小儿急性化脓性股骨颈骨髓炎的早期诊断

为了研讨小儿急性化脓性股骨颈骨髓炎的早期诊断和与化脓性髋关节炎的鉴别诊断，通过２８例小儿急性化脓性股骨颈骨髓炎的临床观察和核医学等检查，以及手术中发现，小儿急性化脓性股骨颈骨髓炎早期除髋关节前后压痛外，股骨大粗隆险近亦有肿胀和压痛，髋关节腔穿刺液体为稀释的渗出液体，同位素股骨颈扫描，可见患侧同位素吸收增多，因此，经过仔细的临床检查和同位素检查，可以早期作出诊断，对诊断困难，临床高度怀疑的病例应行手     

小儿急性化脓性骨髓炎误诊教训

急性化脓性骨髓炎，如延误诊断和不，将影响患儿的肢体功能或危及患儿的生命。近１０年共收治３５例，对其误诊教训和提高治愈率等问题进行了探讨。     

小儿化脓性髂骨骨髓炎24例分析

目的：为了提高小儿化脓性髂骨骨髓炎早期诊治水平。方法：总结近２０年收治的２４例该病患儿的临床资料及随访情况。结果：出院时症状消失、功能恢复者１４例；功能恢复、局部伤口经换药３月内愈合者４例；２年以上窦道遗留再次手术治愈者５例；１例未愈。结论：髂骨骨髓炎Ｘ线改变出现晚，早期诊断主要靠仔细的物理学检查。如诊断确立，应用大剂量抗生素治疗是本病的重要原则，不主张过急切开引流术     

新生儿急性骨髓炎临床特点及预后

目的探讨新生儿急性骨髓炎的临床特点、诊断及早期治疗。方法选择2009—2012年我院NICU收治的急性骨髓炎患儿,回顾性分析其临床特点、诊疗经过及预后情况。结果研究期间共收治8例新生儿急性骨髓炎患儿。发热、肢体活动受限、触摸或被动活动患肢时哭闹明显、患处软组织肿胀等是新生儿急性骨髓炎急性期典型临床表现。5例患儿痊愈,随访10～30个月,均无后遗症发生;穿刺有脓性液体的2例患儿转骨外科行引流、牵引、抗感染等治疗,随访患肢活动存在异常;1例患儿入院不足2天因发生多器官功能衰竭死亡。结论新生儿期急性骨髓炎早期缺乏特异性表现,早期诊断和足疗程治疗可减少后遗症发生。     

骨内压监测在小儿急性骨髓炎诊治中的应用

测定小儿急性骨髓炎早期病灶骨内压变化，探索其在早期诊断和治疗中的应用价值。方法：对１８例早期小儿急性骨髓为为进行了病灶骨内压和健侧骨内压的对照测定。结果：１８例病灶骨内压均显升高（５．５±０．９ｋＰａ，１ｃｍＨ２Ｏ＝０．９８ｋＰａ），与对照侧骨内压（２．６±０．５ｋＰａ）相比，差异有非常显意义（Ｐ〈０．０１）。结论：急性骨髓炎早期病灶骨内压显升高。骨内压测定有助于该病的呻     

儿童慢性化脓性骨髓炎疗效分析

目的 总结不同方法治疗儿童慢性化脓性骨髓炎的疗效。方法 回顾性分析2004年6月-2006年12月我院收治的24例儿童慢性化脓性骨髓炎病例资料,其中采用病灶清除加置管冲洗引流术（冲洗组）10例,病灶清除加碘仿纱条填塞术（碘仿组）8例及病灶清除加肌瓣填塞术（肌瓣组）6例。结果24例均一期愈合,治愈时间冲洗组为3—6周、碘仿组为5—8周,肌瓣组为6—10周。结论病灶清除后采用置管冲洗、碘仿纱条填塞或肌瓣填塞术均是治疗儿童慢性化脓性骨髓炎的良好方法,其中采用病灶清除加置管引流术疗效较好。     

小儿髂骨骨髓炎三例诊治体会

小儿髂骨骨髓炎发病率低 ,早期表现不典型 ,误诊率高。总结我院 1990～1999年收治的 3例患儿 ,探讨诊治失误的原因及预防措施。临床资料例 1:男 ,6岁。因发热 (Ｔ 38.6℃ )伴右下腹痛 1ｄ入院 ,经体检、血常规及腹透检查诊断为急性阑尾炎 ,手术切除阑尾无炎症改变。术后发现右髂嵴深压痛 ,压痛最明显部位穿刺抽出 1.5ｍｌ脓血样液体 ,支持骨髓炎诊断 ,ＣＴ扫描证实。手术刮除病灶 ,置管引流冲洗 ,抗炎治疗 2 0ｄ治愈。例 2 :男 ,10岁。因低热伴右下腹隐痛于当地医院诊断为阑尾炎 ,保守治疗1周后病情缓解 ,停药 3ｄ后又有低热 ,伴右髂部痛 ,…     

