Soraganvi Prasad Channappa, Ramakanth R
PESIMSR Medical college, Kuppam, Andhra Pradesh, India.
J Orthop Case Rep. 2013 Jul-Sep;3(3):7-10. doi: 10.13107/jocr.2250-0685.106.
Pyomyositis of obturator muscles is rare condition. Late presentation with deformities of hip misleads the clinician. Late presentation (6 weeks) of this condition has not been reported earlier. This report highlights this unusual presentation of Pyomyositis of the obturator muscles.
We are reporting a 14year old female patient presented with limp and pain in hip since 6 weeks. Her hip radiographs were unremarkable. Patient was admitted and MRI done. MRI findings were consistent with obturator pyomyositis. Diagnosis of pyomyositis confirmed by MRI and we performed percutaneous aspiration and drained about 25ml of purulent material mixed with blood. The culture grew Staphylococcus aureus. Patient received intravenous antibiotic for 1week and oral antibiotic for 2weeks. Patient was immobilized in fixed skin traction in Thomas splint for 5days, later gentle mobilization was started. Her condition improved dramatically after aspiration. A follow up MRI done at 3 weeks following aspiration revealed a significant reduction in intramuscular collection of obturator internus and obturator externus. Three weeks following aspiration patient was relieved of the pain and was able to walk normally. At 6 months follow up visit patient was asymptomatic.
Late presentation of obturator pyomyositis is rare. We emphasise on careful examination and need for early imaging for diagnosis. Percutaneous drainage results in successful treatment.
闭孔肌脓性肌炎是一种罕见的病症。髋关节畸形的晚期表现会误导临床医生。此前尚未有关于这种病症6周后才出现的报道。本报告着重介绍了闭孔肌脓性肌炎这种不寻常的表现。
我们报告了一名14岁女性患者，自6周前以来出现髋关节跛行和疼痛。她的髋关节X光片未见明显异常。患者入院后进行了磁共振成像（MRI）检查。MRI结果与闭孔肌脓性肌炎相符。通过MRI确诊为脓性肌炎，我们进行了经皮穿刺抽吸，抽出了约25毫升混有血液的脓性物质。培养结果显示为金黄色葡萄球菌。患者接受了1周的静脉抗生素治疗和2周的口服抗生素治疗。患者在托马斯夹板固定皮肤牵引下固定了5天，之后开始进行轻柔的活动。抽吸后她的病情显著改善。抽吸后3周进行的随访MRI显示闭孔内肌和闭孔外肌的肌内积液明显减少。抽吸后3周，患者疼痛缓解，能够正常行走。在6个月的随访中，患者无症状。
闭孔肌脓性肌炎的晚期表现罕见。我们强调仔细检查以及早期影像学检查对诊断的必要性。经皮引流可实现成功治疗。
