15月龄以下和18月龄以上累及骨骺的急性干骺端骨髓炎患儿临床特征分析  

Clinical features of acute metaphyseal osteomyelitis involving epiphysis in children aged below 15 months and over 18 months

作　　者：贾海亭 孙李华 刘涛[1] 孙琳[2] 于嘉智[1] 王世富[3] Jia Haiting;Sun Lihua;Liu Tao;Sun Lin;Yu Jiazhi;Wang Shifu(Department of Orthopedic Trauma Surgery,Children's Hospital Affiliated to Shandong University(Jinan Children's Hospital),Jinan 250022,China;Department of Orthopedics,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;Department of Clinical Microbiology,Children's Hospital Affiliated to Shandong University(Jinan Children's Hospital),Jinan 250022,China)

机构地区：[1]山东大学附属儿童医院(济南市儿童医院)骨科创伤外科,济南250022 [2]国家儿童医学中心,首都医科大学附属北京儿童医院骨科,北京100045 [3]山东大学附属儿童医院临床微生物室,济南250022

出　　处：《临床小儿外科杂志》2024年第8期763-767,共5页Journal of Clinical Pediatric Surgery

基　　金：山东省儿童健康与疾病临床医学研究中心立项项目(RC006)。

摘　　要：目的骨骺和干骺端血管通道通常在15~18月龄消失。本研究以15、18月龄为界,对比分析15月龄以下和18月龄以上累及骨骺的急性干骺端骨髓炎患儿临床特征。方法本研究为回顾性研究。收集2017年7月至2022年10月山东大学附属儿童医院诊治的45例累及骨骺的急性干骺端骨髓炎患儿临床资料,12例15月龄以下患儿设为观察组,其中男5例、女7例,年龄19 d至1岁2个月;33例18月龄以上患儿设为对照组,其中男20例、女13例,年龄1岁7个月至12岁。对比分析两组性别、发病时长、脓液培养阳性率、起病时最高体温、入院24 h内炎症指标情况、住院时间以及有无关节炎。结果观察组和对照组性别分布差异无统计学意义(P>0.05),发病时最高体温分别为(38.78±0.69)℃和(39.29±0.85)℃,血白细胞中位数分别为13.59×10^(9)/L和12.98×10^(9)/L,中性粒细胞中位数分别为4.54×10^(9)/L和8.57×10^(9)/L,C反应蛋白(C-reactive protein,CRP)中位数分别为36.45 mg/L和69.10 mg/L,血沉(erythrocyte sedimentation rate,ESR)分别为(59.75±20.63)mm/h和(70.97±24.34)mm/h,发病时长分别为(7.50±3.66)d和(6.94±3.18)d,住院时间中位数分别为30.0 d和32.0 d,差异均无统计学意义(P>0.05);脓液培养阳性率分别为66.7%(8/12)和69.7%(23/33),差异无统计学意义(P>0.05)。观察组中5例合并关节炎,对照组22例合并关节炎,差异无统计学意义(P>0.05)。随访期间观察组有2例出现髋关节脱位;对照组1例出现髋关节僵硬,1例出现膝关节挛缩。结论15月龄以下和18月龄以上累及骨骺的急性干骺端骨髓炎患儿临床特征基本相同。Objective Epiphyseal and metaphyseal vascular channels usually disappear after 15-18 months.In this paper,the clinical characteristics of acute metaphyseal osteomyelitis involving epiphysis between 15 and 18 months of age were analyzed.Methods From July 2017 to October 2022,the relevant clinical data were retrospectively reviewed for 45 children with acute metaphyseal osteomyelitis involving epiphysis.Based upon age,12 children aged under 15 months were selected as observation group.There were 5 boys and 7 girls aged 19 days to 14 months.And 33 children aged over 18 months were designated as control group.There were 20 boys and 13 girls aged 19 months to 12 years.Gender,duration of onset,positive rate of pus culture,maximal body temperature at onset,inflammation index within 24h after admission,length of stay and presence or absence of arthritis were compared between two groups.Results No significant inter-group difference existed in gender(P>0.050).Maximal body temperature of observation and control groups was(38.78±0.69)℃and(39.29±0.85)℃,median leukocyte 13.59×10^(9)/L and 12.98×10^(9)/L and median neutrophil 4.54×109/L and 8.57×10^(9)/L.Median C-reactive protein was 36.45 and 69.10 mg/L,erythrocyte sedimentation rate(59.75±20.63)and(70.97±24.34)mm/h and duration of onset(7.50±3.66)and(6.94±3.18)day.Median length of hospitalization was 30.0 and 32.0 day.There was no difference of statistical significance(P>0.050).Positive rate of pus culture in observation and control groups was 66.7%and 69.7%.There was no difference of statistical significance(P>0.050).Five cases in observation group and 22 in control group were complicated with arthritis.There was no difference of statistical significance(P>0.050).During follow-ups,hip dislocation(n=2)occurred in observation group and there were hip stiffness(n=1)and knee contracture(n=1)in control group.Conclusions Clinical features of acute metaphyseal osteomyelitis involving epiphysis under an age of 15 months are basically similar to those over an age of 18

关 键 词：骨髓炎 骨骺 体征和症状 病理学 临床 儿童 

分 类 号：R68[医药卫生—骨科学]