新生儿急性骨髓炎13例临床特点分析

Clinical characteristics of 13 cases of neonatal acute osteomyelitis

目的 探讨新生儿急性骨髓炎的临床特点及影像学特点.方法 选择2011-2016年本院新生儿重症监护病房收治的新生儿急性骨髓炎患儿,对其临床特点、实验室检查、病原学结果、影像学特点、治疗及预后进行回顾性分析.结果 研究期间共收治13例新生儿急性骨髓炎患儿,其中男5例,女8例,起病日龄7～30 d.外院转入9例,本院收治4例.入院时有不同程度发热8例,其中5例有气促表现;患处皮温升高、肿胀、活动受限8例;病程中烦躁7例;纳差6例;白细胞升高13例.入院后立即留取血培养,部分患儿留取患处脓液培养,血培养阳性5例,以金黄色葡萄球菌为主;患处脓液培养阳性6例,其中革兰阳性菌4例,革兰阴性菌2例;发病部位以肱骨、胫骨为主.发病后7d内行X线检查4例,均提示软组织肿胀,骨质未见异常;发病7～14d行X线检查13例,其中1例未出现骨质破坏,仅有组织肿胀,12例存在不同程度骨质破坏并骨膜反应;14 d后行X线检查2例,均提示局部骨质出现硬化环,骨质炎性改变并骨膜反应.所有患儿入院后均应用广谱抗生素治疗,四肢长骨感染患儿给予患肢制动,联合手术引流3例.11例好转出院,1例确诊后回当地医院继续抗炎治疗,1例合并重症肺炎及化脓性脑膜炎,住院35 d家长放弃治疗,未随访结局.结论 新生儿急性骨髓炎临床表现不典型,应尽早完善影像学和病原学检查,早期使用足量敏感抗生素、必要时联合手术治疗可减少后遗症的发生.

Objective To study the clinical and imaging features of neonatal acute osteomyelitis.Method From 2011 to 2016,the clinical feature,laboratory results,pathogen,imaging features,treatment and prognosis of neonates who were diagnosed with acute osteomyelitis in NICU of People’s Hospital of Xinjiang Uygur Autonomous Region were retrospectively studied.Result A total of 13 cases were enrolled during the study period,5 males and 8 females,with onset age of 7 ～30 d.8 cases had different degrees of fever and 5 of them showed dyspnea;8 cases had elevated skin temperature and swelling at the affected area;7 cases presented with irritability;6 cases had anorexia;all cases had elevated white blood cell count.Blood culture were taken immediately after their admission,and culture from the pus were taken for some patients.5 cases had positive blood culture and Staphylococcus aureus was the main pathogen.6 cases had positive pus culture,and 4 cases showed gram positive （G ＋） bacteria and 2 cases gram negative （G-） bacteria.Humerus and tibia were the main foci of the infection.4 cases had X-ray examination within 7 days of onset showing soft tissue swelling and no sign of bone destruction.13 cases had X-ray examination at 7 to 14 days of disease.Among them only 1 case showed soft tissue swelling,and the rest 12 cases had different levels of bone destruction and periosteal reaction.2 cases had X-ray examination after 14 days of disease,showing stiffening ring,inflammatory changes and periosteal reaction.All patients were treated with broad-spectrum antibiotics after admission,and the affected limbs were immobilized.3 cases had further surgical treatment.11 patients recovered and were discharged,1 patient was treated at local hospital after diagnosis and 1 patient refused further treatment due to serious complications after 35 d of hospital stay and was lost on follow-up.Conclusion The clinical manifestation of neonatal osteomyelitis is atypical,the radiological and pathogen examination should be carried out once osteomyelitis is suspected.Appropriate antibiotics and timely surgery can prevent further damage and long-term sequela.