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[镰状细胞病患者的感染性病理性肱骨骨折——罕见病例?]

[Infectious, pathologic humeral fracture in a patient with sickle cell disease-A rare case?].

作者信息

Ballhause Tobias Malte, Linke Philip, Hättich Annika, Klatte Till Orla, Frosch Karl-Heinz, Mader Konrad

机构信息

Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 22529, Hamburg, Deutschland.

Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland.

出版信息

Unfallchirurgie (Heidelb). 2024 Feb;127(2):146-150. doi: 10.1007/s00113-023-01334-9. Epub 2023 Jun 4.

DOI:10.1007/s00113-023-01334-9
PMID:37270730
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10834581/
Abstract

The vaso-occlusive crises of sickle cell disease are accompanied by bone necrosis, which favors endogenous bacterial colonization and thus osteomyelitis. This poses a major challenge for eradication and fracture management.A 22-year-old patient with sickle cell disease sustained a multifragmentary, humeral shaft fracture. During surgical management, pus drained from the fracture site and further diagnostic work-up revealed osteomyelitis with evidence of Klebsiella aerogenes. Septicemia due to Klebsiella aerogenes had been treated 5 months prior to the accident, which occured because of a vaso-occlusive crisis. This is associated with clustered bone necrosis and endogenous germ colonization. Eradication of the germs and fracture care become a challenge. Repeated surgical procedures with segmental transfer can be a successful treatment option.

摘要

镰状细胞病的血管闭塞性危象伴有骨坏死,这有利于内源性细菌定植,进而导致骨髓炎。这给根除感染和骨折处理带来了重大挑战。一名22岁的镰状细胞病患者发生了肱骨干多段骨折。在手术治疗过程中,有脓液从骨折部位流出,进一步的诊断检查显示为骨髓炎,有产气克雷伯菌感染的证据。产气克雷伯菌引起的败血症在此次事故发生前5个月已得到治疗,此次事故是由血管闭塞性危象所致。这与聚集性骨坏死和内源性细菌定植有关。根除细菌和处理骨折成为一项挑战。采用节段性转移的反复外科手术可能是一种成功的治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/6beb6790c3f8/113_2023_1334_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/261e66abaa5a/113_2023_1334_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/42c755d59558/113_2023_1334_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/a88a7f6cdd63/113_2023_1334_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/680c224d6736/113_2023_1334_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/edf1712ba088/113_2023_1334_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/6beb6790c3f8/113_2023_1334_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/261e66abaa5a/113_2023_1334_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/42c755d59558/113_2023_1334_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/a88a7f6cdd63/113_2023_1334_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/680c224d6736/113_2023_1334_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/edf1712ba088/113_2023_1334_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/10834581/6beb6790c3f8/113_2023_1334_Fig6_HTML.jpg

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[Osteomyelitis in sickle cell anemia in adults. 4 cases].
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The value of ultrasound and aspiration in differentiating vaso-occlusive crisis and osteomyelitis in sickle cell disease patients.超声检查及穿刺抽吸在鉴别镰状细胞病患者血管闭塞性危象和骨髓炎中的价值
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本文引用的文献

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Sickle cell disease and malaria: decreased exposure and asplenia can modulate the risk from Plasmodium falciparum.
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Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy.骨感染影像学检查:平片、CT、超声、磁共振成像和核素扫描的作用。
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