Rusak P S, Vyshpinskiĭ I M, Brodskiĭ B F
Khirurgiia (Mosk). 1991 Aug(8):136-8.
Experience in treatment of 348 children with acute hematogenic osteomyelitis is analysed. Newborn infants and children whose ages ranged from 1 to 15 years formed a group of patients. Of decisive importance in the outcome of the disease are early diagnosis and emergency operative measures, aimed at decompressing, opening and cleansing the purulent foci, producing a high concentration of antibiotics in the focus. Children who are in a grave condition are subjected to short-term preoperative management for 3-4 hours for detoxification, improvement of hemodynamics, prevention of septic shock and hyperthermia. Antibiotic therapy is given in 3 stages: in the first 10 days no less than 3 antibiotics are injected into the veins, into the muscles, and into the bones; from days 11 to 20 2 antibiotics are injected intramuscularly or into the bone; in the next 10 days one antibiotic is administered into the bone or muscle. Newborns and infants received injections by daily intraosseous puncture during the first 8-10 days of treatment. It is shown that the results of treatment may be improved only by intensive and complex measures applied timely and urgently. The mortality rate was 1.7% for the decade and 0.8% for the last 2 years.
分析了348例儿童急性血源性骨髓炎的治疗经验。新生儿及1至15岁的儿童构成了一组患者。疾病的转归中,早期诊断和紧急手术措施至关重要,这些措施旨在对化脓病灶进行减压、切开和清创,使病灶内产生高浓度的抗生素。病情严重的儿童需进行3至4小时的短期术前处理,以解毒、改善血流动力学、预防感染性休克和高热。抗生素治疗分3个阶段进行:在最初10天,静脉、肌肉和骨内注射不少于3种抗生素;第11至20天,肌肉或骨内注射2种抗生素;接下来的10天,骨内或肌肉内注射1种抗生素。新生儿和婴儿在治疗的前8至10天通过每日骨内穿刺进行注射。结果表明,只有及时、紧急地采取强化和综合措施,才能改善治疗效果。十年间死亡率为1.7%,最近两年为0.8%。