Schilling F, Kessler S
Klinikum der Johannes Gutenberg-Universität Mainz, Germany.
Klin Padiatr. 2001 Sep-Oct;213(5):271-6. doi: 10.1055/s-2001-17218.
Juvenile and adolescent "Chronic Recurrent Multifocal Osteomyelitis" (CRMO) is described on the basis of literature and analysis of 43 own cases (23 cases in children or adolescents). This systemic, non-purulent inflammatory disease occurs mainly metaphyseal in long bones, in pelvic bones or as spondylitis and is not as rare as it seemed. Basis of the disease is a primarily chronic, sterile, in phase of onset often monotopic (e.g. clavicle) and later frequently polytopic osteomyelitis, possibly triggered by an immuno-pathological process (e.g. Proprionibacterium acnes), and showing histologically plasmacellular invasion and a sclerosing process in different stages. Association with pustulous dermatosis (psoriasis, acne, palmo-plantar pustulosis) is found in about 25 % of children and adolescents and in more than 50 % of the adult patients. 5 differents types of distribution of osteomyelitic lesions can be found by using Te99m-bone scan primarily, of which the "pelvic type" is the most common. Because of the close neighbourhood of meta-/epiphyseal osteomyelitic focuses, "sympathetic arthritis" with synovitis is seen frequently. A therapeutic approach with azithromycine and calcitonine is presented.
基于文献及对43例自身病例（23例儿童或青少年病例）的分析，对青少年“慢性复发性多灶性骨髓炎”（CRMO）进行了描述。这种全身性非化脓性炎症性疾病主要发生在长骨的干骺端、骨盆骨或表现为脊柱炎，其发病率并不像看上去那么低。该病的基础是一种原发性慢性无菌性骨髓炎，在发病初期常为单灶性（如锁骨），后期常为多灶性，可能由免疫病理过程（如痤疮丙酸杆菌）引发，组织学上表现为浆细胞浸润和不同阶段的硬化过程。约25%的儿童和青少年以及超过50%的成年患者中发现与脓疱性皮肤病（银屑病、痤疮、掌跖脓疱病）有关。通过99m锝骨扫描主要可发现5种不同类型的骨髓炎病变分布，其中“骨盆型”最为常见。由于干骺端/骨骺骨髓炎病灶相邻，常可见伴有滑膜炎的“反应性关节炎”。本文介绍了阿奇霉素和降钙素的治疗方法。
