儿童急性肺炎链球菌骨髓炎9例临床特征分析  

Clinical features of 9 children with osteomyelitis caused by Streptococcus pneumonia

作　　者：宁雪[1] 邓继岿[2] 刘世花 陈必全 邓慧玲[5] 张艳虹 刘钢[1] Ning Xue;Deng Jikui;Liu Shihua;Chen Biquan;Deng Huiling;Zhang Yanhong;Liu Gang(Key Laboratory for Major Disease in Children,Ministry of Education,Department of Infectious Disease,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Infectious Disease,Shenzhen Children′s Hospital,Shenzhen 518038,Guangdong Province,China;Department of Infectious Disease,Qilu Children′s Hospital of Shandong University,Jinan 250022,China;Department of Infectious Disease,Children′s Hospital of Anhui Province,Hefei 230051,China;Department of the Second Infectious Disease,Xi′an Children′s Hospital,Xi′an 710003,China;Department of Infectious and Gastroenterological Disease,Women and Children′s Hospital of Qinghai,Xining 810007,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院感染内科,儿科重大疾病研究教育部重点实验室,北京100045 [2]深圳市儿童医院感染科,518038 [3]山东大学齐鲁儿童医院感染科,济南250022 [4]安徽省儿童医院感染科,合肥230051 [5]西安市儿童医院感染2科,710003 [6]青海省妇女儿童医院感染消化科,西宁810007

出　　处：《中华实用儿科临床杂志》2020年第8期605-608,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：福棠儿童科学基金(FTCSF-2018-01);北京市医院管理中心儿科学科协同发展中心专项经费资助(XTZD 20180501);北京市医院管理中心"登峰"人才培养计划团队(DFL 20181201);北京儿童医院苗圃人才项目(BCHYIPB-2016-03)。

摘　　要：目的探讨儿童肺炎链球菌骨髓炎的临床特点、诊断、治疗及预后。方法回顾性分析2012年1月至2017年12月18所儿童医院收治的诊断为肺炎链球菌骨髓炎患儿的临床资料,包括临床表现、影像学特征、诊断、治疗及短期预后等。结果9例肺炎链球菌骨髓炎患儿中位发病年龄1岁3个月。4例患儿有基础疾病;局部肿胀、疼痛、活动受限(9例)及发热(8例)是主要表现,感染部位包括肱骨(4例),股骨(3例),胫腓骨(2例),8例并化脓性关节炎;病初有白细胞升高(8例,中位数22.02×10^9/L),C反应蛋白升高(7例,中位数55.44 mg/L)及红细胞沉降率增快(6例,中位数70 mm/1 h)。病初有5例单用头孢菌素治疗,后根据培养及药敏结果调整抗生素使用;患儿均予穿刺、切开引流或开窗减压治疗;最终8例患儿好转出院。结论儿童肺炎链球菌骨髓炎多见于低年龄幼儿,可无危险因素,常见感染部位为长骨干骺端,易合并化脓性关节炎,抗生素联合外科治疗是预后良好的关键。Objective To investigate the clinical features,diagnosis,treatment and prognosis of children with osteomyelitis caused by Streptococcus pneumonia.Methods The demographic characteristics,diagnosis,clinical manifestations,imaging features,treatment and short-term prognosis of Streptococcus pneumonia osteomyelitis cases in 18 children′s hospitals from January 2012 to December 2017 were retrospectively collected and analyzed.Results A total of 9 cases were enrolled,with a median age of 1 year and 3 months.Four children had underlying diseases.The main manifestations were local swelling,pain,limited mobility(9 cases)and fever(8 cases).Sites of infection included humerus(4 cases),femur(3 cases)and tibiofibula(2 cases),and 8 cases were complicated with septic arthritis;The laboratory tests showed increased white blood cells(8 cases,median 22.02×10^9/L),C-reactive protein(7 cases,median 55.44 mg/L)and erythrocyte sedimentation rate(6 cases,median 70 mm/1 h)of those patients.Five patients received monotherapy in the initial treatment regimen with cephalosporins.Then the therapeutic schedules were adjusted according to the culture and antibiotic sensitivity.All patients were treated with puncture,incision drainage or fenestrating decompression.Eight patients were cured and discharged finally.Conclusions Streptococcus pneumonia osteomyelitis is more common in younger children and may have no risk factors.The common infection site is long bone metaphysis,and those patients are easily complicated with septic arthritis.Antibiotic combined with surgical treatment are crucial to a good outcome.

关 键 词：肺炎链球菌 骨髓炎 儿童 回顾性研究 

分 类 号：R726[医药卫生—儿科]