CAJ | 학술논문

目的骨骺骨髓炎是一种少见的骨感染性疾病,由于感染可能破坏骺板,如不能及时诊断和治疗将会造成比较严重的后遗症.本文介绍和总结了几种不同类型的骨骺骨髓炎的治疗经验.方法 2007年至2012年共收治骨骺骨髓炎患儿15例,根据X线片表现将患儿分为三组:A组2例为急性感染,且感染局限于骨骺,B、C两组骨骺及干骺端同时累及,B组8例为亚急性感染,C组5例为慢性感染,治疗方法包括手术清除坏死组织配合抗生素使用.结果 A、B组患儿对治疗非常敏感,术后临床症状逐渐消失,抗生素共使用6周.C组患儿病程较长,经过1次以上的手术,抗生素治疗时间平均为12.5周.随访时间4个月～3.5年,平均1.9年,B、C组各有1例出现膝外翻畸形,无复发病例.结论早期诊断以及合理的应用抗生素是骨骺骨髓炎治疗成功的关键.急性及亚急性的骨骺骨髓炎由于病程较短、病灶范围相对局限,手术彻底清除坏死组织后结合抗生素治疗效果比较理想.而自干骺端蔓延至骨骺的感染,由于病程长、病灶范围大,儿童骺板未闭难以彻底清除病灶,局部冲洗引流可能效果更为可靠.
목적 골후골수염시일충소견적골감염성질병,유우감염가능파배후판,여불능급시진단화치료장회조성비교엄중적후유증.본문개소화총결료궤충불동류형적골후골수염적치료경험.방법 2007년지2012년공수치골후골수염환인15례,근거X선편표현장환인분위삼조:A조2례위급성감염,차감염국한우골후,B、C량조골후급간후단동시루급,B조8례위아급성감염,C조5례위만성감염,치료방법포괄수술청제배사조직배합항생소사용.결과 A、B조환인대치료비상민감,술후림상증상축점소실,항생소공사용6주.C조환인병정교장,경과1차이상적수술,항생소치료시간평균위12.5주.수방시간4개월～3.5년,평균1.9년,B、C조각유1례출현슬외번기형,무복발병례.결론 조기진단이급합리적응용항생소시골후골수염치료성공적관건.급성급아급성적골후골수염유우병정교단、병조범위상대국한,수술철저청제배사조직후결합항생소치료효과비교이상.이자간후단만연지골후적감염,유우병정장、병조범위대,인동후판미폐난이철저청제병조,국부충세인류가능효과경위가고.
Objective To report our preliminary experiences in treatment of different type hematogenous epiphyseal osteomyelitis.Methods From 2007 to 2012,15 patients diagnosed as hematogenous epiphyseal were admitted to our department.They were divided into 3 groups according to the plain film,Group A,2 patients with primary acute epiphyseal osteomyelitis,Group B,8 patients with subacute form,and Group C,5 patients with chronic osteomyelitis.Both epiphysis and metaphysis were affected in group B and C.All of 3 groups were treated with surgical intervention and antibiotic therapy.Results The patients in group A and B were sensitive to the treatment,the clinical signs subsided.The duration of antibiotic therapy was six weeks.All of the patients in group C had a long treatment course because of inadequate clinical response.They underwent more than one operation and the average time of antibiotic therapy was 12.5 weeks.The patients were followed up from 4 months to 3.5 years (mean,1.9 years).Knee valgus was observed in each 1 patient in group B and C.There were no recurrence cases.Conclusions Early diagnosis and appropriate antibiotic treatment are keys to the successful treatment of hematogenous epiphyseal osteomyelitis.As the lesions in acute and subacute forms are relatively localized and the duration is short,the results are good after necrotic tissues removed in combination with antibiotic therapy.It seems more difficult to treat the patients with infection spreads from the metaphysis to the bone marrow because that the chronic course and the extensive lesions involving the growth plate could not be removed completely.Continuous irrigation and vacuum sealing drainage (VSD) are more effective than debridement.