Vuslat Sema ÜNAL, Avni DAYICAN, Murat DEMİREL, Süleyman PORTAKAL, Güray ÖZKAN, Ahmet UÇANER

Kronik osteomiyelitli çocuklarda cerrahi tedavi yöntemlerinin seçimi

Amaç: Kronik osteomiyelit tanısıyla tedavi edilen çocuk hastalarda klinik ve izlem bulguları ve tedavi yöntemleri değerlendirildi. Çalışma planı: Çalışmaya kronik osteomiyelit nedeniyle tedavi edilen 22 çocuk hasta (14 erkek, 8 kız; ort. yaş 8±7) alındı. Enfeksiyon bölgeleri 11 hastada femur, sekiz hastada tibia, bir hastada ulna, iki hastada radiustu. On altı hastada geçirilmiş travma öyküsü, 14 hastada patolojik kırık, bunların da dokuzunda segmenter kemik kaybı vardı. Tüm olgulara en az bir kez debridman uygulandı ve en az altı hafta olmak üzere antibiyotik tedavisi verildi. Gerektiğinde antibiyogram sonuçlarına göre ilaçlar değiştirildi. İmmobilizasyon alçıyla sağlandı; ancak, kemik instabilitesi varlığında eksternal fiksasyon yapıldı. Ortalama takip süresi 54 ay idi. Sonuçlar: On üç hastada debridman işlemleri, altı haftalık antibiyotik tedavisi, ek greftleme (5 hasta) ve immobilizasyon ile klinik iyileşme sağlandı. Segmenter kemik kaybı olan dokuz hastanın yedisinde kemik rekonstrüksiyonu işlemlerine gerek duyuldu. Ulnar osteomiyeliti olan bir olguda kendiliğinden cisim rejenerasyonu gözlendi. Çıkarımlar: Çocuk kronik osteomiyelitlerinin yarısından çoğu debridman ve antibiyotik tedavisiyle tedavi edilebilir. Bununla birlikte, debridman sonrası segmenter kemik kaybı görülen hastalarda kemik rekonstrüksiyonu işlemleri gerekir.

Anahtar Kelimeler:

Osteomiyelit, Debridman, Mikrobiyoloji, Çocuk

Selection of treatment modalities in children with chronic osteomyelitis

Objectives: We evaluated clinical and follow-up findings and treatment methods of pediatric patients with chronic osteomyelitis. Methods: The study included 22 children (14 boys, 8 girls; mean age 8±7 years) who were treated for chronic osteomyelitis. Infection sites were the femur, tibia, ulna, and radius in 11, 8, 1, and 2 patients, respectively. Sixteen patients had a history of trauma. Fourteen patients had fractures, nine of which were associated with segmentary bone defects. All the patients underwent at least one debridement and received antibiotic treatment for at least six weeks. When necessary, medications were modified according to the antibiogram results. Cast immobilization was applied, but external fixation was used when bone instability existed. The mean follow-up period was 54 months. Results: Clinical improvement was achieved in 13 patients following surgical debridement procedures, antibiotic treatment for six weeks, secondary grafting (5 patients), and cast immobilization. Of nine patients with segmentary bone losses, seven patients needed bone reconstruction procedures. Spontaneous shaft regeneration was observed in one patient with ulnar osteomyelitis. Conclusion: The results of surgical debridement and antibiotic treatment are satisfactory in more than half of the pediatric patients with chronic osteomyelitis. However, those developing segmentary bone defects after surgical debridement require bone reconstruction procedures.

Keywords:

Osteomyelitis, Debridement, Microbiology, Child,

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