儿童急性骨髓炎伴临近化脓性关节炎临床特征分析

Clinical Characteristics of Acute Osteomyelitis with Adjacent Septic Arthritis in Children

目的通过和不伴有化脓性关节炎的儿童急性骨髓炎对比分析,探讨儿童急性骨髓炎伴临近化脓性关节炎的临床特征。方法收集2017年11月至2022年5月山东大学附属儿童医院诊治的108例急性骨髓炎患儿的病例资料进行回顾性分析,根据有无化脓性关节炎分为观察组和对照组。骨髓炎伴临近化脓性关节炎的48例患儿为观察组,其中男孩28例,女孩20例,年龄为19天~12岁。无化脓性关节炎的60例骨髓炎患儿为对照组,其中男孩38例,女孩22例,年龄为1个月9天~15岁。所有患儿治疗均采用抗生素联合骨皮质开窗引流,观察组患儿同时行关节引流。对两组患儿性别、年龄、起病时最高体温、发病时间、细菌培养阳性率、炎症指标、手术次数、住院天数、并发症等进行对比分析。结果观察组和对照组在年龄、性别、细菌培养阳性率上差异无统计学意义(P>0.05);观察组和对照组发病时最高体温分别为(39.21±0.84)℃和(39.01±0.84)℃,白细胞中位数分别为15.95×10^(9)/L和15.79×10^(9)/L,中性粒细胞中位数分别为12.08×10^(9)/L和10.35×10^(9)/L,红细胞沉降率分别为(62.26±25.57)mm/h和(60.49±25.38)mm/h,差异均无统计学意义(P>0.05);观察组和对照组C-反应蛋白分别为(94.29±62.11)mg/L和(64.02±45.25)mg/L,发病时间中位数分别为5天和6天,住院天数中位数分别为32.5天和26.0天,手术次数中位数分别为3次和2次,差异均有统计学意义(P<0.05);观察组2例出现关节僵硬,2例复发,2例出现髋关节病理性脱位,对照组1例出现关节僵硬,1例出现病理性骨折,差异无统计学意义(P>0.05)。结论和不伴有化脓性关节炎的儿童急性骨髓炎相比,骨髓炎伴临近化脓性关节炎的患儿就诊时间较早,C-反应蛋白升高程度更高,治疗需要更多的手术次数,住院时间较长,治疗上采用抗生素联合骨皮质开窗和关节引流,整体预后良好。

Objective To explore the clinical characteristics of acute osteomyelitis with adjacent septic arthritis in children by comparing with those without septic arthritis.Methods Data of 108 children with acute osteomyelitis from November 2017 to May 2022 at Children's Hospital Affiliated to Shandong University were collected for retrospective analysis.According to the presence or absence of septic arthritis,48 children with osteomyelitis with adjacent septic arthritis were included in the observation group,including 28 boys and 20 girls,aged from 19 days to 12 years.A total of 60 children with acute osteomyelitis without septic arthritis were included in the control group,including 38 boys and 22 girls,aged from 1 month and 9 days to 15 years.All children were treated with antibiotics combined with cortical fenestration drainage,and the observation group was treated with joint drainage at the same time.The gender,age,maximum body temperature at onset,duration of onset,positive rate of bacterial culture,inflammatory indicators,operation times,hospitalization days and complications were compared and analyzed between the two groups.Results There was no statistically significant difference between the observation group and the control group in terms of age,gender,and positive rate of bacterial culture(P>0.05).The highest body temperature at the onset of the disease in the observation group and the control group was(39.21±0.84)℃and(39.01±0.84)℃,respectively.The median of white blood cells in the observation group and the control group was 15.95×10^(9)/L and 15.79×10^(9)/L,respectively.The median of neutrophils in the observation group and the control group was 12.08×10^(9)/L and 10.35×10^(9)/L,respectively.The erythrocyte sedimentation rate in the observation group and the control group was(62.26±25.57)mm/h and(60.49±25.38)mm/h,respectively,and the difference was not statistically significant(P>0.05).The levels of C⁃reactive protein in the observation group and control group were(94.29±62.11)mg/L and(64.02±45.25)mg/L,respectively.In the observation group and the control group,the median time of onset was 5 d and 6 d,the median length of hospital stay was 32.5 d and 26.0 d,and the median number of surgeries was 3 and 2 times,respectively.The differences were statistically significant(P<0.05).In the observation group,there were 2 cases of joint stiffness,2 cases of recurrence,and 2 cases of pathological dislocation of the hip joint.There was 1 case of joint stiffness and 1 case of pathological fracture in the control group,and there was no significant difference between the two groups(P>0.05).Conclusion Compared with children with acute osteomyelitis without septic arthritis,children with acute osteomyelitis with adjacent septic arthritis present earlier,have higher levels of C⁃reactive protein,require more surgeries,and have longer hospital stays.Antibiotics combined with cortical fenestration and joint drainage were used for treatment and the overall prognosis was good.