广州医科大学学报

目的:探讨影响小儿急性骨髓炎治疗转归的因素。方法:回顾性分析本院1995年至2005年共11年间收治的小儿急性骨髓炎47例,按治疗转归分为4组:优组(A组,n=20),良组(n=9),差组(B组,n=15)和死亡组(n=3),比较A,B两组的临床特征,采用非参数直线相关分析方法筛选与慢性骨髓炎转归关系密切的因素。结果:B组中位年龄较低[90 d(26 d⁷岁)比2岁(30 d~13岁)]、扁平骨受累的比例较高(26.7%比0%)、贫血的比例较高(40.0%比0%)、从发病到获确诊的时间较长[(5.5±2.3)d比(2.7±1.7)d],与A组比较均有统计学差异(P<0.05)。两组间性别、诱因、典型临床表现、血培养、X线征象出现时间、抗生素使用时间以及是否手术等方面均无统计学差异(P>0.05)。相关分析结果显示,慢性骨髓炎转归与发热的持续时间、局部肿胀以及活动受限的持续时间呈正相关关系(r=0.506,P<0.05)。结论:影响小儿急性骨髓炎转归的主要因素是全身及局部症状的持续时间,早期确诊及有效治疗对减少本病慢性骨髓炎转归有积极作用。

Objective:To explore the risk factors related to poor prognosis in children with acute osteomyelitis.Methods: Data on forty-seven children who were treated for acute osteomyelitis in our hospital between 1995 and 2005,were allocated to four groups based on their outcomes: excellent(group A,n=20),good(n=9),fair(group B,n=15) and dead(n=3).Clinical features were compared between groups A and B.Nonparametric linear correlation analysis was used to screen for risk factors related to chronic osteomyelitie prognosis.Results: Younger age[9 d(26 d-7 y) vs 2y(30 d~13 y)],higher prevalence of flat bone involvement(25.7% vs 0%) and anemia(40.0% vs 0%) and longer time to a confirmed diagnosis[(5.5±2.3)d vs(2.7±1.7)d]were found in group B,with significant differences from group A(P<0.05,respectively).Correlation analysis showed that prognosis of chronic osteomyelitis was positively correlated with durations with fever,local tenderness and motion limitation(r=0.506,P<0.05).Conclusion: Duration of general or local symptoms seemed to be major factors related to prognosis of pediatric acute osteomyelitis.Early detection and effective treatment may helpful for better outcomes in these children.