12例非典型性慢性化脓性骨髓炎的诊治分析

Analysis of the diagnosis and treatment of 12 cases atypical chronic suppurative osteomyelitis

目的避免非典型性慢性化脓性骨髓炎延误诊治及探讨有效的治疗方法。方法2003年8月至2009年5月共收治非典型性慢性化脓性骨髓炎12例；均在当地卫生站接受治疗60～150d，平均93．3d，误诊软组织炎症11例，类风湿性关节炎1例；收入我院后，其中11例经切开取活检确诊，全部病例均行开窗病灶清除，闭式冲洗引流术，术后用1500ml抗生素盐水，6000～9000ml生理盐水持续闭式冲洗，输液抗炎3周，然后口服抗生素2～3周。结果全部病例切口均正常愈合，随访3～12个月，平均6．6个月，感染无复发。结论提高基层医院的业务水平，对不明原因肢体肿疼患者，即使疼痛不甚严重，均应指导去中心医院经一步检查是预防非典型性慢性化脓性骨髓炎延误诊治的关键。开窗病灶清除，闭式冲洗引流术结合抗生素治疗疗效肯定。

Objective To avoide the delay in the diagnosis and treatment of atypical chronic suppurative osteomyelitis and study on the effective treatments. Methods From August 2003 to May 2009,12 cases of atypical chronic suppurative osteomyelitis were treated in local 60-150 days, average 93.3 days, 11 cases were misdiagnosised as soft tissues inflammation, another one as rheumatoid arthritis ; After entering our hospital, 11 cases were diagnosed by cutting biopsies, all were focus elimination by fenestration and continuous washing closed drainage, all were given continuous washing closed drainage by 1500 ml saline with antibiotics, and 6000- 9000 ml saline,resisted inflammation 3 weeks, then oraled antibiotics 2-3 weeks. Results To All wounds nor- mal healed by postoperative follow-up 3-12 months, average 6. 6 months, no infection recurrence. Conclusion Improving the basic hospital service level. To the patients unknown reason limb swelling and pain, even if the pain are not so serious, it is important that preventing the delay in the diagnosis and treatment of atypical chronic suppurative osteomyelitis to instruct patients to hospital examine. It is definite curative effect that focus elimination by fenestration and continuous washing closed drainage with oral antibiotics