以深静脉血栓起病的儿童急性骨髓炎临床特征分析  

Clinical features of pediatric acute osteomyelitis with deep vein thrombosis as the chief complaint

作　　者：武洁[1] 霍枫[1] 张哲哲[1] 范祎慕 廖琨[1] 王荃[1] Wu Jie;Huo Feng;Zhang Zhezhe;Fan Yimu;Liao Kun;Wang Quan(Department of Emergency,Beijing Children's Hospital,Capital Medical University,National Children's Medical Center,Beijing 100045,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急诊科,北京100045

出　　处：《中华小儿外科杂志》2022年第7期617-622,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨以深静脉血栓起病的儿童急性骨髓炎的临床特点、诊断、治疗。方法收集2017年1月至2022年1月以"发现深静脉血栓"为主诉, 急诊就诊于首都医科大学附属北京儿童医院的21例急性骨髓炎患儿的临床资料。其中, 男14例, 女7例;年龄为(8.5±2.9)岁;中位住院时间为23 d;急诊就诊的中位时间为病程第三天, 19例存在发热, 均有患侧肢体局部疼痛、肿胀、活动受限等症状;骨髓炎病变部位为股骨14例、胫腓骨6例、肱骨1例。19例培养分离出金黄色葡萄球菌, 其中10例为甲氧西林敏感金黄色葡萄球菌, 9例为耐甲氧西林金黄色葡萄球菌。所有患儿都在外院完成四肢软组织超声和(或)血管超声检查并提示患侧肢体存在深静脉血栓(deep vein thrombosis, DVT), 所有DVT位置均与急性骨髓炎感染灶位置相邻。既往均无基础疾病、长期应用免疫制剂史及血栓性疾病史, 1例起病前有外伤史。所有患儿在本院急诊完善血常规、C反应蛋白(C-reactive protein, CRP)、红细胞沉降率、凝血功能检查, 结果提示:白细胞计数(18.4±3.4)×10^(9)/L, 中性粒细胞占比升高, CRP(139.9±47.8)mg/L, 红细胞沉降率(45.3±16.5) mm/1 h, 中位D-二聚体含量为3.7 mg/L。结果所有患儿在急诊即予抗菌药物治疗, 抗感染疗程4~8周, 11例接受手术治疗。21例均在急诊启动低分子肝素抗凝治疗, 其中2例发现DVT合并肺动脉栓塞后改为肝素抗凝。低分子肝素和(或)肝素抗凝疗程为7~28 d, 治疗后血栓均有回缩。9例在出院前血栓消失, 9例在随访过程中消失, 3例末次随访时提示血栓机化。部分患儿出院后随访行血管超声及其他相关影像学检查。结论对以DVT起病的急性骨髓炎患儿, 在充分抗感染治疗的基础上给予抗凝治疗可取得较满意疗效。Objective To explore the clinical characteristics,diagnosis and treatment of acute osteomyelitis(AO)in children with deep vein thrombosis(DVT).Methods Clinical data were retrospectively reviewed for 21 AO children at emergency department with a chief complaint of DVT detected from January 2017 to January 2022.There were 14 boys and 7 girls with an age range of(8.5±2.9)years;median hospitalization stay was 23 days and median time of emergency treatment Day 3 during the disease course.There were fever(n=19),local extremity pain,swelling and limited mobility.The lesion sites were femur(n=14),tibia&fibula(n=6)and humerus(n=1).Staphylococcus aureus was isolated from 19 cases,including methicillin-sensitive S.aureus(n=10)and methicillin-resistant S.aureus(n=9).All of them received soft tissue ultrasonography and(or)vascular ultrasonography of extremities at an another hospital.The presence of DVT was confirmed in extremities and all DVT locations were adjacent to the location of AO infectious foci.None had a previous history of underlying diseases,long-term use of immune agents or thrombotic diseases.One child had a history of trauma before onset.Blood routine,C-reactive protein(CRP),erythrocyte sedimentation rate and coagulation function tests were performed.The results revealed that leucocyte count(18.4±3.4)×10^(9)/L,elevated neutrophil percentage,CRP(139.9±47.8)mg/L,erythrocyte sedimentation rate(45.3±16.5)mm/1h and D-dimer 3.7 mg/L.Results All of them were treated promptly with antibiotics at emergency department for 4 to 8 weeks and 11 children were operated.Low-molecular-weight heparin anticoagulation therapy was initiated at emergency department.And heparin anticoagulation was altered for 2 cases of DVT with pulmonary embolism.The course of anticoagulant therapy with low-molecular-weight heparin and/or heparin ranged from 7 to 28 days and thrombi became retracted after treatment.Thrombus disappeared before discharge(n=9)and during follow-ups(n=9).Thrombus organization occurred(n=3).Vascular ultrasound and o

关 键 词：骨髓炎 深静脉血栓 低分子肝素 儿童 

分 类 号：R726.8[医药卫生—儿科]