Weber Christian D, Migliorini Filippo, Delbrück Heide, Hildebrand Frank
Department of Orthopedic Surgery, Trauma and Reconstructive Surgery, RWTH Aachen University Medical Center, Pauwelsstr. 30, 52074 Aachen, Germany.
Life (Basel). 2022 Nov 1;12(11):1754. doi: 10.3390/life12111754.
Subchondral bone defects around the knee joint are uncommon in skeletally immature patients. These lesions require comprehensive management, especially if related to periarticular bacterial infections. While pediatric osteomyelitis typically affects the metaphysis of long bones, the epiphysis is also a potential site for pyogenic osteomyelitis. Long-term sequelae may include growth plate injury and articular cartilage degradation. Primary epiphyseal subacute osteomyelitis is an extremely rare condition, mainly affecting neonates or young infants, as the cartilage of the growth plate generally acts as a barrier for pathogens. Radiographically, the lesions may appear radiolucent or lytic and often demonstrate a substantial perilesional bone marrow edema in MRI studies, but do not primarily contact the articular surface. However, if diagnosis and treatment of epiphyseal infections are delayed or missed, abscess formation may spread into the knee joint and progress to septic arthritis. Approaching a distal femoral epiphyseal lesion or subsequent bone defect surgically may be limited anatomically by both the subchondral plate and articular cartilage on the distal side and the growth plate proximally. Of the few reported cases of epiphyseal osteomyelitis, most underwent non-operative treatment including antibiotic coverage, or (staged) aggressive surgical care involving open curettage, irrigation and bone grafting. We report a novel combination of arthroscopic techniques, namely "ossoscopy", bone grafting and antibiotics, to approach a large lateral femoral epiphyseal lesion with knee involvement. In this case report, we present a 5-year old male patient with subacute posttraumatic knee pain and a significant bone defect of the lateral femoral epiphysis related to pyogenic osteomyelitis. The knee joint and periarticular bone lesion were both debrided and irrigated based on arthroscopic and ossoscopic techniques.The osseous lesion was filled with bone graft. The single-stage procedure proved to be a viable treatment to restore both the large subchondral bone defect and full knee function. Over a course of two years, no recurrent symptoms, infection or growth disturbances were observed in the individual.
膝关节周围的软骨下骨缺损在骨骼未成熟的患者中并不常见。这些病变需要综合管理，特别是如果与关节周围细菌感染有关。虽然小儿骨髓炎通常影响长骨的干骺端，但骨骺也是化脓性骨髓炎的潜在发病部位。长期后遗症可能包括生长板损伤和关节软骨退化。原发性骨骺亚急性骨髓炎是一种极其罕见的疾病，主要影响新生儿或幼儿，因为生长板的软骨通常对病原体起到屏障作用。在影像学上，病变可能表现为透X线或溶骨性，并且在MRI研究中通常显示出明显的病灶周围骨髓水肿，但并不直接累及关节面。然而，如果骨骺感染的诊断和治疗延迟或漏诊，脓肿形成可能扩散到膝关节并发展为化脓性关节炎。从手术角度处理股骨远端骨骺病变或随后的骨缺损，在解剖学上可能会受到远端的软骨下板和关节软骨以及近端生长板的限制。在少数已报道的骨骺骨髓炎病例中，大多数接受了非手术治疗，包括抗生素治疗，或（分阶段进行的）积极手术治疗，包括开放刮除、冲洗和植骨。我们报告了一种关节镜技术的新组合，即“骨窥镜检查”、植骨和抗生素，用于处理累及膝关节的大的股骨外侧骨骺病变。在本病例报告中，我们介绍了一名5岁男性患者，因化脓性骨髓炎出现亚急性创伤后膝关节疼痛和股骨外侧骨骺明显的骨缺损。基于关节镜和骨窥镜技术对膝关节和关节周围骨病变进行了清创和冲洗。骨病变用骨移植填充。单阶段手术被证明是恢复大的软骨下骨缺损和膝关节全部功能的可行治疗方法。在两年的时间里，该患者未观察到复发症状、感染或生长障碍。
