18例儿童足部骨髓炎临床特征分析

目的 总结儿童足部骨髓炎临床特点及诊治体会。方法 收集2017年9月至2023年1月山东大学附属儿童医院诊治的18例儿童足部骨髓炎的病例资料进行回顾性分析，其中男孩13例，女孩5例，年龄为1个月14天~11岁，就诊时发病时长为3天~2个月。发病部位跟骨6例，趾骨4例，跖骨4例，距骨3例，足舟骨1例。18例患儿起病时均表现为患处肿胀压痛，16例伴有患处皮温高，7例起病时无明显诱因，9例发病过程中伴有发热。8例入院前于外院行抗生素治疗，4例入院前于外院行抗生素联合软组织清创引流。入院后2例患儿采用抗生素保守治疗，16例患儿采用抗生素联合骨质开窗引流。结果 入院24小时内实验室检查13例白细胞升高，8例中性粒细胞升高，11例C-反应蛋白升高，15例红细胞沉降率升高。所有患儿均行MRI检查提示骨质异常信号。血培养仅有1例患儿阳性，为耐甲氧西林金黄色葡萄球菌。行手术治疗的16例患儿中脓液培养6例为甲氧西林敏感性金黄色葡萄球菌，2例为耐甲氧西林金黄色葡萄球菌，1例为肺炎链球菌，1例同时有甲氧西林敏感性金黄色葡萄球菌和化脓性链球菌。住院总时间为11~49 d，所有患儿均治愈。其中1例发病过程中伴有大隐静脉血栓性静脉炎，1个月后复查血栓消失，血管完全再通；1例残留足部畸形；1例足趾短缩。结论 儿童足部骨髓炎比较少见，临床多表现为足部肿胀压痛，多数起病时有明显诱因，治疗上积极采用抗生素，保守治疗效果欠佳时需行清创引流。

Clinical Features of 18 Children with Foot Osteomyelitis

Objective To summarize the clinical characteristics and treatment experience of pediatric foot osteomyelitis. Methods The data of 18 children with foot osteomyelitis diagnosed and treated at the Children''s Hospital Affiliated to Shandong University from September 2017 to January 2023 were collected for retrospective analysis, including 13 boys and 5 girls, aged one month and 14 days to 11 years, with onset duration of 3 days to 2 months. The affected sites were calcaneal bone (6 cases), phalangeal bone (4 cases), metatarsal bone (4 cases), talus bone (3 cases) and scaphoid bone (1 case). All the 18 cases presented swelling and tenderness at the onset of the disease, 16 cases were accompanied by high skin temperature, 7 cases had no obvious cause at the onset, and 9 cases were accompanied by fever. A total of 8 cases received antibiotics in other hospitals before admission, and 4 cases received antibiotics combined with soft tissue debridement and drainage before admission. After admission, 2 cases received conservative treatment with antibiotics, and 16 cases received antibiotics combined with bone window drainage. Results Laboratory examination within 24 h of admission showed elevated white blood cells in 13 cases, elevated neutrophils in 8 cases, elevated C-reactive protein in 11 cases, and elevated erythrocyte sedimentation in 15 cases. All the children underwent MRI examination which indicated abnormal bone signal. Only 1 patient showed methicillin-resistant Staphylococcus aureus in blood culture. Among the 16 children who underwent surgery, 6 cases were infected by methicillin-sensitive Staphylococcus aureus, 2 cases by methicillin-resistant Staphylococcus aureus, 1 case by Streptococcus pneumoniae, and 1 case by both methicillin-sensitive Staphylococcus aureus and Streptococcus pyogenes. The total length of hospitalization was 11-49 days. All the children were cured, but 1 of them was accompanied by great saphenous vein thrombophlebitis during the course of onset, and the thrombus disappeared and the blood vessels were completely recanalized after reexamination 1 month later; 1 case had residual foot deformity; and 1 case had toe shrinkage. Conclusion Pediatric foot osteomyelitis is relatively rare, most clinical manifestations are swelling and tenderness of the foot, most have obvious causes at the onset of the disease, antibiotics are actively used in treatment, and debridement and drainage should be actively performed if the effect of conservative treatment is poor.