Sexton D J, Heskestad L, Lambeth W R, McCallum R, Levin L S, Corey G R
Divisions of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710.
Clin Infect Dis. 1993 Oct;17(4):695-700. doi: 10.1093/clinids/17.4.695.
Osteitis pubis is a painful inflammatory process resulting in bony destruction of the margins of the symphysis pubis. Despite six decades of speculation, the pathogenesis of, criteria for diagnosis of, natural history of, and optimal therapy for osteitis pubis remain controversial. We present four cases of postoperative pubic osteomyelitis that were initially thought to be typical cases of osteitis pubis. These cases illustrate that pubic osteomyelitis can mimic the principal features of osteitis pubis including characteristic pelvic pain and gait disturbance, symmetrical bony destruction of the symphysis pubis, absence of fever, a long interval between surgery and onset of symptoms, lack of response to antimicrobial therapy, and apparent spontaneous cure. We believe that many previously reported cases of osteitis pubis were actually cases of unrecognized pubic osteomyelitis. We advise an aggressive diagnostic approach to cases of apparent postoperative osteitis pubis including biopsy and needle aspiration of the symphysis pubis guided by computer-assisted tomography. If cultures of biopsy specimens are not diagnostic, open biopsy of the symphysis pubis is recommended.
耻骨炎是一种疼痛性炎症过程，可导致耻骨联合边缘骨质破坏。尽管经过了六十年的推测，但耻骨炎的发病机制、诊断标准、自然病程及最佳治疗方法仍存在争议。我们报告了4例术后耻骨骨髓炎病例，这些病例最初被认为是典型的耻骨炎病例。这些病例表明，耻骨骨髓炎可模仿耻骨炎的主要特征，包括特征性的骨盆疼痛和步态障碍、耻骨联合对称性骨质破坏、无发热、手术与症状出现之间间隔时间长、对抗菌治疗无反应以及明显的自愈情况。我们认为，许多先前报告的耻骨炎病例实际上是未被识别的耻骨骨髓炎病例。我们建议对明显的术后耻骨炎病例采取积极的诊断方法，包括在计算机断层扫描引导下对耻骨联合进行活检和针吸活检。如果活检标本培养不能确诊，建议对耻骨联合进行切开活检。
