Kiran Manish, Mohamed Saffwan, Newton Ashley, George Harvey, Garg Neeraj, Bruce Colin
Department of Trauma and Orthopaedic Surgery, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK.
Int Orthop. 2018 May;42(5):1143-1147. doi: 10.1007/s00264-017-3746-1. Epub 2017 Dec 30.
We present the largest series of paediatric pelvic pyomyositis from a temperate country, analyse the factors influencing long term prognosis and suggest a diagnostic protocol.
We included 41 patients diagnosed with primary paediatric pelvic pyomyositis between 1998 and 2016, in this study with a mean age of 7.5 years. Demographic, clinical, radiological and follow-up data were reviewed. Statistical analysis was performed to analyse the influence of early diagnosis and treatment on the final outcome.
There was an increased occurrence of primary pelvic pyomyositis in the last two years. Of cases identified, 85% fulfilled Kocher's criteria for hip septic arthritis. The mean time to diagnosis was 2.8 ± 0.8 days. The most common muscle affected was obturator internus (65.85%) and multifocal involvement was common (46.34%). Early diagnosis and antibiotic treatment within seven days from the time of onset of symptoms was the only factor that influenced final outcome (p < 0.001).
Pyomyositis is no longer restricted to tropical countries. The time from onset of symptoms to start of antibiotic treatment influences the final outcome. Clinical examination and inflammatory markers have low specificity in distinguishing between pyomyositis, septic arthritis, osteomyelitis or other infections. MRI is more sensitive and can diagnose pyomyositis in its early stages. Every suspected case of septic arthritis of the hip should undergo an ultrasound. MRI scan may be performed if the ultrasound shows inconclusive evidence of an effusion. Early identification will facilitate early antibiotic treatment which will improve the final outcome.
There is an increasing occurrence of this tropical disease in temperate countries. Early diagnosis with an MRI scan and early antibiotic use results in good outcomes.
我们展示了来自一个温带国家的最大规模小儿盆腔脓性肌炎系列病例，分析影响长期预后的因素，并提出一种诊断方案。
本研究纳入了1998年至2016年间诊断为原发性小儿盆腔脓性肌炎的41例患者，平均年龄7.5岁。回顾了人口统计学、临床、放射学和随访数据。进行统计分析以分析早期诊断和治疗对最终结局的影响。
在过去两年中，原发性盆腔脓性肌炎的发病率有所增加。在确诊的病例中，85%符合髋部化脓性关节炎的柯赫尔标准。平均诊断时间为2.8±0.8天。最常受累的肌肉是闭孔内肌（65.85%），多灶性受累很常见（46.34%）。症状出现后7天内的早期诊断和抗生素治疗是影响最终结局的唯一因素（p<0.001）。
脓性肌炎不再局限于热带国家。从症状出现到开始抗生素治疗的时间影响最终结局。临床检查和炎症标志物在区分脓性肌炎、化脓性关节炎、骨髓炎或其他感染方面特异性较低。MRI更敏感，可在早期诊断脓性肌炎。每例疑似髋部化脓性关节炎的病例都应进行超声检查。如果超声显示积液证据不明确，可进行MRI扫描。早期识别将有助于早期抗生素治疗，从而改善最终结局。
这种热带疾病在温带国家的发病率正在增加。通过MRI扫描早期诊断并早期使用抗生素可取得良好结局。
