51例婴幼儿急性骨髓炎临床特征分析

Clinical Characteristics of 51 Cases of Acute Osteomyelitis in Infants

目的探讨婴幼儿急性骨髓炎的临床特征。方法收集2017年11月至2022年5月诊治的51例急性骨髓炎患儿的病例资料,其中男30例,女21例,年龄为19天~2岁11月,回顾性分析婴幼儿骨髓炎的临床特点、实验室指标、治疗及预后等。将同期收治的3岁以上急性骨髓炎患儿的临床资料与其进行对比分析。结果所有患儿起病时均伴有发热,发病时均表现为患处不同程度的疼痛肿胀、肢体活动受限(新生儿可表现为假瘫),发病部位以股骨、胫骨多见。细菌培养阳性者41例,其中金黄色葡萄球菌最多见。入院24小时内实验室检查白细胞升高者39例(76.5%),中性粒细胞计数升高者32例(62.7%),C-反应蛋白(CRP)升高者44例(86.3%),红细胞沉降率(ESR)升高者49例(96.1%)。51例患儿均采用抗生素联合骨质开窗引流治疗,总住院天数为16~61 d。随访截至2022年11月,出现并发症者3例,其中髋关节病理性脱位2例,关节挛缩1例。3岁以上急性骨髓炎患儿与3岁以下急性骨髓炎患儿的性别、细菌培养阳性率、发病时最高体温、中性粒细胞升高程度、CRP升高程度、ESR升高程度、发病时长、住院天数、合并关节炎和并发症的差异均无统计学意义(P>0.05);白细胞升高程度的差异有统计学意义(P<0.05)。结论婴幼儿骨髓炎由于临床表现不典型,易漏诊或误诊,若患儿出现肢体异常,应警惕急性骨髓炎的可能,及时进行相关检查,做到早期诊断及早期治疗,减少相关并发症、后遗症的发生。

Objective To investigate the clinical characteristics of acute osteomyelitis in infants.Methods Clinical data of children with acute osteomyelitis diagnosed and treated from November 2017 to May 2022 were collected,including 30 males and 21 females,aged 19 days to 2 years and 11 months old.Clinical characteristics,laboratory indicators,treatment and prognosis of children with infantile osteomyelitis were analyzed retrospectively.The clinical data were compared with those of children over 3 years old with acute osteomyelitis admitted during the same period.Results All the children were accompanied by fever at the onset of the disease,and presented with varying degrees of pain and swelling in the affected area and limited limb movement(the newborn may present with pseudoparalysis).Femur and tibia were the most common sites of disease.41 cases were positive in bacterial culture,and Staphylococcus aureus was the most common.Thirty⁃nine cases(76.5%)had increased leukocyte count,32 cases(62.7%)had increased neutrophil count,44 cases(86.3%)had increased C⁃reactive protein(CRP),and 49 cases(96.1%)had increased erythrocyte sedimentation rate(ESR).All the 51 cases were treated with antibiotics combined with bone fenestration and drainage,and the total length of hospitalization ranged from 16 to 61 days.Followed up to November 2022,complications occurred in 3 cases,including pathological dislocation of hip joint in 2 cases and joint contracture in 1 case.The differences in gender,positive bacterial culture rate,maximum body temperature at onset,degree of neutrophil elevation,degree of CRP elevation,degree of ESR elevation,duration of onset,length of hospital stay,combined arthritis and complications between children with acute osteomyelitis over 3 years and children with acute osteomyelitis under 3 years were not statistically significant(P>0.05).The difference in the degree of leukocyte elevation was statistically significant(P<0.05).Conclusion Infant osteomyelitis is easy to be missed or misdiagnosed due to atypical clinical manifestations.If the child has limb abnormalities,the possibility of acute osteomyelitis should be vigilant.Timely examination,early diagnosis and early treatment are necessary to reduce the occurrence of related complications and sequelae.