Jia Haiting,Sun Lihua,Liu Tao,et al.Clinical features of acute metaphyseal osteomyelitis involving epiphysis in children aged below 15 months and over 18 months[J].Journal of Clinical Pediatric Surgery,2024,(08):763-767.[doi:10.3760/cma.j.cn101785-202306036-011]
15月龄以下和18月龄以上累及骨骺的急性干骺端骨髓炎患儿临床特征分析
- Title:
- Clinical features of acute metaphyseal osteomyelitis involving epiphysis in children aged below 15 months and over 18 months
- Keywords:
- Osteomyelitis; Epiphyses; Signs and Symptoms; Pathology; Clinical; Child
- 摘要:
- 目的 骨骺和干骺端血管通道通常在15~18月龄消失。本研究以15、18月龄为界,对比分析15月龄以下和18月龄以上累及骨骺的急性干骺端骨髓炎患儿临床特征。 方法 本研究为回顾性研究。收集2017年7月至2022年10月山东大学附属儿童医院诊治的45例累及骨骺的急性干骺端骨髓炎患儿临床资料,12例15月龄以下患儿设为观察组,其中男5例、女7例,年龄19 d至1岁2个月;33例18月龄以上患儿设为对照组,其中男20例、女13例,年龄1岁7个月至12岁。对比分析两组性别、发病时长、脓液培养阳性率、起病时最高体温、入院24 h内炎症指标情况、住院时间以及有无关节炎。 结果 观察组和对照组性别分布差异无统计学意义(P＞0.05),发病时最高体温分别为(38.78±0.69)℃和(39.29±0.85)℃,血白细胞中位数分别为13.59×109/L和12.98×109/L,中性粒细胞中位数分别为4.54×109/L和8.57×109/L,C反应蛋白(C-reactive protein,CRP)中位数分别为36.45 mg/L和69.10 mg/L,血沉(erythrocyte sedimentation rate,ESR)分别为(59.75±20.63)mm/h和(70.97±24.34)mm/h,发病时长分别为(7.50±3.66)d和( 6.94±3.18)d,住院时间中位数分别为30.0 d和32.0 d,差异均无统计学意义(P＞0.05);脓液培养阳性率分别为66.7%(8/12)和69.7%(23/33),差异无统计学意义(P＞0.05)。观察组中5例合并关节炎,对照组22例合并关节炎,差异无统计学意义(P＞0.05)。随访期间观察组有2例出现髋关节脱位;对照组1例出现髋关节僵硬,1例出现膝关节挛缩。 结论 15月龄以下和18月龄以上累及骨骺的急性干骺端骨髓炎患儿临床特征基本相同。
- Abstract:
- Objective Epiphyseal and metaphyseal vascular channels usually disappear after 15-18 months.In this paper,the clinical characteristics of acute metaphyseal osteomyelitis involving epiphysis between 15 and 18 months of age were analyzed.Methods From July 2017 to October 2022,the relevant clinical data were retrospectively reviewed for 45 children with acute metaphyseal osteomyelitis involving epiphysis.Based upon age,12 children aged under 15 months were selected as observation group.There were 5 boys and 7 girls aged 19 days to 14 months.And 33 children aged over 18 months were designated as control group.There were 20 boys and 13 girls aged 19 months to 12 years.Gender,duration of onset,positive rate of pus culture,maximal body temperature at onset,inflammation index within 24h after admission,length of stay and presence or absence of arthritis were compared between two groups.Results No significant inter-group difference existed in gender (P>0.050).Maximal body temperature of observation and control groups was (38.78±0.69)℃ and (39.29±0.85)℃,median leukocyte 13.59×109/L and 12.98×109/L and median neutrophil 4.54×109/L and 8.57×109/L.Median C-reactive protein was 36.45 and 69.10 mg/L,erythrocyte sedimentation rate (59.75±20.63) and (70.97±24.34) mm/h and duration of onset (7.50±3.66) and (6.94±3.18) day.Median length of hospitalization was 30.0 and 32.0 day.There was no difference of statistical significance (P>0.050).Positive rate of pus culture in observation and control groups was 66.7% and 69.7%.There was no difference of statistical significance (P>0.050).Five cases in observation group and 22 in control group were complicated with arthritis.There was no difference of statistical significance (P>0.050).During follow-ups,hip dislocation (n=2) occurred in observation group and there were hip stiffness (n=1) and knee contracture (n=1) in control group.Conclusions Clinical features of acute metaphyseal osteomyelitis involving epiphysis under an age of 15 months are basically similar to those over an age of 18 months.
参考文献/References:
[1] 文玉伟,贾海亭,王春华,等.儿童短管状骨及扁平骨骨髓炎的治疗[J].临床小儿外科杂志,2023,22(2):158-162.DOI:10.3760/cma.j.cn101785-202109013-012. Wen YW,Jia HT,Wang CH,et al.Treatment of osteomyelitis of short tubular and flat bones in children[J].DOI:10.3760/cma.j.cn101785-202109013-012.
