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Viêm tủy xương

Các nhân vật của viêm xương tủy cấp tính đường máu (AHO) ở Bắc Mỹ trẻ em đã thay đổi đáng kể trong vài thập kỷ qua. Mặc dù hình ảnh lâm sàng điển hình của viêm xương tủy cấp tính được thành lập ở trẻ em (bệnh tật, mất nước, và chân tay đau đớn sâu sắc) vẫn được nhìn thấy | Pediatric Hematogenous Osteomyelitis New Trends in Presentation Diagnosis and Treatment John P. Dormans MD and Denis S. Drummond MD Abstract The character of acute hematogenous osteomyelitis AHO in North American children has changed significantly during the past several decades. Although the typical clinical picture ofestablished acute osteomyelitis in children illness dehydration and an acutely painful limb is still seen more subtle presentations appear more frequently. Children often present with subacute osteomyelitis. Less common variants include Brodie s abscess subacute epiphyseal osteomyelitis and chronic recurrent multifocal osteomyelitis. Some patients present with a bone lesion that may be confused with other disease entities including neoplasms. Biopsy is often needed to clarify the diagnosis. With the trend toward more invasive procedures in the neonatal intensive care unit neonatal osteomyelitis is also seen more frequently. Advances in imaging technology particularly improvements in technetium bone scanning and the advent of magnetic resonance imaging have contributed to more precise diagnosis and better management of AHO. With the increased concern about medical economics the recent trend toward decreasing the duration of intravenous antibiotic treatment of these infections appears to be appropriate as long as certain criteria are met. Neither surgery nor antibiotics alone will be associated with successful treatment in all cases and this fact may explain the rare but continued morbidity that is still seen in children with AHO. The clinical presentation of acute hematogenous osteomyelitis AHO in children has changed in several ways over the past few decades. Fulminating infection is seen less frequently than before. Instead atypical forms of infection including subacute osteomyelitis are more common and children often present less ill and with less destructive radiologic features than previously described. This may be due to a variety of reasons .