| Epiphyseal osteomyelitis is a kind of infectious disease of the epiphyseal,and usually only be found among the infants and young children.The reason for this case is that there is a vascular channels between the epiphyseal and stem epiphyseal end before epiphyseal plate grow mature,and once epiphyseal plate grow mature,it becomes a defense to block infection spread.The disease would lead to adverse consequences--epiphyseal closed early,bone defect,and joint deformities,body differ long,limb function barrier.At present,different people have different diagnosis and treatment experience in the field of epiphyseal osteomyelitis.The operation method is relatively single.until now,doctors still haven’t got a clear understanding of surgery damage to patients’ epiphysis.The morbidity rate is very high in case that children appear epiphyseal closed early.So it is significant to decrease the deformity rate by summarizing the experiences of surgery and comparing the influence on the prognosis of operation way.Now,the operation methods are mainly epiphyseal and stem epiphyseal reducing the tension,pure washing drainage.Epiphyseal and metaphyseal relaxation technique use electric drill and Kirschner wire to relaxa epiphyseal and metaphyseal by drilling,then put drainage tube inside the joint,continuous irrigation and drainage after the treatment,simple irrigation and drainage technique are not supply for epiphyseal and metaphyseal relaxation technique.It makes certain guiding sense about how to choose operation method in the clinical work,through this study and analysis.Objective:There is analysis for the epiphyseal osteomyelitis of pathological changes and influence on the prognosis of three different treatment by follow-up investigation.Method:The study objects are 2-month to 2-year old children of diagnosing osteomyelitis of Epiphysis and the site of lesion are proximal humeral epiphyseal,femoral head epiphyseal,distal femoral epiphyseal and proximal tibial epiphyseal.Both of them-white blood cells and blood,Creactive of children patient must be higher than normal value,and there were30 children undergone joint incision and drain + epiphysis and metaphyseal drilling reduction surgery(group A),30 children undergone simple incision and drainage(group B),30 children who have not undergone any treatment as(group C).Because of partial follow-up and incomplete data measurement,21 cases of each group,including shoulder joint 8 cases,hip joint 7 cases,knee joint 6 cases.Children were divided to several groups owing to different operation methods on them,and the guys who have no surgery treatment are selected as C group.All the members should be retrospectively analysised and tracked after surgery.The physiological indicators,such as blood routine,erythrocyte sedimentation rate,C-reactive protein,should be examined and recorded at least once a week.If these indicators are normal for three weeks continuously,the check cycle could be adjusted to a month.Then,doctors should focus on X-ray and MRI,and compare the conditions of epiphyseal with before to judge whether further damage or epiphyseal growth is on the way.All the children should be tracked to record the changes about the length of limbs and the recovery of joint function in the next three months,furthermore,limb deformities and recurrent condition should be recorded in the next six months.Through the check and analysis the length of the healthy side and the other,changes in range of motion(ROM)(shoulder,hip,knee),X-ray and MRI imaging changes(destruction range,bone density,surrounding soft tissue).Based on above records of test groups,the effect of different treament on prognosis was analyzed.Result:Children who had joint incision,rinse and drain + epiphysis and metaphyseal drilling seduction surgery,7 ~ 14 days after removed the drainage tube and hospitalized in 14 ~ 25 days.Three months after the treatment: involving the range of shoulder movement for proximal humeral epiphyseal in 8 children: outreach range was 145°~160°,flexion range was93°~113°,extension range was 39°~61°;involving the range of hip joint movement for femoral head epiphysis in 7 children: outreach range was141°~159°,flexion range was 71°~84°,adduction range was 36°~53°;involving the range of knee movement for proximal humeral epiphyseal in 6children were 159°.Six months after the treatment: involving the range of shoulder movement for proximal humeral epiphyseal in 8 children: outreach range was 157°~185°,flexion range was 112°~136°,extension range was71° ~ 91°;involving the range of hip joint movement for femoral head epiphysis in 7 children: outreach range was 109° ~ 142°,flexion range was75°~89°,adduction range was 38°~59°;involving the range of knee movement for proximal humeral epiphyseal in 6 children were 161°.Children who had joint incision,rinse and drain,15~19 days after removed the drainage tube and hospitalized in 26~34.Three months after the treatment: involving the range of shoulder movement for proximal humeral epiphyseal in 8 children: outreach range was 132°~153°,flexion range was89°~111°,extension range was 48°~61°;involving the range of hip joint movement for femoral head epiphysis in 7children: outreach range was101°~116°,flexion range was 69°~85°,adduction range was 31°~49°;involving the range of knee movement for proximal humeral epiphyseal in 6child was 149°.Six months after the treatment: involving the range of shoulder movement for proximal humeral epiphyseal in 8 children: outreach range was 139°~156°,flexion range was 102°~118°,extension range was48° ~ 62°;involving the range of hip joint movement for femoral head epiphysis in 7 children: outreach range was 101°~126°,flexion range was74° ~ 94°,adduction range was 31° ~ 51°;involving the range of knee movement for proximal humeral epiphyseal in 6 children were 153°.Children who have not undergone surgery,and hospitalized in 31~40days.Three months after the treatment: involving the range of shoulder movement for proximal humeral epiphyseal in 8 children: outreach range was132°~142°,flexion range was 68°~91°,extension range was 46°~52°;involving the range of hip joint movement for femoral head epiphysis in 7children: outreach range was 67° ~ 83°,flexion range was 67° ~ 70°,adduction range was 28°~32°;involving the range of knee movement for proximal humeral epiphyseal in 6 children were 143°.Six months after the treatment: involving the range of shoulder movement for proximal humeral epiphyseal in 8 children: outreach range was 134°~156°,flexion range was81°~91°,extension range was 47°~56°;involving the range of hip joint movement for femoral head epiphysis in 7 children: outreach range was 76°~92°,flexion range was 60°~76°,adduction range was 33°~42°;involving the range of knee movement for proximal humeral epiphyseal in 6 children were 148°.Joint incision,rinse and drain + epiphysis and metaphyseal drilling reduction surgery can effectively reduce the metaphyseal tension,fully drained,stimulate metaphyseal,improve and recovery its blood supply,shortening of children’s hospitalized and removed the drainage tube days.Long-term follow-up and clinically import differences are significant.Shoulder,hip and knee joint function recovery are better than children who undergone simple incision and drainage,also are better than children who have not undergone surgery.Conclusion: Children who undergone incision and drain + epiphysis and metaphyseal drilling seduction surgery,their hospitalized and removed the drainage tube days were shorten,can effectively reduce the family economic burden,increase the bed turnover rate.The results of 3 months and 6 months after the treatment,children who undergone incision and drain + epiphysis and metaphyseal drilling reduction surgery had better recovery of each joint’smovement range and imaging restoration than children who undergone simple incision and drainage,also is better than children who have not undergone surgery,can reduce morbidity,improve the quality of life. |
PDF Full Text Request