Chandrasenan J, Klezl Z, Bommireddy R, Calthorpe D
Department of Trauma and Orthopaedics, Spinal Unit, Uttoxeter Road, Derby DE22 3NE, UK.
J Bone Joint Surg Br. 2011 Aug;93(8):1122-5. doi: 10.1302/0301-620X.93B8.25588.
We retrospectively reviewed the records of 16 children treated for spondylodiscitis at our hospital between 2000 and 2007. The mean follow-up was 24 months (12 to 38). There was a mean delay in diagnosis in hospital of 25 days in the ten children aged less than 24 months. At presentation only five of the 16 children presented with localising signs and symptoms. Common presenting symptoms were a refusal to walk or sit in nine children, unexplained fever in six, irritability in five, and limping in four. Plain radiography showed changes in only seven children. The ESR was the most useful investigation when following the clinical course of the disease. Positive blood cultures were obtained in seven children with Staphylococcus aureus being isolated in five. Antibiotics were used in 14 children and spinal bracing in six. Children with spondylodiscitis often present with a confusing clinical picture leading to late diagnosis. The early use of MRI in the investigation of children with an atypical picture may avoid unnecessary delay in starting treatment and possibly prevent long-term problems. All except one of our children had made a complete clinical recovery at final follow-up. However, all six children in the > 24-month age group showed radiological evidence of degenerative changes which might cause problems in the future.
我们回顾性分析了2000年至2007年间在我院接受脊椎骨髓炎治疗的16例儿童的病历。平均随访时间为24个月（12至38个月）。10名年龄小于24个月的儿童在医院的诊断平均延迟25天。就诊时，16名儿童中只有5名表现出定位性体征和症状。常见的就诊症状包括9名儿童拒绝行走或坐下、6名儿童不明原因发热、5名儿童易激惹、4名儿童跛行。普通X线摄影仅在7名儿童中显示有变化。在跟踪疾病临床过程时，红细胞沉降率（ESR）是最有用的检查。7名儿童血培养呈阳性，其中5名分离出金黄色葡萄球菌。14名儿童使用了抗生素，6名儿童使用了脊柱支具。脊椎骨髓炎患儿的临床表现往往令人困惑，导致诊断延迟。对于临床表现不典型的儿童，早期使用磁共振成像（MRI）进行检查可能避免开始治疗时的不必要延迟，并可能预防长期问题。除1名儿童外，我们所有的患儿在最终随访时均已完全临床康复。然而，所有6名年龄大于24个月的儿童均显示有退行性改变的影像学证据，这可能在未来引发问题。
