血源性骨骺骨髓炎的治疗体会

The treatment of hematogenous epiphyseal osteomyelitis

目的骨骺骨髓炎是一种少见的骨感染性疾病，由于感染可能破坏骺板，如不能及时诊断和治疗将会造成比较严重的后遗症。本文介绍和总结了几种不同类型的骨骺骨髓炎的治疗经验。方法2007年至2012年共收治骨骺骨髓炎患儿15例，根据X线片表现将患儿分为三组：A组2例为急性感染，且感染局限于骨骺，B、C两组骨骺及干骺端同时累及，B组8例为亚急性感染，C组5例为慢性感染，治疗方法包括手术清除坏死组织配合抗生素使用。结果A、B组患儿对治疗非常敏感，术后临床症状逐渐消失，抗生素共使用6周。C组患儿病程较长，经过1次以上的手术，抗生素治疗时间平均为12．5周。随访时间4个月～3．5年，平均1．9年，B、C组各有1例出现膝外翻畸形，无复发病例。结论早期诊断以及合理的应用抗生素是骨骺骨髓炎治疗成功的关键。急性及亚急性的骨骺骨髓炎由于病程较短、病灶范围相对局限，手术彻底清除坏死组织后结合抗生素治疗效果比较理想。而白干骺端蔓延至骨骺的感染，由于病程长、病灶范围大，儿童骺板未闭难以彻底清除病灶，局部冲洗引流可能效果更为可靠。

Objective To report our preliminary experiences in treatment of different type hematogenous epiphyseal osteomyelitis. Methods From 2007 to 2012, 15 patients diagnosed as hematogenous epiphyseal were admitted to our department. They were divided into 3 groups according to the plain film,Group A,2 patients with primary acute epiphyseal osteomyelitis, Group B, 8 patients with subacute form, and Group C, 5 patients with chronic osteomyelitis. Both epiphysis and metaphysis were affected in group B and C. All of 3 groups were treated with surgical intervention and antibiotic therapy. Results The patients in group A and B were sensitive to the treatment, the clinical signs subsided. The duration of antibiotic therapy was six weeks. All of the patients in group C had a long treatment course because of inadequate clinical response. They underwent more than one operation and the average time of antibiotic therapy was 12.5 weeks. The patients were followed up from 4 months to 3.5 years （mean, 1.9 years）. Knee valgus was observed in each 1 patient in group B and C. There were no recurrence cases. Conclusions Early diagnosis and appropriate antibiotic treatment are keys to the successful treatment of hematogenous epiphyseal osteomyelitis. As the lesions in acute and subacute forms are relatively localized and the duration is short, the results are good after necrotic tissues removed in combination with antibiotic therapy. It seems more difficult to treat the patients with infection spreads from the metaphysis to the bone marrow because that the chronic course and the extensive lesions involving the growth plate could not be removed completely. Continuous irrigation and vacuum sealing drainage （VSD） are more effective than debridement.