Azouz E M, Greenspan A, Marton D
Department of Radiology, McGill University, Montreal Children's Hospital, Quebec, Canada.
Skeletal Radiol. 1993;22(1):17-23. doi: 10.1007/BF00191520.
We reviewed the clinical, radiographic, and computed tomographic (CT) findings in eight children with a histologically proven diagnosis of epiphyseal or apophyseal osteomyelitis. In all cases the femur was involved: in five the osteomyelitis was localized in the femoral condyle, in two it was in the greater trochanter, and in one it was in the femoral head epiphysis. In four of the six cases of epiphyseal involvement there was associated joint effusion or septic arthritis. CT examination may demonstrate a serpentine tract, a sequestrum, cortical destruction or adjacent soft tissue swelling and can differentiate osteomyelitis from other epiphyseal lucent lesions, particularly chondroblastoma and osteoid osteoma. CT yielded important new diagnostic information in seven of the eight patients, failing to do so in only one. In one case, CT showed a wooden splinter in an abscess cavity, which had been mistaken for a sequestrum. When combined with accurate clinical and laboratory information and good quality plain radiographs, CT can lead to an early diagnosis of epiphyseal infection. Early diagnosis helps avoid delays in initiating antibiotic or surgical treatment caused by the unusual (epiphyseal or apophyseal) location of the bone abscess.
我们回顾了8例经组织学证实为骨骺或骨突骨髓炎患儿的临床、影像学及计算机断层扫描（CT）表现。所有病例均累及股骨：5例骨髓炎局限于股骨髁，2例位于大转子，1例位于股骨头骨骺。6例骨骺受累病例中有4例伴有关节积液或化脓性关节炎。CT检查可显示蜿蜒的窦道、死骨、皮质破坏或邻近软组织肿胀，并可将骨髓炎与其他骨骺透亮病变，特别是成软骨细胞瘤和骨样骨瘤相鉴别。8例患者中有7例通过CT获得了重要的新诊断信息，仅1例未获得。有1例CT显示脓肿腔内有一根木刺，此前被误诊为死骨。当CT与准确的临床和实验室信息以及高质量的平片相结合时，可早期诊断骨骺感染。早期诊断有助于避免因骨脓肿位置特殊（骨骺或骨突）而导致抗生素或手术治疗延误。
