儿童短管状骨及扁平骨骨髓炎的治疗

Treatment of osteomyelitis of short tubular and flat bones in children

目的探讨儿童短管状骨及扁平骨骨髓炎的临床特点、治疗和预后。方法回顾性分析山东大学附属儿童医院(济南市儿童医院)骨科创伤外科于2017年9月至2020年7月收治的15例短管状骨及扁平骨骨髓炎患儿临床资料,其中病变位于短管状骨12例、扁平骨3例;男9例,女6例;年龄1个月至9岁,平均年龄42.3个月。15例均采用负压辅助愈合系统(vacuum-assisted closure,VAC)治疗,收集患儿临床症状、体征、体温、炎症指标、影像学检查以及患肢功能等临床资料,总结其临床特点、疗效及预后。结果本组15例中10例临床表现为局部红肿热痛,功能受限,6例有发热,7例血白细胞计数、血沉、CRP升高。15例经切开清创、VAC负压引流后,炎症指标均降至正常。11例短管状骨和2例扁平骨骨髓炎恢复良好;1例髌骨骨髓炎患儿术后复发,经再次手术治愈,膝关节功能正常;1例趾骨骨髓炎患儿术后存在足趾短缩。结论儿童短管状骨及扁平骨骨髓炎临床表现以局部症状为主,全身症状较少,炎症指标可无明显升高,诊断主要依靠MRI检查,VAC负压引流治疗有效,预后较好。

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.