The Royal Hospital for Sick Children, Dalnair Street, Yorkhill, Glasgow G3 8SJ, UK.
Scott Med J. 2011 Aug;56(3):i-181. doi: 10.1258/smj.2011.011131.
Pyomyositis is a primary pyogenic infection in skeletal muscle, often progressing to abscess formation. It is rare in temperate climates and generally deep-seated within the pelvis with non-specific clinical features, making diagnosis difficult. Magnetic resonance imaging (MRI) is highly sensitive for muscle inflammation and fluid collection, and with its increasing availability is now the investigation of choice. Treatment of pyomyositis abscess has traditionally been with incision and drainage or guided aspiration followed by a prolonged course of antibiotics, although there are sporadic reports of cases treated successfully with antibiotics alone. Our aim was to describe our own experience with the treatment of pyomyositis abscess in children. From our 20-year database of over 16,000 paediatric orthopaedic admissions, we identified only three cases with MRI-confirmed pyomyositis abscess. These were all in boys (aged 2-12 years) and affected the gluteal, piriformis and adductor muscles. Despite the organisms not being identified, each patient was treated successfully with a short (4-7 days) course of intravenous antibiotics followed by 2-6 weeks of oral therapy. There were no recurrences or complications and all made a full recovery. In conclusion, we propose that uncomplicated pyomyositis abscess in children may usually be managed conservatively without the need for open or percutaneous drainage.
肌脓肿是一种原发性化脓性肌肉感染，常进展为脓肿形成。它在温带气候中很少见，通常位于骨盆深部，具有非特异性的临床特征，因此难以诊断。磁共振成像（MRI）对肌肉炎症和液体积聚非常敏感，随着其可用性的增加，现在已成为首选的检查方法。肌脓肿的传统治疗方法是切开引流或引导抽吸，然后再使用长时间的抗生素治疗，尽管有零星的报道称单独使用抗生素可成功治疗病例。我们的目的是描述我们自己在治疗儿童肌脓肿方面的经验。从我们超过 16000 例儿科骨科住院患者的 20 年数据库中，我们仅发现了 3 例 MRI 证实的肌脓肿病例。这些病例均发生于男孩（年龄 2-12 岁），影响臀肌、梨状肌和内收肌。尽管未确定病原体，但每位患者均成功接受了 4-7 天的短疗程静脉内抗生素治疗，随后再进行 2-6 周的口服治疗。没有复发或并发症，所有患者均完全康复。总之，我们提出，儿童单纯性肌脓肿通常可以保守治疗，无需进行开放性或经皮引流。
