11.037.
[12] Gigante A,Coppa V,Marinelli M,et al.Acute osteomyelitis and septic arthritis in children:a systematic review of systematic reviews[J].Eur Rev Med Pharmacol Sci,2019,23(2 Suppl):145-158.DOI:10.26355/eurrev_201904_17484.
[13] Pendleton A,Kocher MS.Methicillin-resistant staphylococcus aureus bone and joint infections in children[J].J Am Acad Orthop Surg,2015,23(1):29-37.DOI:10.5435/JAAOS-23-01-29.
[14] Morykwas MJ,Argenta LC,Shelton-Brown EI,et al.Vacuum-assisted closure:a new method for wound control and treatment:animal studies and basic foundation[J].Ann Plast Surg,1997,38(6):553-562.DOI:10.1097/00000637-199706000-00001.
[15] Streubel PN,Stinner DJ,Obremskey WT.Use of negative-pressure wound therapy in orthopaedic trauma[J].J Am Acad Orthop Surg,2012,20(9):564-574.DOI:10.5435/JAAOS-20-09-564.
[16] Orgill DP,Manders EK,Sumpio BE,et al.The mechanisms of action of vacuum assisted closure:more to learn[J].Surgery,2009,146(1):40-51.DOI:10.1016/j.surg.2009.02.002.
[17] Timmers MS,Graafland N,Bernards AT,et al.Negative pressure wound treatment with polyvinyl alcohol foam and polyhexanide antiseptic solution instillation in posttraumatic osteomyelitis[J].Wound Repair Regen,2009,17(2):278-286.DOI:10.1111/j.1524-475X.2009.00458.x.
[18] 薛文,王栓科.儿童血源性髌骨骨髓炎一例[J].中华小儿外科杂志,2007,28(11):615.DOI:10.3760/cma.j.issn.0253-3006.2007.11.019. Xue W,Wang SK.Hematogenous patellar osteomyelitis in children:one case report[J].Chin J Pediatr Surg,2007,28(11):615.DOI:10.3760/cma.j.issn.0253-3006.2007.11.019.
Memo
收稿日期:2021-9-9。
通讯作者:贾海亭,Email:626333674@qq.com