18例儿童手和足骨髓炎诊治分析  

Analysis of diagnosis and treatment of 18 cases of hand and foot osteomyelitis in children

作　　者：张晓乐 赵国强[1] 赵旭飞[1] Zhang Xiaole;Zhao Guoqiang;Zhao Xufei(Department of Trauma Surgery,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Pediatric Surgery,The First Peopl’s Hospital of Chuzhou,Chuzhou,239000,China)

机构地区：[1]浙江大学医学院附属儿童医院急诊创伤外科,浙江省杭州市310000 [2]滁州市第一人民医院儿外科,安徽省滁州市239000

出　　处：《临床小儿外科杂志》2020年第10期921-925,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的总结儿童手和足骨髓炎诊治经验,提高临床医生对其的认识。方法回顾性分析2015年1月至2019年1月浙江大学医学院附属儿童医院收治的18例手和足骨髓炎患儿的临床资料。其中男童10例,女童8例。年龄1岁6个月至12岁2个月,平均93.1个月。手指骨骨髓炎7例,足跗骨和趾骨骨髓炎11例。入院前13例有外伤史,5例无外伤史。11例手术治疗,7例保守治疗。选用广谱抗生素,而后根据血培养和创面培养药敏结果调整用药。结果所有患儿感染得到控制、创面痊愈,出院后继续口服抗生素治疗,总疗程6~8周。随访5个月至4年,5例失访,13例恢复良好。随访发现,收治前病程超过1个月的患儿中,3例手指外观畸形,其中2例手指有麻木感、灵活性降低,X线检查显示指骨部分缺损。结论对于手和足有外伤史、局部红肿痛和活动受限、病程超过7 d者,应引起重视,需行X线和MRI检查,明确是否为骨髓炎。骨髓炎早期的诊治对患儿预后相当重要。当病程迁延形成慢性骨髓炎,后期可导致骨质缺损、肢体畸形和活动感觉异常。Objective To summarize the diagnosis and treatment of hand and foot osteomyelitis and improve its understanding in children.Methods The clinical data were retrospectively analyzed for 18 hospitalized children with distal extremity osteomyelitis from January 2015 to January 2019.There were 10 boys and 8 girls with an average age of 93.1(18-146)months.There were digital osteomyelitis(n=7)and osteophytes or phalangeal osteomyelitis(n=11).Traumatic history before admission was positive(n=13)and negative(n=5).During hospitalization,11 children were operated while another 7 received conservative measures.Broad-spectrum antibiotics were prescribed and adjusted according to the results of blood culture and wound culture susceptibility assay.Results After an adequate control of local infection,all children were discharged after wound healing.Oral antibiotic treatment continued after discharge.The total course of treatment was 6-8 weeks.During a follow-up period of 5 months to 4 years,5 patients became lost.Clinical symptoms and imaging abnormalities disappeared in 13 children.In three cases with a course of over 1 month before treatment,the symptoms of digits were abnormal.Two fingers had numbness,digital flexibility was lower than that of normal side and radiology indicated a partial defect of phalanx.Conclusion For children with a history of trauma,redness and swelling of distal extremities,limited mobility and having a course of disease>1 week,radiology and MRI should be performed to determine the possibility of osteomyelitis.Early diagnosis and treatment of osteomyelitis are vital for achieving an excellent prognosis in children.With a prolonged disease course of chronic osteomyelitis,it may lead to bone defects,extremity malformations and abnormal senses or motions.

关 键 词：骨髓炎 手 足 儿童 诊断 治疗 

分 类 号：R681.2[医药卫生—骨科学]