Department of Pediatric Orthopedics, Shriners Hospital for Children, 3101 S.W. Sam Jackson Park Road, Portland, OR 97239, USA.
J Bone Joint Surg Am. 2010 Sep 15;92(12):2196-203. doi: 10.2106/JBJS.I.01468.
Patients who survive the initial acute phase of fulminant meningococcemia are at increased risk for serious orthopaedic complications. This report describes our experience with purpura fulminans related to meningococcemia, with emphasis on musculoskeletal sequelae and their treatment.
We retrospectively reviewed the cases of forty-eight patients (twenty-two boys and twenty-six girls) who survived the acute phase of meningococcal septicemia and developed musculoskeletal sequelae. Early sequelae required surgical treatment within six months after the onset of sepsis and were primarily amputations. Late sequelae required surgical management six months or more following the initial infection and included growth disturbances, stump overgrowth, scar contractures, and soft-tissue and bone infections.
The mean age at the onset of sepsis (and standard deviation) was 2.6 ± 3.0 years, and the mean duration of follow-up was 11.7 ± 5.1 years. The mean number of surgical procedures required was 4.4 ± 2.9 per patient. Early sequelae included amputations at a variety of levels. Upper-extremity amputations were less frequent than lower-extremity amputations. Growth disturbances in the upper extremities were less frequent than growth disturbances in the lower extremities. Stump overgrowth occurred in only eleven patients (23%) with a lower-extremity amputation. The prevalence of scar contractures in the upper extremities was similar to that in the lower extremities. Eight patients (17%) acquired soft-tissue and bone infections at the distal portion of the amputation stump, at a mean of 7.2 ± 5.4 years after the initial sepsis. Thirteen patients (27%) were found to have developmental delay at the time of follow-up, and it was severe in seven of them.
All patients who survive meningococcal septicemia should be followed by an orthopaedic surgeon who is experienced in pediatric limb deformities and amputations. Children requiring surgery for purpura fulminans are often limited by physical disability due to amputation, scarring, and abnormal bone growth. Despite advances in orthopaedic management, children are still at risk of developing physical and developmental limitations.
暴发性脑膜炎球菌血症存活下来的患者存在严重骨科并发症的风险增加。本报告描述了我们在暴发性脑膜炎球菌血症相关坏疽性紫癜方面的经验，重点介绍了肌肉骨骼后遗症及其治疗。
我们回顾性分析了 48 例（22 名男孩和 26 名女孩）存活下来的脑膜炎球菌败血症患者的病例，这些患者发生了肌肉骨骼后遗症。早期后遗症需要在脓毒症发病后 6 个月内进行手术治疗，主要是截肢。晚期后遗症需要在初次感染后 6 个月或更长时间进行手术处理，包括生长障碍、残端过度生长、瘢痕挛缩以及软组织和骨感染。
脓毒症发病时的平均年龄（标准差）为 2.6 ± 3.0 岁，平均随访时间为 11.7 ± 5.1 年。每位患者平均需要进行 4.4 ± 2.9 次手术。早期后遗症包括各种水平的截肢。上肢截肢的发生率低于下肢截肢。上肢生长障碍的发生率低于下肢生长障碍。只有 11 例（23%）下肢截肢患者出现残端过度生长。上肢瘢痕挛缩的发生率与下肢相似。8 例（17%）患者在初次脓毒症后平均 7.2 ± 5.4 年出现远端截肢残端的软组织和骨感染。13 例（27%）患者在随访时发现发育迟缓，其中 7 例严重。
所有存活下来的脑膜炎球菌败血症患者都应接受小儿肢体畸形和截肢经验丰富的矫形外科医生的随访。需要手术治疗暴发性脑膜炎球菌血症的儿童常因截肢、瘢痕和异常骨生长而导致身体残疾。尽管矫形管理取得了进步，但儿童仍存在身体和发育受限的风险。
