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急性新生儿肱骨骨骺骨髓炎是否需要早期手术干预：31例患者的回顾性研究

Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study of 31 Patients.

作者信息

Gao Yun, Liu Ruikang, Rai Saroj, Liang Qingtuan, Liu Yuan, Xiao Xiaoliang, Hong Pan

机构信息

Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China.

Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.

出版信息

Children (Basel). 2022 Apr 7;9(4):527. doi: 10.3390/children9040527.

DOI:10.3390/children9040527
PMID:35455571
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9028880/
Abstract

Objective: To review the treatment experience of neonatal humeral epiphyseal osteomyelitis retrospectively. Study design: Retrospective cohort study of infants with neonatal humeral epiphyseal osteomyelitis. Patients were divided into conservative group and surgical group, and the surgical group was subdivided into early and delayed surgical group. Results: In total, there were 7 patients in the conservative group and 24 in the surgical group. The length of hospital stay and intravenous course of antibiotic therapy were both significantly shorter in the surgical group (p < 0.001). The full recovery rate was also higher in the surgical group (83.3%) than the conservative group (14.3%) (p < 0.001). Early surgery group (n = 14) had an insignificantly higher positive rate of pus/aspirate culture and full recovery rate than delayed surgery group (n = 10). Conclusion: Surgical treatment for neonatal humeral epiphyseal osteomyelitis demonstrated significantly higher rates of positive culture for the pathogen, a shorter course of intravenous oral antibiotics, and lower incidence of growth abnormality than conservative treatment. In our institution, most of culture outcome Gram-positive bacteria, and early surgical treatment was recommended with better outcome than delayed surgical group. Empirical antibiotics should be tailored to the epidemiological characteristics of local virulent bacteria.

摘要

目的

回顾性分析新生儿肱骨骨骺骨髓炎的治疗经验。研究设计：对新生儿肱骨骨骺骨髓炎患儿进行回顾性队列研究。将患者分为保守治疗组和手术治疗组，手术治疗组再细分为早期手术组和延迟手术组。结果：保守治疗组共7例患者，手术治疗组24例。手术治疗组的住院时间和静脉应用抗生素疗程均显著缩短（p<0.001）。手术治疗组的完全康复率（83.3%）也高于保守治疗组（14.3%）（p<0.001）。早期手术组（n=14）的脓液/抽吸物培养阳性率和完全康复率略高于延迟手术组（n=10）。结论：与保守治疗相比，新生儿肱骨骨骺骨髓炎的手术治疗显示病原体培养阳性率显著更高、静脉口服抗生素疗程更短且生长异常发生率更低。在我们机构，大多数培养结果为革兰氏阳性菌，建议早期手术治疗，其效果优于延迟手术组。经验性抗生素应根据当地致病细菌的流行病学特征进行调整。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaac/9028880/b98dc06ca77b/children-09-00527-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaac/9028880/1d7cae0c5045/children-09-00527-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaac/9028880/62dcbcbc9468/children-09-00527-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaac/9028880/f73d940ac791/children-09-00527-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaac/9028880/b98dc06ca77b/children-09-00527-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaac/9028880/1d7cae0c5045/children-09-00527-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaac/9028880/62dcbcbc9468/children-09-00527-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaac/9028880/f73d940ac791/children-09-00527-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaac/9028880/b98dc06ca77b/children-09-00527-g004.jpg

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本文引用的文献

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Acute Hematogenous Osteomyelitis in Children.儿童急性血源性骨髓炎
Ochsner J. 2019 Summer;19(2):116-122. doi: 10.31486/toj.18.0138.
3
Nationwide epidemiologic study for pediatric osteomyelitis and septic arthritis in South Korea: A cross-sectional study of national health insurance review and assessment service.韩国小儿骨髓炎和化脓性关节炎的全国性流行病学研究：一项基于国民健康保险审查与评估服务的横断面研究
Medicine (Baltimore). 2019 Apr;98(17):e15355. doi: 10.1097/MD.0000000000015355.
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Antimicrobial Stewardship in the Neonatal Intensive Care Unit: An Update.新生儿重症监护病房的抗菌药物管理：最新进展
Curr Pediatr Rev. 2019;15(1):47-52. doi: 10.2174/1573396315666190118101953.
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Clinical analysis of 17 cases of neonatal osteomyelitis: A retrospective study.17例新生儿骨髓炎的临床分析：一项回顾性研究。
Medicine (Baltimore). 2019 Jan;98(2):e14129. doi: 10.1097/MD.0000000000014129.
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Validity and comprehensibility of outcome measures in children with shoulder and elbow disorders: creation of a new Pediatric and Adolescent Shoulder and Elbow Survey (Pedi-ASES).儿童肩肘疾病结局评估工具的有效性和可理解性：新的儿童青少年肩肘评估问卷（Pedi-ASES）的制定。
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