摘要
目的探讨新生儿急性血源性骨髓炎的临床特点及误诊原因、防范措施。方法回顾性分析曾误漏诊的新生儿急性血源性骨髓炎3例的临床资料。结果3例均因患侧肢体活动障碍就诊,其中2例为下肢,1例为上肢;2例伴有发热。3例血白细胞和C反应蛋白均升高,下肢2例入院后行患侧髋关节B超检查示化脓性髋关节炎。曾诊断为患侧化脓性髋关节炎2例,臂丛神经损伤1例。误漏诊时间4~10 d,平均6.5 d。2例经患侧股骨、胫腓骨MRI检查确诊为股骨急性血源性骨髓炎,给予相应治疗病情好转后出院。1例行降钙素原检查示0.33 ng/ml,起病10 d后行X线检查示患侧肱骨骨膜反应,进一步行患侧肱骨分层穿刺抽吸出黄色脓液确诊肱骨急性血源性骨髓炎,予抗感染治疗后病情好转出院。随访1年,2例预后良好;1例转为股骨慢性骨髓炎伴髋关节病理性脱位,现仍在进一步治疗、随访中。结论新生儿急性血源性骨髓炎病初缺乏特异性临床表现,易伴发关节化脓性感染,容易误漏诊。掌握该病临床特点和及时行患肢骨骼MRI检查等是减少或避免其误漏诊的关键。
Objective To investigate clinical characteristics,causes of misdiagnosis and preventive measures of acute hematogenous osteomyelitis(AHO)in neonates.Methods Clinical data of three patients with AHO that was missed or misdiagnosed as other diseases were analyzed retrospectively.Results In this group,all patients presented to our department for dyskinesia of limbs on the affected side,including 2 cases of lower limb and 1 case of upper limb,and 2 patients got fever.Blood leukocytes and C-reactive protein were elevated in 3 cases.B-ultrasound examination of the affected hip joint showed septic arthritis in 2 cases after admission.Two patients had been misdiagnosed as septic arthritis of the affected side,and one patient as brachial plexus injury.The duration of misdiagnosis was 4-10 days(with an average of 6.5 days).MRI scanning of the femur,tibia and fibula on the affected side confirmed AHO in two patients who,therefore,got corresponding treatment.Then,they all recovered and discharged.Another case had 0.33 ng/ml procalcitonin in procalcitonin test.At 10 days after onset,X-ray examination showed periosteal reaction of the humerus.Furthermore,the patient was diagnosed with AHO of humerus by aspiration of yellow pus in the affected humerus after a layered puncture.The patient was discharged after anti-infection treatment.At one-year of follow-up,two patients got favorable prognosis.One patients was converted to chronic osteomyelitis of the femur with pathological dislocation of the hip joint,and is still under treatment and follow-up.Conclusion There is no specific clinical manifestations of AHO in neonatus at the beginning,which is prone to be combined with joint purulent infection,therefore,it is more likely to lead to missed diagnosis or misdiagnosis.To grasp the clinical characteristics of this disease and to perform timely MRI scanning are the key to reducing or avoiding misdiagnosis and missed diagnosis.
作者
李论
徐涛涛
杨佳
LI Lun;XU Tao-tao;YANG Jia(Department of Orthopedics,Kunming Children's Hospital,Kunming 650000,China)
出处
《临床误诊误治》
2021年第1期5-8,共4页
Clinical Misdiagnosis & Mistherapy
基金
昆明市科技计划项目(2019-1-S-25318000001557)。
关键词
骨髓炎
新生儿
误诊
骨关节炎
髋
臂丛神经损伤
Osteomyelitis
Neonatal
Misdiagnosis
Osteoarthritis,hip
Brachial plexus nerve injuries
