Danielsson Lars G, Düppe Henrik
Department of Orthopedics, Malmö University Hospital, Sweden.
Acta Orthop Scand. 2002 Jun;73(3):311-6. doi: 10.1080/000164702320155310.
We re-examined 11 children (mean age 6.5 years) who had been treated with surgical drilling and intravenous (i.v.) antibiotics in high doses for acute hematogenous osteomyelitis of the neck of the femur. The mean follow-up time was 3.9 (2.9-6.4) years. 9 children who had been treated with early surgical drilling and i.v. antibiotics were all symptom-free and had normal radiographs at follow-up. The other 2 children had radiographic changes (metaphyseal rarefaction) already when referred to us. They had been treated with antibiotics alone before referral until the infection had spread to the hip joint. At follow-up, the clinical and radiographical findings were abnormal, 1 had a severely deformed hip. In our opinion, treatment with i.v. antibiotics alone may not prevent extension of the infectious process to the hip joint in some cases, even when the medication is given in high doses. Therefore, we believe that the addition of early surgical drilling is justified to prevent this feared complication.
我们对11名儿童（平均年龄6.5岁）进行了重新检查，这些儿童曾因股骨颈急性血源性骨髓炎接受过外科钻孔术和大剂量静脉注射抗生素治疗。平均随访时间为3.9（2.9 - 6.4）年。9名接受早期外科钻孔术和静脉注射抗生素治疗的儿童在随访时均无症状，且X线片正常。另外2名儿童在转诊至我们这里时就已经有X线改变（干骺端稀疏）。他们在转诊前仅接受了抗生素治疗，直到感染蔓延至髋关节。随访时，临床和影像学检查结果均异常，1名儿童髋关节严重畸形。我们认为，在某些情况下，即使大剂量使用静脉注射抗生素，单独使用抗生素治疗也可能无法防止感染过程蔓延至髋关节。因此，我们认为加用早期外科钻孔术以预防这种可怕的并发症是合理的。
