Acute hematogenous osteomyelitis of tubular bones in children
Abstract
Background . Acute hematogenous osteomyelitis (AHO) is one of the most serious bones diseases associated with surgical infection. However, many issues of diagnosis and treatment of AHO in children remain unresolved to date, which confirms the importance and relevance of the pathology under study. Objective . To determinate of the most significant diagnostic criteria, identification of the most common localization of the process and assessment of the effectiveness of complex treatment of hematogenous osteomyelitis in children. Materials and methods . A retrospective analysis of the treatment results of 294 patients with AHO who were treated in a tertiary hospital in the Kyrgyz Republic in the period from 2015 to 2022 was carried out. By gender, 198 (66.3 %) were boys, 96 (33.7 %) were girls, the ratio was 2:1. The largest number were children under the age of 2 months – 88 (29.9 %), from 6 to 8 years – 51 (17.3 %), from 3 to 5 years – 49 (16.7 %). Children aged 9–15 years, from 1 year to 2 years, from 2 months to 1 year were less common – 14.6; 12.9 and 8.5 %, respectively. According to the clinical course, the generalized form of AHO was found in 59 (20.1 %), and in 235 (79.9 %) – the focal form. Research results . In children under one year old, lesions of the meta-epiphyseal zone with involvement in the inflammatory process of joints prevailed, in children over 1 year old, lesions of the metadiaphyseal zone prevailed. Of these, 74.8 % of patients were hospitalized more than 2 weeks after the onset of the disease, which explains the predominant extramedullary lesions. All patients received comprehensive treatment, including surgical intervention according to indications,systemic antibacterial and symptomatic therapy. Fatal outcome was observed in 1 (0.3 %) case in a patient with a generalized form, and in 12 (4,0 %) cases – chronization of the process. Conclusion . In the early diagnosis of AHO in the intramedullary phase, magnetic resonance imaging plays a special role in determining areas of pathological hydration, and computed tomography plays a special role in assessing cortical bone. Dynamic control of procalcitonin and C-reactive protein levels, along with the determination of the number of leukocytes and the absolute number of neutrophils, are markers of systemic infectious and inflammatory reactions that determine the outcome of treatment in patients with AHO.