Clinical Characteristics of Acute Osteomyelitis with Adjacent Septic Arthritis in Children
Objective To explore the clinical characteristics of acute osteomyelitis with adjacent septic arthritis in children by comparing with those without septic arthritis.Methods Data of 108 children with acute osteomyelitis from November 2017 to May 2022 at Children's Hospital Affiliated to Shandong University were collected for retrospective analysis.According to the presence or absence of septic arthritis,48 children with osteomyelitis with adjacent septic arthritis were included in the observation group,including 28 boys and 20 girls,aged from 19 days to 12 years.A total of 60 children with acute osteomyelitis without septic arthritis were included in the control group,including 38 boys and 22 girls,aged from 1 month and 9 days to 15 years.All children were treated with antibiotics combined with cortical fenestration drainage,and the observation group was treated with joint drainage at the same time.The gender,age,maximum body temperature at onset,duration of onset,positive rate of bacterial culture,inflammatory indicators,operation times,hospitalization days and complications were compared and analyzed between the two groups.Results There was no statistically significant difference between the observation group and the control group in terms of age,gender,and positive rate of bacterial culture(P＞0.05).The highest body temperature at the onset of the disease in the observation group and the control group was(39.21±0.84)℃ and(39.01±0.84)℃,respectively.The median of white blood cells in the observation group and the control group was 15.95×109/L and 15.79×109/L,respectively.The median of neutrophils in the observation group and the control group was 12.08×109/L and 10.35 ×109/L,respectively.The erythrocyte sedimentation rate in the observation group and the control group was(62.26±25.57)mm/h and(60.49±25.38)mum/h,respectively,and the difference was not statistically significant(P＞0.05).The levels of C-reactive protein in the observation group and control group were(94.29±62.11)mg/L and(64.02±45.25)mg/L,respectively.In the observation group and the control group,the median time of onset was 5 d and 6 d,the median length of hospital stay was 32.5 d and 26.0 d,and the median number of surgeries was 3 and 2 times,respectively.The differences were statistically significant(P＜0.05).In the observation group,there were 2 cases of joint stiffness,2 cases of recurrence,and 2 cases of pathological dislocation of the hip joint.There was 1 case of joint stiffness and 1 case of pathological fracture in the control group,and there was no significant difference between the two groups(P＞0.05).Conclusion Compared with children with acute osteomyelitis without septic arthritis,children with acute osteomyelitis with adjacent septic arthritis present earlier,have higher levels of C-reactive protein,require more surgeries,and have longer hospital stays.Antibiotics combined with cortical fenestration and joint drainage were used for treatment and the overall prognosis was good.
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