[2] 伍江雁,胡雄科,曾凌嵘,等.儿童股骨远端具核梭杆菌感染致亚急性骨骺骨髓炎1例并文献综述[J].临床小儿外科杂志,2023,22(12):1189-1193.DOI:10.3760/cma.j.cn101785-202310052-017. Wu JY,Hu XK,Zeng LR,et al.Subacute epiphyseal osteomyelitis caused by Fusobacterium nucleatum in distal femur:one case report with a literature review[J].J Clin Ped Sur,2023,22(12):1189-1193.DOI:10.3760/cma.j.cn101785-2310052-017.
[3] McNeil JC.Acute hematogenous osteomyelitis in children:clinical presentation and management[J].Infect Drug Resist,2020,13:4459-4473.DOI:10.2147/IDR.S257517.
[4] Longjohn DB,Zionts LE,Stott NS.Acute hematogenous osteomyelitis of the epiphysis[J].Clin Orthop Relat Res,1995,316:227-234.
[5] Trueta J.The normal vascular anatomy of the human femoral head during growth[J].J Bone Joint Surg Br,1957,39-B(2):358-394.DOI:10.1302/0301-620X.39B2.358.
[6] Morgan JD.Blood supply of growing rabbit’s tibia[J].J Bone Joint Surg Br,1959,41-B(1):185-203.DOI:10.1302/0301-620X.41B1.185.
[7] Trueta J.The three types of acute haematogenous osteomyelitis:a clinical and vascular study[J].J Bone Joint Surg Br,1959,41-B(4):671-680.DOI:10.1302/0301-620X.41B4.671.
[8] Shah MM,Gupta G,Makadia AS,et al.Primary epiphyseal osteomyelitis (PEO) in 18 children:a rare entity with atypical features[J].J Pediatr Orthop,2020,40(7):361-366.DOI:10.1097/BPO.0000000000001551.
[9] Alderson M,Speers D,Emslie K,et al.Acute haematogenous osteomyelitis and septic arthritis-a single disease.An hypothesis based upon the presence of transphyseal blood vessels[J].J Bone Joint Surg Br,1986,68(2):268-274.DOI:10.1302/0301-620X.68B2.3958014.
[10] Perlman MH,Patzakis MJ,Kumar PJ,et al.The incidence of joint involvement with adjacent osteomyelitis in pediatric patients[J].J Pediatr Orthop,2000,20(1):40-43.DOI:10.1097/01241398-200001000-00009.
[11] Gilbertson-Dahdal D,Wright JE,Krupinski E,et al.Transphyseal involvement of pyogenic osteomyelitis is considerably more common than classically taught[J].AJR Am J Roentgenol,2014,203(1):190-195.DOI:10.2214/AJR.13.11279.
[12] Cochard B,Habre C,Pralong-Guanziroli N,et al.Transphyseal hematogenous osteomyelitis:an epidemiological,bacteriological,and radiological retrospective cohort analysis[J].Microorganisms,2023,11(4):894.DOI:10.3390/microorganisms11040894.
[13] 李玉婵,王志刚,蔡海清,等.血源性骨骺骨髓炎的治疗体会[J].中华小儿外科杂志,2014,35(1):1-5.DOI:10.3760/cma.j.issn.0253-3006.2014.01.001. Li YC,Wang ZG,Cai HQ,et al.Treatments of hematogenous epiphyseal osteomyelitis[J].Chin J Pediatr Surg,2014,35(1):1-5.DOI:10.3760/cma.j.issn.0253-3006.2014.01.001.
[14] Whalen JL,Fitzgerald RH Jr,Morrissy RT.A histological study of acute hematogenous osteomyelitis following physeal injuries in rabbits[J].J Bone Joint Surg Am,1988,70(9):1383-1392.
[15] Weichert S,Sharland M,Clarke NMP,et al.Acute haematogenous osteomyelitis in children:is there any evidence for how long we should treat?[J].Curr Opin Infect Dis,2008,21(3):258-262.DOI:10.1097/QCO.0b013e3283005441.
[16] Ceroni D,Belaieff W,Cherkaoui A,et al.Primary epiphyseal or apophyseal subacute osteomyelitis in the pediatric population:a report of fourteen cases and a systematic review of the literature[J].J Bone Joint Surg Am,2014,96(18):1570-1575.DOI:10.2106/JBJS.M.00791.
[17] Castellazzi L,Mantero M,Esposito S.Update on the management of pediatric acute osteomyelitis and septic arthritis[J].Int J Mol Sci,2016,17(6):855.DOI:10.3390/ijms17060855.
[18] Woods CR,Bradley JS,Chatterjee A,et al.Clinical practice gui-deline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America:2021 guideline on diagnosis and management of acute hematogenous osteomyelitis in pediatrics[J].J Pediatric Infect Dis Soc,2021,10(8):801-844.DOI:10.1093/jpids/piab027.
[19] 贾海亭,刘涛,于嘉智,等.负压辅助愈合治疗系统对儿童骨髓炎的治疗体会及文献复习[J].中国研究型医院,2021,8(5):50-53.DOI:10.19450/j.cnki.jcrh.2021.05.014. Jia HT,Liu T,Yu JZ,et al.Experience of vacuum-assisted closure healing therapy system for osteomyelitis in children and a review of literature[J].Chin Res Hosp,2021,8(5):50-53.DOI:10.19450/j.cnki.jcrh.2021.05.014.
