Fitoussi Frank, Litzelmann Estelle, Ilharreborde Brice, Morel Etienne, Mazda Keyvan, Penneçot Georges F
Robert Debre Hospital, Paris, France.
J Pediatr Orthop. 2007 Oct-Nov;27(7):810-3. doi: 10.1097/BPO.0b013e3181558a9a.
Wrist osteomyelitis is a rare infection, and few studies have been published about its prognosis and treatment.
We retrospectively examined the medical records of 18 children older than 4 months who were diagnosed with wrist osteomyelitis. A definite diagnosis of wrist osteomyelitis required either confirmatory radiographic/bone scintigraphy changes associated with compatible clinical picture and elevated laboratory indices consistent with infection. The clinical evaluation was based on clinical and radiographic assessment at 1 week, 2 weeks, 3 months, 6 months, 1 year, and 2 years after the diagnosis.
Delay between initial symptoms and treatment ranged from 1 to 45 days (mean, 7 days). The radiographs at diagnosis demonstrated a lytic zone in the distal radial or ulnar metaphysis in 5 cases. All patients were treated with 6 weeks' course of antibiotics with sequential parenteral (7 days)-oral with a third-generation cephalosporin (Cefotaxim) associated with Fosfomycin. Surgical debridement was needed in 5 cases because plain radiographs, ultrasonography, or magnetic resonance imaging (MRI) had confirmed the presence of an intraosseous or subperiosteal abscess. Seven isolated organisms were methicillin-susceptible Staphylococcus aureus, and 1 was methicillin-resistant S. aureus. The average follow-up was 2 years. Significant orthopaedic sequelae as distal radius/ulna epiphysiodesis were apparent in 2 patients.
Wrist osteomyelitis is a severe infection with initial radiographic lytic zone in almost 30% of cases and with growth disturbance in 11% at the last follow-up. If we include the presence of intraosseous or subperiosteal abscess that required surgical debridement, the initial complication rate is 33%, which is superior to the 5% complication rate in the literature about general osteomyelitis. Misdiagnosis at initial clinical examination can explain this condition.
腕部骨髓炎是一种罕见的感染性疾病，关于其预后和治疗的研究报道较少。
我们回顾性分析了18例年龄大于4个月、诊断为腕部骨髓炎患儿的病历。腕部骨髓炎的确切诊断需要影像学检查/骨闪烁扫描结果与临床表现相符，且实验室指标升高符合感染表现。临床评估基于诊断后1周、2周、3个月、6个月、1年和2年的临床及影像学检查。
初始症状出现至治疗的间隔时间为1至45天（平均7天）。诊断时的X线片显示5例患儿桡骨或尺骨远端干骺端有溶骨区。所有患者均接受了为期6周的抗生素治疗，先静脉注射（7天），后口服第三代头孢菌素（头孢噻肟）联合磷霉素。5例患者因X线平片、超声或磁共振成像（MRI）证实存在骨内或骨膜下脓肿而需要手术清创。7株分离菌为甲氧西林敏感金黄色葡萄球菌，1株为耐甲氧西林金黄色葡萄球菌。平均随访时间为2年。2例患者出现明显的骨科后遗症，如桡骨/尺骨远端骨骺早闭。
腕部骨髓炎是一种严重的感染性疾病，近30%的病例初始X线表现为溶骨区，末次随访时11%的患者出现生长障碍。如果将需要手术清创的骨内或骨膜下脓肿也算在内，初始并发症发生率为33%，高于文献报道的一般骨髓炎5%的并发症发生率。初始临床检查误诊可能是导致这种情况的原因。
