Cochard Blaise, Ciprani Asia, Cirillo Marco, Habre Céline, Vazquez Oscar, Frizon Louise, Bracci Benedetta, Dayer Romain, Krzysztofiak Andrezj, Ceroni Dimitri
Pediatric Orthopaedic Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland.
Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland.
J Bone Joint Surg Am. 2024 Dec 27;107(3). doi: 10.2106/JBJS.24.00101.
Transphyseal hematogenous osteomyelitis (THO) is a common infectious condition, being present in 25% of patients with hematogenous osteomyelitis. A large proportion of pediatric hematogenous osteomyelitis infections can spread through the growth cartilage and therefore may be potentially responsible for growth disorders, leading to limb-length discrepancy or angular deformities. The purpose of the present study was to identify both the prevalence of complications caused by transphyseal osteomyelitis and factors influencing their occurrence.
The records for all patients who had been treated for THO over a 17-year period at the University Hospitals of Geneva and the Gesù Bambino Hospital in Rome were retrospectively analyzed. Clinical, biological, and bacteriological data were analyzed. Magnetic resonance imaging (MRI) scans were reviewed for all patients to assess the cross-sectional area of growth plate involvement. Restart of growth of the affected physeal cartilage was subsequently monitored by means of iterative radiographic examination.
From a cohort of 594 patients with hematogenous osteomyelitis, 89 patients (15.0%) were found to have THO. The median age was 84 months (range, 1 to 167 months), with a bimodal distribution and peaks at 30 and 150 months; 59.6% (53) of the 89 patients were male. The lower limbs were most often affected, with the distal tibia and fibula accounting for 47.2% of all cases. Methicillin-sensitive Staphylococcus aureus and Kingella kingae were the most frequently identified pathogens, accounting for 61.8% of the cases. Virulence factors, such as Panton-Valentine leukocidin (PVL), toxic shock syndrome toxin (TSST), and accessory gene regulator (Agr), were recorded in 12.4% of MSSA strains. Transphyseal lesions affected a median of 7.6% (range, 0.79% to 58.2%) of the physeal surface. Complications affecting further growth were noted in 13% of patients with THO. Thrombocytopenia, leukocytosis, and the presence of virulence factors significantly influenced the occurrence of complications.
THO affects all age categories of the pediatric population. In the present study, growth disturbance occurred in 13% of cases. The presence of deep thrombocytopenia, leukocytosis, and virulence factors, such as Agr, TSST, and PVL, seems to strongly influence the occurrence of such complications.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
经骨骺血源性骨髓炎（THO）是一种常见的感染性疾病，占血源性骨髓炎患者的25%。很大一部分儿童血源性骨髓炎感染可通过生长软骨扩散，因此可能是生长障碍的潜在原因，导致肢体长度差异或角畸形。本研究的目的是确定经骨骺骨髓炎引起的并发症的发生率以及影响其发生的因素。
回顾性分析在日内瓦大学医院和罗马耶稣儿童医院接受17年THO治疗的所有患者的记录。分析临床、生物学和细菌学数据。对所有患者的磁共振成像（MRI）扫描进行回顾，以评估生长板受累的横截面积。随后通过迭代X线检查监测受影响的骨骺软骨的生长恢复情况。
在594例血源性骨髓炎患者队列中，发现89例（15.0%）患有THO。中位年龄为84个月（范围1至167个月），呈双峰分布，高峰在30个月和150个月；89例患者中有59.6%（53例）为男性。下肢最常受累，胫腓骨远端占所有病例的47.2%。对甲氧西林敏感的金黄色葡萄球菌和金氏金杆菌是最常鉴定出的病原体，占病例的61.8%。毒力因子，如杀白细胞素（PVL）、毒性休克综合征毒素（TSST）和辅助基因调节因子（Agr），在12.4%的甲氧西林敏感金黄色葡萄球菌菌株中被记录。经骨骺病变累及骨骺表面的中位数为7.6%（范围0.79%至58.2%）。13%的THO患者出现影响进一步生长的并发症。血小板减少、白细胞增多和毒力因子的存在显著影响并发症的发生。
THO影响儿童各年龄段人群。在本研究中，13%的病例出现生长障碍。严重血小板减少、白细胞增多以及毒力因子（如Agr、TSST和PVL）的存在似乎强烈影响此类并发症的发生。
治疗水平IV。有关证据水平的完整描述，请参阅作者指南。
