The Valley Hospital Sports Institute, Ridgewood, NJ.
J Athl Train. 1999 Jan;34(1):29-33.
To present the case of a high school hockey player with vertebral osteomyelitis in the body of the third lumbar vertebra.
Vertebral osteomyelitis is an infrequently reported cause of back pain in otherwise healthy adolescent athletes. Osteomyelitis is an inflammation of bone caused by a pyogenic organism. It can remain localized or spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum.
Lumbar dysfunction, tumor, fracture, and degenerative conditions.
High-dose intravenous antimicrobial therapy for 4 to 6 weeks is the rule; rest, limitation of movement, and analgesics as needed; and periodic reevaluation for complications.
An otherwise healthy student-athlete developed low back pain with no history of acute trauma or significant medical history. Back pain and fever began approximately 4 weeks before the athlete reported to the athletic trainer. At the onset of symptoms, the patient took acetaminophen, which reduced the fever. Back pain remained, however, and increased to a radiating left-sided pain. At this point, the patient saw a pediatrician, who treated him for influenza-like symptoms with oral antibiotics. Symptoms decreased, probably from a dampening of the infection as a result of the antibiotics, but back pain was not completely resolved. A magnetic resonance imaging scan was ordered by a consulting orthopaedic surgeon for suspicion of hereditary disc disease or infection. It was at this time that the patient presented his complaints to the school athletic trainer. The physical assessment was indicative of typical low back pain of a mechanical nature. Development of high fever and chills prompted the athlete's visit to the family physician, who reviewed the magnetic resonance imaging report of abnormal L3 vertebral body uptake and ordered standard blood work. His initial impression was a bone contusion and influenza-like symptoms. However, laboratory results 48 hours later suggested probable infection, and the athlete was referred to a pediatric orthopaedic specialist. A diagnosis of osteomyelitis was made, and the patient was admitted emergently for open biopsy, irrigation, and débridement. After appropriate treatment, he returned after 5 months to full activity with no complications.
Low back pain can have many etiologies. Health care providers need to be aware of the distinctive features of vertebral osteomyelitis, so that they can recognize the disorder and institute appropriate diagnostic testing and treatment. Early diagnosis and identification of the infecting microbe are the keys to determining the appropriate antimicrobial therapy and reducing complications and the need for surgical intervention.
报告一例高中曲棍球运动员第三腰椎体骨骨髓炎的病例。
骨髓炎是健康青少年运动员腰背疼痛少见的病因。骨髓炎是一种由化脓性生物体引起的骨炎症。它可以局限于一处，也可以通过骨骼扩散，累及骨髓、皮质、松质骨和骨膜。
腰椎功能障碍、肿瘤、骨折和退行性疾病。
4-6 周大剂量静脉抗菌治疗是常规治疗；休息、限制运动和按需使用镇痛药；定期评估并发症。
一名健康的学生运动员出现腰背疼痛，无急性外伤或重大病史。腰背疼痛和发热大约在运动员向运动训练师报告前 4 周开始。症状出现时，患者服用对乙酰氨基酚，这降低了体温。然而，背痛仍然存在，并发展为左侧放射痛。此时，患者看了儿科医生，儿科医生用口服抗生素治疗他流感样症状。症状减轻，可能是由于抗生素抑制了感染，但背痛并未完全缓解。一名咨询骨科医生怀疑遗传性椎间盘疾病或感染，开了磁共振成像扫描。正是在这个时候，患者向学校运动训练师提出了自己的投诉。体检提示典型的机械性下背痛。高热和寒战促使运动员去看家庭医生，家庭医生查看了 L3 椎体摄取异常的磁共振成像报告，并开了常规血液检查。他的初步印象是骨挫伤和流感样症状。然而，48 小时后的实验室结果提示可能有感染，运动员被转介给儿科骨科专家。诊断为骨髓炎，患者紧急入院行开放活检、灌洗和清创术。经过适当治疗，他在 5 个月后完全康复，无并发症。
腰背疼痛有许多病因。医务人员需要了解骨髓炎的独特特征，以便识别该疾病，并进行适当的诊断性检查和治疗。早期诊断和确定感染微生物是确定适当抗菌治疗和减少并发症以及减少手术干预的关键。
