Pseudomonas Osteomyelitis of the Foot Following Puncture Wound Cases Report and Literature Review

足部穿刺傷造成之綠膿桿菌性骨髓炎兩病例報告及文獻回顧

趙英豪(Yin-Hao Chao) ； 楊振(Cheng Yang) ； 方嘉良(Chia-Liang Fang) ； 許文明(Wen-Ming Hsu)

《中華民國重建整形外科醫學會雜誌》 7卷4期 (1998/12) Pp. 331-336

https://doi.org/10.7096/JPRSA.199812.0331

摘要

足部鐵釘穿刺傷在鄉下地區相當普遍，可是通常沒有接受完整適當的治療。此類病患初期常會有足部蜂窩組織炎症狀，在接受短期間口服抗生素治療之後，大部分病患可以稍微緩解，但有些足部仍會腫脹而造成跛行。於幾個星期過後，一般可由足部放射學檢查及骨骼掃瞄來診斷出骨髓炎。早期澈底的外科清創及給予適當的抗生素治療對於預後更是特別重要。
本文報告兩例因為足部鐵釘穿刺傷，造成綠膿桿菌性骨髓炎的病例以及回顧文獻。並且強調以下幾點：1．外科醫師面對病患足部遭鐵釘刺傷時必須考慮其造成綠膿桿菌性骨髓炎之可能性 2．應於門診密切觀察及必要時住院治療 3．足部放射學檢查及骨骼掃瞄可以確定診斷 4．對於確定骨髓炎者應儘快施行外科清創，並依細菌培養給予適當（七至十二天）靜脈抗生素治療。

並列摘要

Puncture wounds of the foot are an universal problem, that frequently occur to country-born people. Patients suffering this kind of injury usually received an inadequate evaluation and management. For instance, patients usually experienced foot cellulitis without an open wound. The symptoms were relieved after short period of empiric antibiotic therapy. The pain and the swelling of the punctured foot persisted several weeks later, osteomyelitis was suspected and confirmed by bone scan. Thorough surgical debridement and antibiotics therapy according to the tissue culture should be given. Two cases regarding pseudomonas osteomyelitis result from puncture wounds of their foot are presented and literatures were reviewed also. Several points are emphasized from the medical aspects: 1). The surgeon should realize that the punctured foot may develop pseudomonas osteomyelitis. 2) Close follow up in clinics or even hospitalization if necessary. 3) Diagnosis may confirmed by roentgenorgram and the bone scans. 4) Prompt surgical debridement, bone tissue culture and 7~12 days parenteral antibiotic therapy is indicated.

並列關鍵字

osteomyelitis ； nail injury