气肿性骨髓炎的影像学特征、诊断及治疗  

Diagnosis and treatment of emphysematous osteomyelitis

作　　者：赵娜 谢立远 刘记存[3] 吴文娟[3] 韩桂芬[3] Zhao Na;Xie Liyuan;Liu Jicun;Wu Wenjuan;Han Guifen(Department of Radiology,No.1 Outpatient Department of Hebei Province,Shijiazhuang 050000,China;Department of Radiology,Luquan Prison Hospital of Hebei Province,Shijiazhuang 050209,China;Department of Medical Imaging,Hebei Medical University Third Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省直属机关第一门诊部放射科,石家庄050001 [2]河北省鹿泉监狱医院放射科,石家庄050209 [3]河北医科大学第三医院医学影像科,石家庄050051

出　　处：《中华骨科杂志》2025年第4期241-245,共5页Chinese Journal of Orthopaedics

基　　金：河北省医学科学研究课题计划(20200987)。

摘　　要：回顾性分析2020年12月至2024年5月于河北医科大学第三医院经临床、影像学、微生物培养及手术综合诊断为气肿性骨髓炎(emphysematous osteomyelitis,EO)5例患者的资料,男3例、女2例,年龄11~69岁。3例存在感染危险因素(2例糖尿病、1例贫血),2例无感染危险因素(或病史中未提及)。5例患者均存在发热、感染部位疼痛及炎性指标升高。发病部位:腰椎3例、髂骨1例、股骨1例。病原微生物:肺炎克雷伯菌亚种2例、大肠杆菌1例、洋葱伯克霍尔德菌1例、金黄色葡萄球菌感染合并鲍曼不动杆菌感染1例。影像学表现:3例行X线检查者中1例表现正常、2例有骨质破坏;5例CT检查均表现为典型浮石征,均无骨膜反应及骨质硬化;4例行MR检查者均有骨质破坏、周围软组织肿胀及软组织脓肿形成。治疗及预后:4例经手术清创及术前和术后抗感染治疗,3例恢复良好,1例感染控制良好,但关节破坏严重;1例治疗中断后死亡。EO与普通急性骨髓炎的临床表现及实验室检查结果相似,但有特征性的影像学表现。对EO患者及时诊断、积极清创并加强有效的抗生素应用可获得良好预后,延迟诊疗可能引起严重并发症或死亡。A retrospective analysis was conducted on data from five patients comprehensively diagnosed with emphysematous osteomyelitis(EO)based on clinical,imaging,microbiological culture,and surgical findings at Hebei Medical University Third Hospital from December 2020 to May 2024.Among these five cases,there were three males and two females,aged between 11 and 69 years.Three patients had infection risk factors(two with diabetes and one with anemia),while two had no documented risk factors in their medical history.All patients presented with fever,localized pain at the infection site,and elevated inflammatory markers.Site of incidence:EO affected the lumbar spine in three cases,the ilium in one case,and the femur in one case.Pathogenic microorganisms:The causative agents included Klebsiella pneumoniae(two cases),Escherichia coli(one case),Burkholderia cepacia(one case),and a mixed infection of Staphylococcus aureus and Acinetobacter baumannii(one case).Imaging findings:Among the three patients who underwent X-ray examinations,one showed normal results,while two exhibited bone destruction.CT scans of all five cases revealed the characteristic"pumice sign"without periosteal reaction or osteosclerosis.MRI,performed on four patients,demonstrated bone destruction,swelling of surrounding soft tissues,and soft tissue abscess formation.Treatment and outcomes:Four patients underwent surgical debridement combined with perioperative antibiotic therapy.Of these,three recovered well,while one achieved good infection control but suffered severe joint destruction.One patient died after treatment was discontinued.The clinical and laboratory findings of EO resemble those of common acute osteomyelitis;however,EO has distinct imaging characteristics.Timely diagnosis,aggressive surgical debridement,and strong,targeted antibiotic therapy can result in favorable outcomes.Conversely,delayed diagnosis and treatment may lead to severe complications or death.

关 键 词：骨髓炎 体层摄影术 螺旋计算机 磁共振成像 病例报告 骨内气体 

分 类 号：R681.2[医药卫生—骨科学] R816.8[医药卫生—外科学]