Lin Shuting, Gu Donghao, Ning Peng, Wu Jingyu, Yang Zhixin, Liu Tianjing
Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.
Shanghai University of Traditional Chinese Medicine, Shanghai, China.
BMC Musculoskelet Disord. 2025 May 27;26(1):523. doi: 10.1186/s12891-025-08671-3.
This study conducted statistical analysis of clinical data from cases of acute hematogenous osteomyelitis (AHO) with or without concomitant septic arthritis, with the objective of identifying factors that are indicative of concomitant septic arthritis. Predictive models will be developed to predict coexisting infections, with one that is independent of MR findings and another that incorporates MRI data.
A retrospective review of 127 children (132 cases of AHO) treated for AHO was performed. All patients underwent MRI. The data encompassed various demographic, clinical, and diagnostic factors. Graphical and logistical regression analysis was used to determine variables independently predictive of adjacent infection. Optimal cutoff values were determined for each variable and a prediction model was created. Finally, the model was applied to our patient database and each patient with isolated AHO, or concomitant infection was stratified based upon the number of positive predictive factors.
The overall incidence of coexisting septic arthritis in patients with AHO was 52.2% (69/132). Four risk factors (age below 4 years, a history of preceding infection, platelet count > 390.5 × 10^9/L, and absolute neutrophil count < 5.45 × 10^3 cells/ml) were found to be predictive of concomitant infection and were included in the algorithm. Patients with ≥ 2 risk factors were classified as high risk for AHO with concomitant infection (Sensitivity: 79.41% (95% CI: [64.10%, 94.71%]), Specificity: 76.56% (95% CI: [58.61%, 94.51%]), Positive Predictive Value (PPV): 78.26% (95% CI: [63.43%, 93.09%]), and Negative Predictive Value (NPV): 77.78% (95% CI: [61.02%, 94.54%]). In MRI, joint effusion was the primary indicator of concomitant septic arthritis in patients with AHO, followed by the absence of subperiosteal abscess. The presence of subperiosteal abscess in the absence of joint effusion was highly correlated with isolated AHO, showing a 100% occurrence rate (39/39).
Our study successfully identified several risk factors and radiologic signs associated with concomitant septic arthritis in patients with AHO. These findings can assist clinicians in early recognition and management of coexisting infections, especially in situations where MRI is not readily available or when its findings are inconclusive. Timely identification of these factors is crucial for appropriate treatment planning and improved patient outcomes.
本研究对伴有或不伴有化脓性关节炎的急性血源性骨髓炎（AHO）病例的临床数据进行了统计分析，目的是确定提示伴有化脓性关节炎的因素。将开发预测模型以预测合并感染，一个独立于磁共振成像（MR）结果，另一个纳入MRI数据。
对127例接受AHO治疗的儿童（132例AHO病例）进行回顾性研究。所有患者均接受了MRI检查。数据包括各种人口统计学、临床和诊断因素。采用图形分析和逻辑回归分析来确定独立预测相邻感染的变量。确定每个变量的最佳临界值并创建预测模型。最后，将该模型应用于我们的患者数据库，并根据阳性预测因素的数量对每例单纯性AHO或合并感染的患者进行分层。
AHO患者中合并化脓性关节炎的总体发生率为52.2%（69/132）。发现四个危险因素（4岁以下、既往感染史、血小板计数>390.5×10^9/L和绝对中性粒细胞计数<5.45×10^3个细胞/ml）可预测合并感染，并纳入算法。有≥2个危险因素的患者被归类为AHO合并感染的高危患者（敏感性：79.41%（95%CI：[64.10%，94.71%]），特异性：76.56%（95%CI：[58.61%，94.51%]），阳性预测值（PPV）：78.26%（95%CI：[63.43%，93.09%]），阴性预测值（NPV）：77.78%（95%CI：[61.02%），94.54%]）。在MRI中，关节积液是AHO患者合并化脓性关节炎的主要指标，其次是无骨膜下脓肿。无关节积液时骨膜下脓肿的存在与单纯性AHO高度相关，发生率为100%（39/39）。
我们的研究成功地确定了与AHO患者合并化脓性关节炎相关的几个危险因素和放射学征象。这些发现可帮助临床医生早期识别和管理合并感染，尤其是在无法获得MRI或其结果不确定的情况下。及时识别这些因素对于适当的治疗计划和改善患者预后至关重要。