[20] Gao Y,Liu RK,Rai S,et al.Is early surgical intervention necessary for acute neonatal humeral epiphyseal osteomyelitis:a retrospective study of 31 patients[J].Children (Basel),2022,9(4):527.DOI:10.3390/children9040527.
[21] Sukswai P,Kovitvanitcha D,Thumkunanon V,et al.Acute hematogenous osteomyelitis and septic arthritis in children:clinical characteristics and outcomes study[J].J Med Assoc Thai,2011,94(Suppl 3):S209-S216.
[22] Rehm PK,Delahay J.Epiphyseal photopenia associated with metaphyseal osteomyelitis and subperiosteal abscess[J].J Nucl Med,1998,39(6):1084-1086.
相似文献/References:
[1]王恩波 王 康 张立军 赵 群 吉士俊.骨牵引在青少年股骨头骨骺滑脱治疗中的应用价值[J].临床小儿外科杂志,2010,9(04):0.
WANG En-bo,WANG Kang,ZHANG Li-jun,et al.Bone traction in the treatment of slipped capttal femoral epiphysis in adolescent.[J].Journal of Clinical Pediatric Surgery,2010,9(08):0.
[2]曹琪 段晓岷 尹光恒 孙琳 李东辉. 儿童创伤性骺板及骨骺损伤的多排螺旋CT诊断分析[J].临床小儿外科杂志,2011,10(04):263.
[J].Journal of Clinical Pediatric Surgery,2011,10(08):263.
[3]何明哲,孙一硕,张放.. 新生儿肱骨远端骨骺分离的诊治体会[J].临床小儿外科杂志,2018,17(10):787.
He Mingzhe,Sun Yishuo,Zhang Fang..Diagnosis and treatment of distal humeral epiphyseal separation in neonates.[J].Journal of Clinical Pediatric Surgery,2018,17(08):787.
[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.[doi:10.3969/j.issn.1671-6353.2020.10.011]
Zhang Xiaole,Zhao Guoqiang,Zhao Xufei.Analysis of diagnosis and treatment of 18 cases of hand and foot osteomyelitis in children[J].Journal of Clinical Pediatric Surgery,2020,19(08):921.[doi:10.3969/j.issn.1671-6353.2020.10.011]
[5]文玉伟,贾海亭,王春华,等.儿童短管状骨及扁平骨骨髓炎的治疗[J].临床小儿外科杂志,2023,22(02):158.[doi:10.3760/cma.j.cn101785-202202018-012]
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,2023,22(08):158.[doi:10.3760/cma.j.cn101785-202202018-012]
[6]李雅琴,李论,徐涛涛,等.儿童亚急性骨髓炎的研究进展[J].临床小儿外科杂志,2023,22(05):485.[doi:10.3760/cma.j.cn101785-202211063-016]
Li Yaqin,Li Lun,Xu Taotao,et al.Research advances of subacute osteomyelitis in children[J].Journal of Clinical Pediatric Surgery,2023,22(08):485.[doi:10.3760/cma.j.cn101785-202211063-016]
[7]伍江雁,胡雄科,曾凌嵘,等.儿童股骨远端具核梭杆菌感染致亚急性骨骺骨髓炎1例并文献综述[J].临床小儿外科杂志,2023,22(12):1189.[doi:10.3760/cma.j.cn101785-202310052-017]
Wu Jiangyan,Hu Xiongke,Zeng Lingrong,et al.Subacute epiphyseal osteomyelitis caused by Fusobacterium nucleatum in distal femur:one case report with a literature review[J].Journal of Clinical Pediatric Surgery,2023,22(08):1189.[doi:10.3760/cma.j.cn101785-202310052-017]
[8]贾海亭,王玉亭,孙琳,等.耐甲氧西林和甲氧西林敏感性金黄色葡萄球菌致儿童急性骨髓炎的临床特征比较[J].临床小儿外科杂志,2024,(05):452.[doi:10.3760/cma.j.cn101785-202206023-010]
Jia Haiting,Wang Yuting,Sun Lin,et al.Clinical features of acute osteomyelitis due to methicillin-resistant Staphylococcus aureus in children[J].Journal of Clinical Pediatric Surgery,2024,(08):452.[doi:10.3760/cma.j.cn101785-202206023-010]
[9]王怀铿,黄少敏,梁龙芳,等.灌洗负压引流在儿童急性血源性骨髓炎开窗减压加病灶清除术中的应用[J].临床小儿外科杂志,2024,(08):757.[doi:10.3760/cma.j.cn101785-202309018-010]
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,2024,(08):757.[doi:10.3760/cma.j.cn101785-202309018-010]
备注/Memo
收稿日期:2023-6-20。
基金项目:山东省儿童健康与疾病临床医学研究中心立项项目(RC006)
通讯作者:刘涛,Email:ltetyy@163.com