新生儿血源性骨髓炎误诊原因分析和对策

新生儿急性血源性骨髓炎临床并不多见，因其具有较高的致残率，早期诊断对于减少后遗症的发生非常重要。但是，由于新生儿急性血源性骨髓炎临床表现不典型，误诊时有发生。我们对近年来4例有误诊病史的急性血源性骨髓炎患儿进行了原因分析，并提出了相应对策，现报告如下：     

小儿急性化脓性甲状腺炎诊治20例

目的探讨小儿急性化脓性甲状腺炎的诊断与治疗方法.方法回顾性分析本院2000年1月至2010年5月收治的20例急性化脓性甲状腺炎患儿的治疗经过.结果患儿均联合应用抗生素,部分患儿采取穿刺或手术切开引流,尽量清除化脓病灶,彻底引流,术后做细菌培养及药敏检测,继续应用敏感抗生素.均治愈,随访3个月至10年,2例复发.结论化脓性甲状腺炎采取手术切除感染病灶,并联合应用抗生素,效果良好,可缩短愈合过程,减少复发,降低医疗费用.     

婴儿急性骨骺骨髓炎临床病理特点

总结５３例婴儿急性骨骺骨髓炎临床病理特点。多发于２个月以下婴儿，以股骨上端多见，临床表现不典型，低体温，易合并化脓性关节炎和病理性脱位。发病机理为免疫功能不成熟和骨骺血运分布特点所决定，一般不演变成慢性骨髓炎，但后遗畸形严重。     

Acute lymphocytic leukemia masquerading as acute osteomyelitis

Two children each developed a focal destructive bone lesion accompanied by intermittent fever, swelling, tenderness and elevated ESR. Blood counts were normal; bone marrow aspiration showed acute leukemia. The bone lesions healed in both patients after anti-leukemic therapy. We suggest that the similar roentgenographic appearance of osteomyelitis, bone infarction and focal destructive lesions in leukemia probably reflects a common, basically ischemic process of bone.     

A Case of Pelvic Osteomyelitis

A patient presenting with osteomyelitis of the pelvis is described. In this case it was difficult to establish a correct diagnosis by use of scintigraphic scanning, in spite of clear roentgenographic evidence of osteomyelitis.     

OSTEOMYELITIS OF THE PUBIS

Abstract. Heldrich, F. J. and Harris, V. C. (Departments of Pediatrics, St. Agnes Hospital, Baltimore, Maryland, USA). Osteomyelitis of the pubis. Acta Paediatr Scand, 67: 39, 1979.—Three cases of osteomyelitis of the pubis are presented and the clinical and laboratory features summarized. A review of the literature revealed 49 cases and emphasizes the rarity of this location for acute primary osteomyelitis.     

带血供腓骨移植Ⅰ期修复小儿慢性骨髓炎死骨缺损

目的：探讨小儿慢性骨髓炎大段死骨早期摘除后骨缺损的Ⅰ期修复效果。方法：16例胫骨慢性骨髓炎并大段死骨清除后，作吻合血管腓骨移植Ⅰ期重建；2例作炎性骨段切除，采用带血供腓骨移植Ⅰ期修复。结果：18例胫骨慢性骨髓炎在摘除大段死骨后，应用吻合血管腓骨移植或带血管蒂腓骨移植重建。术后平均随访26个月，见重建骨完全骨性愈合，累及的炎症得到完全控制；修复技体的功能，外形令人满意。结论：慢性骨髓炎所形成的大段死骨在作病灶清除的同时，进行早期的血管吻合或带血管腓骨移植Ⅰ期重建术，可免疫死骨爬行替代的漫长病程，改善受区血液循环，抑制炎症漫延，缩短了住院时间，阔手术次数，为骨髓炎早期死骨清除骨缺损的重建提供了有效外科治疗手段。     

Candida infection in a premature infant presenting as discitis

Vertebral disc space narrowing at multiple levels was observed in a preterm infant. Post mortem examination showed discitis and osteomyelitis due to Candida. Candida enters into the differential diagnosis of vertebral discitis and osteomyelitis in infants and children.     

