| 刘亚,郭志雄,甄允方,等.儿童跟骨骨髓炎临床特征及治疗.骨科,2021,12(4): 317-322. |
| 儿童跟骨骨髓炎临床特征及治疗 |
| Clinical Characteristics and Management of Pediatric Calcaneal Osteomyelitis |
| 投稿时间：2020-10-27 |
| DOI：10.3969/j.issn.1674-8573.2021.04.005 |
| 中文关键词: 跟骨 骨髓炎 儿童 硫酸钙 |
| 英文关键词: Calcaneus Osteomyelitis Children Calcium sulphate |
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| 中文摘要: |
| 目的 分析儿童跟骨骨髓炎病例特点，观察治疗效果，总结治疗方法。方法 回顾性分析2013年1月至2019年12月我院治疗的12例儿童跟骨骨髓炎病人的临床资料，其中男7例，女5例，年龄为9个月~15岁，平均8.8岁；左侧9例，右侧3例。7例无诱因，5例有外伤史。就诊前病程大于1周7例（58.3%），12例就诊时均有足跟疼痛、跛行，5例发热。12例均有足跟肿胀压痛，9例局部皮温高。5例入院时白细胞升高，7例C-反应蛋白升高，9例红细胞沉降率升高。1例血培养阳性（耐甲氧西林金黄色葡萄球菌）。4例脓培养阳性（3例金黄色葡萄球菌，1例铜绿假单胞菌）。5例X线检查（41.7%）阳性，骨质破坏（3例），密度减低（2例）。9例MRI检查阳性，表现为软组织的水肿、跟骨信号异常（5例），局部脓肿形成（4例）。5例单纯抗生素治疗，7例静脉抗生素治疗结合手术冲洗、抗生素硫酸钙人工骨植入治疗。结果 12例患儿静脉抗生素治疗7 d~22 d，平均16.3d，口服抗生素3周。7例行跟骨开窗引流、脓肿清除及载药硫酸钙植骨。治疗后随访8~32个月，平均14.7个月，所有病例均痊愈。结论 儿童跟骨骨髓炎常延迟就诊，主要症状为足跟肿痛、跛行，根据症状、炎症检查结果，结合X线和MRI可诊断。合理选用静脉抗生素积极治疗，脓肿形成病例辅助手术引流、抗生素硫酸钙人工骨植入，可获得满意疗效。 |
| 英文摘要: |
| Objective The characteristics of calcaneal osteomyelitis in children were analyzed and the therapeutic methods and results were evaluated. Methods The records of 12 cases of calcaneal osteomyelitis, who were treated in our hospital from January 2013 to December 2019 were reviewed retrospectively. There were 7 males and 5 females, with an average age of 8.8 years (9 months to 15 years). The lesions occurred on the left side in 9 cases, right in 3 cases. In 12 cases of calcaneal osteomyelitis in children, 5 had a history of trauma and 7 had no cause. The symptom duration was more than one week in 7 (58.3%) before visiting the clinic. All 12 cases had heel pain and limp and 5 had fever during visiting the outpatient department. All cases had heel swelling and tenderness and 9 cases had local warmth. White blood cells were increased in 5 cases, CRP elevated in 7 cases and ESR elevated in 9 cases. Blood cultures were performed on 9 patients upon admission and 1 patient had positive findings (MRSA). Seven cases were cultured with pus, 3 cases were positive for MSSA and 1 for PAE. Among the 12 cases, 5 (41.7%) were positive on X-ray examinations, revealing bony destruction in 3 cases and density decrease in 2 cases. Nine of the 12 cases was positive (100%) in MRI, revealing soft tissue edema and abnormal signal (5 cases), local abscess formation (4 cases). Five cases were treated with antibiotics alone and 7 cases were treated with intravenous antibiotics combined with surgical irrigation and antibiotic-loaded calcium sulfate artificial bone implantation. Results All 12 cases had intravenous antibiotics treatment within 7 to 22 d (average 16.3 d), and oral antibiotics were used for 3 weeks. Seven cases were treated with debridement technique plus antibiotic-loaded calcium sulphate. All the patients were followed up for 8-32 months, with an average of 14.7 months. All cases recovered. Conclusion Pediatric calcaneal osteomyelitis was often delayed for diagnosis and the main symptoms were sore heel, pain and limp. According to the symptoms, inflammation test results, X-ray and MRI findings, it can be diagnosed. Treatment with intravenous antibiotics alone or combined with debridement and implant antibiotic-loaded calcium sulphate, the results were satisfactory. |
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