Sacher P, Meuli M
Chirurgische Klinik, Universitäts-Kinderspitals Zürich.
Ther Umsch. 1990 Jul;47(7):574-85.
Not all children with osteomyelitis or septic arthritis will present with the characteristic findings, i.e. localized pain and swelling, fever and generalized malaise. Diagnostic problems arise in case of the following four special forms or locations of the diseases: neonatal osteomyelitis, because neonates frequently have no signs of infection; osteomyelitis of the spine and septic arthritis of the sacroiliac joint; subacute hematogenous osteomyelitis; chronic osteomyelitis. Acute bone and joint infections are diagnosed clinically. Positive blood cultures are found in only about half of all cases. Cultures of joint fluid or bone cultures are positive in 50 to 90%. The aim of therapy is to avoid destruction of bones or joints or even invalidity. Effective treatment consists of sufficient antibiotics for an adequate period of time and of immobilization. Surgical drainage is mandatory in case of abscess formation in soft tissue, of intramedullary or joint abscess, mainly hip-joint and shoulder, of persistent fever and in all chronic forms of osteomyelitis where areas of sequestra, dead tissue and abscesses may be assumed.
并非所有患有骨髓炎或化脓性关节炎的儿童都会表现出典型症状，即局部疼痛、肿胀、发热和全身不适。在以下四种疾病的特殊形式或部位会出现诊断问题：新生儿骨髓炎，因为新生儿常常没有感染迹象；脊柱骨髓炎和骶髂关节化脓性关节炎；亚急性血源性骨髓炎；慢性骨髓炎。急性骨与关节感染通过临床诊断。在所有病例中，仅有约一半血培养呈阳性。关节液培养或骨培养的阳性率为50%至90%。治疗目的是避免骨骼或关节遭到破坏甚至导致残疾。有效的治疗包括在足够长的时间内使用足量抗生素以及进行固定。若软组织形成脓肿、髓内或关节脓肿（主要是髋关节和肩关节）、持续发热，以及在所有可能存在死骨、坏死组织和脓肿区域的慢性骨髓炎病例中，均必须进行手术引流。