Nonbacterial osteitis in children: data of a German Incidence Surveillance Study

Aim:  To analyse the incidence, clinical presentation, laboratory and radiological findings, as well as diagnostic approaches and therapeutic procedures in paediatric patients suffering from nonbacterial osteitis. Methods:  A nationwide incidence survey was conducted from 2006 to 2008 through monthly contacts with all German paediatric and paediatric–orthopaedic hospitals. Children with osteomyelitic bone lesions newly diagnosed as suffering from nonbacterial osteitis were identified. Cases were assessed using a questionnaire to be filled in by the treating physician containing information on time since first symptoms, associated diseases, diagnostic procedures, localization of lesions, complications, laboratory and histological results, and treatment. Results:  Nonbacterial osteitis was newly reported in 148 children. The annual incidence was estimated at 0.4 per 100 000 children. Mean manifestation age was 11.4 years (SD 3.2); 99 children (67%) were girls. Palmoplantar pustulosis was observed in 8 (6%). Unifocal manifestations were seen in 50 (34%) patients. Of all patients with vertebral involvement (15%), 9% suffered from vertebral fractures. Bone biopsies were taken in 79 (53%) patients. Conclusions:  Nonbacterial osteitis is an auto‐inflammatory disorder resulting in at least 60 new paediatric cases/year in Germany. Spinal lesions and complications are frequently observed, even at first diagnosis.     

Bone and joint infection in neonates

A retrospective study was done to review the clinical experience of septic arthritis and osteomyelitis in the newborns in our centre. Case records of all the neonates born from January 1989 to August 1994 and those admitted to outborn nursery from 1985 to 1993 were reviewed. Diagnosis of septic arthritis/osteomyelitis was made in the presence of relevant clinical signs and supported by positive culture from blood or joint fluid and abnormal X-ray or ultrasound findings. The incidence of septic arthritis and osteomyelitis among inborn babies was 1 in 1500. There were 25 neonates with mean gestational age 34.5 (range 27–40) weeks and mean birth weight 2269 (range 990–4750) gms. Limitation of movement (64%) and local swelling (60%) were commonest presentations. A total of 33 joints were involved in 25 babies. Eight babies (32%) had multiple joint involvement. Hip and knee were the most commonly involved joints (48% each). In 19 babies (76%) joint involvement occurred in association with a generalized septicemic illness while 6 babies (24%) had localised signs and symptoms. Joint aspirate was positive for gram stain or culture in 12 (48%) and 10 babies (40%) had positive blood culture.Klebsiella pneumoniae andStaphylococcus aureus were commonest isolates. Radiological changes were seen in 13 (52%) babies. All were treated with appropriate antibiotics and open surgical drainage was done in 5 (20%) cases. Bone and joint infections are important complications in sick septicemic neonates and need early diagnosis, appropriate management with antibiotics, surgical drainage in selected cases to prevent long term morbidity.     

Locations of osteomyelitis in children with sickle-cell disease at Tokoin teaching hospital (Togo)

Background  The sickle-cell children are particularly affected by osteomyelitis in specific locations. This study was done in order to point out the locations of osteomyelitis in children with sickle-cell disease. This direct clinical examination for a quick diagnosis. Materials and methods  This is a retrospective study done by examining files of 43 children (15 girls and 28 boys), aged from 0 to 15 years, treated for osteomyelitis between January 1998 and December 2006. Their phenotypes included 18 SS, 14 SC and 11 AS. Osteomyelitis was acute in 20 cases and chronic in 23 cases. The different localisations are classified according to the type of osteomyelitis and the kind of bones concerned. Results  The 43 children presented 63 locations: 57 on long bones and 6 on short bones. The osteomyelitis was unifocal in 32 cases, and multifocal in 11 cases. The locations on long bones were humeral (18 cases), tibial (12 cases), femoral (9 cases), fibular (7 cases), radial (7 cases) and ulnar (4 cases). The 6 short bones included 3 metacarpus and 3 phalanxes. The 11 multifocal locations concerned 8 SS, 2 AS and 1 SC. In chronic osteomyelitis, 7 patients had sequestrum and 2 had pathological fracture. Conclusion  During examination of sickle-cell children with fever, particular attention must be shown, respectively to the arm, the leg and the thigh, in order to track down quickly, an acute osteomyelitis. Early diagnosis and quick treatment permit to avoid complications and heavy sequela in these children.