Unkila-Kallio L, Kallio M J, Peltola H
Children's Hospital, University of Helsinki, Finland.
Ann Med. 1993 Dec;25(6):545-9.
The purpose of the study was to evaluate the history, clinical picture and diagnostic difficulties of acute haematogenous osteomyelitis (AHOM) in children. Forty-seven children under the age of 15 with bacteriologically proven AHOM were collected prospectively in Finland in 1981-93. Staphylococcus aureus was responsible for 89% of the cases. The commonest sites affected were the tibia (25%) and the femur (23%) followed by the pelvis (15%) and the calcaneus (11%). Sites other than the long bones increased in frequency in children over the age of 4 years. Most of the children came with a history of a week or less with classic signs and symptoms of AHOM, increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values but negative X-rays. Delay in hospital admission was observed in 19%. In 11% antimicrobial therapy was not instituted within 48 hours on ward. All children were clinically healthy at the 1-year check-up with minor X-ray changes seen in 11 patients. We conclude that children in Finland seek treatment early in the course of AHOM and have a good outcome. S. aureus is the main aetiological agent affecting primarily the long bones, but in older children pelvic and calcaneic sites are also frequent. No significant delays affecting the outcome were noticed in admittance to hospital or in the diagnosis of AHOM.
该研究的目的是评估儿童急性血源性骨髓炎（AHOM）的病史、临床表现及诊断难点。1981年至1993年期间，在芬兰前瞻性收集了47例15岁以下经细菌学证实的AHOM患儿。89%的病例由金黄色葡萄球菌引起。最常受累的部位是胫骨（25%）和股骨（23%），其次是骨盆（15%）和跟骨（11%）。4岁以上儿童中，长骨以外部位的发病率有所增加。大多数患儿就诊时病程为一周或更短，伴有AHOM的典型症状和体征，C反应蛋白（CRP）和红细胞沉降率（ESR）值升高，但X线检查为阴性。19%的患儿存在住院延迟。11%的患儿在病房内48小时内未开始抗菌治疗。在1年的检查中，所有患儿临床均健康，11例患儿X线有轻微改变。我们得出结论，芬兰的儿童在AHOM病程早期即寻求治疗，且预后良好。金黄色葡萄球菌是主要病原体，主要影响长骨，但在大龄儿童中，骨盆和跟骨部位也较为常见。在AHOM的住院或诊断方面，未发现影响预后的显著延迟情况。
