儿童股骨远端具核梭杆菌感染致亚急性骨骺骨髓炎1例并文献综述  

Subacute epiphyseal osteomyelitis caused by Fusobacterium nucleatum in distal femur:one case report with a literature review

作　　者：伍江雁[1] 胡雄科 曾凌嵘 向晓琴 吴丽霞[1] 梅海波[1] Wu Jiangyan;Hu Xiongke;Zeng Lingrong;Xiang Xiaoqin;Wu Lixia;Mei Haibo(Department of Orthopedics,Hunan Children's Hospital,Hunan Key Laboratory of Pediatric Orthopedics,Changsha 410007,China;Department of Pharmacy,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院骨科,儿童骨科学湖南省重点实验室,长沙410007 [2]湖南省儿童医院药学部,长沙410007

出　　处：《临床小儿外科杂志》2023年第12期1189-1193,共5页Journal of Clinical Pediatric Surgery

基　　金：儿童骨科学湖南省重点实验室专项经费资助(2023TP1019)

摘　　要：目的探讨儿童具核梭杆菌感染致亚急性骨骺骨髓炎的临床特征、诊断以及治疗策略。方法回顾性分析2023年7月湖南省儿童医院骨科收治的1例具核梭杆菌感染致股骨远端亚急性骨骺骨髓炎患儿临床资料,并检索1970—2023年PubMed、万方医学网和中国知网中具核梭杆菌致儿童骨髓炎相关文献,总结分析患儿临床表现、确诊方式、治疗方案及治疗结果。结果本院收治病例男性,4岁2个月,因右股骨远端骨骺骨髓炎入院。经病原微生物高通量宏基因检测二代测序技术(next generation sequencing,NGS)确诊为G-厌氧菌具核梭杆菌感染,予克林霉素治疗11 d后行局部病灶清理、人工骨载药克林霉素、股骨髁关节软骨修复术,术后10周右侧股骨症状消失、膝关节活动正常。共检索到符合纳入与排除标准文献8篇,均为外文文献,报道10例儿童具核梭杆菌骨髓炎,其中9例经组织培养确诊,1例经聚合酶链式反应(polymerase chain reaction,PCR)确诊;7例予药物及病灶穿刺引流术,3例单纯予药物治疗;随访过程中患儿均症状消失,运动功能接近正常。结论具核梭杆菌可以导致儿童骨髓炎,患儿常有发热、局部疼痛,影像学见骨质破坏、骨髓及周围异常信号改变。厌氧菌培养及NGS是确诊具核梭杆菌感染致骨髓炎的重要方法。采取病灶切开引流与敏感抗生素联合治疗,可获得满意疗效。Objective To explore the clinical characteristics,diagnoses and treatments of subacute osteomyelitis of epiphyseal plate caused by Fusobacterium nucleatum infection in children.Methods Clinical data were retrospectively reviewed for a child with subacute osteomyelitis of distal femoral epiphysis caused by F.nucleatum infection admitted on July 9,2023.The relevant literature items of F.nucleatum-induced osteomyelitis in children were retrieved from the databases of PubMed,Wanfang Medical Network and CNKI from 1970 to 2023.Clinical manifestations,diagnoses,treatments and outcomes were analyzed.Results A 50-month-old boy with osteomyelitis of right distal femoral metaphysis was hospitalized.The pathogenic anaerobic Gram-negative bacillus was confirmed as G-proteobacterium by intraoperative tissue microbiome analysis using next generation sequencing(NGS).After 11-day treatment of clindamycin,local lesion debridement,bone augmentation with clindamycin-impregnated synthetic bone graft and cartilage repair of femoral condyle joint were performed.During 10-week follow-ups,the symptoms of right femur disappeared and knee joint function normalized.A search of domestic and foreign databases revealed that only 10 cases have been reported and there was no domestic report.Among 10 reported children with G-proteobacterium osteomyelitis,diagnosis was confirmed by tissue culture(n=9)and polymerase chain reaction(PCR,n=1).The interventions included lesion drainage(n=7),medication alone(n=3)and dosing of sensitive antibiotics(n=11).Follow-up showed disappearance of symptoms and near-normal motor function.Conclusions G-proteobacterium may cause osteomyelitis in children.There are common signs of fever and local pain.Imaging studies reveal bone destruction and abnormal signals in bone marrow and surrounding tissues.Anaerobic culture and NGS are important diagnostic tools for confirming G-proteobacterium infection-related osteomyelitis.Local debridement and dosing of sensitive antibiotics are efficacious.

关 键 词：股骨 骨髓炎 具核梭杆菌 感染 治疗结果 儿童 

分 类 号：R726.8[医药卫生—儿科]