经骨骺血液性骨髓炎并发症的发生率。

Blaise Cochard,Asia Ciprani,Marco Cirillo,Céline Habre,Oscar Vazquez,Louise Frizon,Benedetta Bracci,Romain Dayer,Andrezj Krzysztofiak,Dimitri Ceroni
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引用次数: 0

摘要

背景:经骨骺血流性骨髓炎(THO)是一种常见的感染性疾病,在25%的血流性骨髓炎患者中存在。很大一部分儿童血液性骨髓炎感染可以通过生长软骨传播,因此可能潜在地导致生长障碍,导致肢体长度差异或角度畸形。本研究的目的是确定由骨髓炎引起的并发症的患病率和影响其发生的因素。方法回顾性分析日内瓦大学医院和Gesù罗马Bambino医院17年来治疗THO的所有患者的记录。对临床、生物学和细菌学资料进行分析。对所有患者进行磁共振成像(MRI)扫描以评估生长板受累的横截面积。随后通过反复x线检查监测受影响的骨骺软骨的重新生长。结果594例血液性骨髓炎患者中,89例(15.0%)发现有THO。年龄中位数为84月龄(1 ~ 167月龄),呈双峰分布,高峰在30月龄和150月龄;89例患者中男性53例,占59.6%。下肢多见,胫骨远端和腓骨占47.2%。以甲氧西林敏感金黄色葡萄球菌和金氏菌最为常见,占病例数的61.8%。12.4%的MSSA菌株存在潘通-瓦伦丁杀白细胞素(PVL)、中毒性休克综合征毒素(TSST)和辅助基因调节剂(Agr)等毒力因子。经骨骺病变影响骨骺表面的中位数为7.6%(范围0.79%至58.2%)。13%的THO患者出现影响进一步生长的并发症。血小板减少症、白细胞增多症和毒力因子的存在显著影响并发症的发生。结论tho影响所有年龄段的儿童人群。在本研究中,13%的病例发生生长障碍。深度血小板减少症、白细胞增多症和毒力因子(如Agr、TSST和PVL)的存在似乎强烈影响此类并发症的发生。证据级别:治疗性IV级。参见《作者说明》获得证据级别的完整描述。
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Prevalence of Complications Due to Transphyseal Hematogenous Osteomyelitis.
BACKGROUND Transphyseal hematogenous osteomyelitis (THO) is a common infectious condition, being present in 25% of patients with hematogenous osteomyelitis. A large proportion of pediatric hematogenous osteomyelitis infections can spread through the growth cartilage and therefore may be potentially responsible for growth disorders, leading to limb-length discrepancy or angular deformities. The purpose of the present study was to identify both the prevalence of complications caused by transphyseal osteomyelitis and factors influencing their occurrence. METHODS The records for all patients who had been treated for THO over a 17-year period at the University Hospitals of Geneva and the Gesù Bambino Hospital in Rome were retrospectively analyzed. Clinical, biological, and bacteriological data were analyzed. Magnetic resonance imaging (MRI) scans were reviewed for all patients to assess the cross-sectional area of growth plate involvement. Restart of growth of the affected physeal cartilage was subsequently monitored by means of iterative radiographic examination. RESULTS From a cohort of 594 patients with hematogenous osteomyelitis, 89 patients (15.0%) were found to have THO. The median age was 84 months (range, 1 to 167 months), with a bimodal distribution and peaks at 30 and 150 months; 59.6% (53) of the 89 patients were male. The lower limbs were most often affected, with the distal tibia and fibula accounting for 47.2% of all cases. Methicillin-sensitive Staphylococcus aureus and Kingella kingae were the most frequently identified pathogens, accounting for 61.8% of the cases. Virulence factors, such as Panton-Valentine leukocidin (PVL), toxic shock syndrome toxin (TSST), and accessory gene regulator (Agr), were recorded in 12.4% of MSSA strains. Transphyseal lesions affected a median of 7.6% (range, 0.79% to 58.2%) of the physeal surface. Complications affecting further growth were noted in 13% of patients with THO. Thrombocytopenia, leukocytosis, and the presence of virulence factors significantly influenced the occurrence of complications. CONCLUSIONS THO affects all age categories of the pediatric population. In the present study, growth disturbance occurred in 13% of cases. The presence of deep thrombocytopenia, leukocytosis, and virulence factors, such as Agr, TSST, and PVL, seems to strongly influence the occurrence of such complications. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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