suppurative osteomyelitis
Introduction
Introduction to suppurative osteomyelitis Suppurative osteomyelitis refers to bone marrow inflammation caused by various infection factors, and is divided into acute and chronic by the length of the disease. Acute osteomyelitis is mainly caused by bone resorption and destruction. Chronic osteomyelitis is mainly composed of dead bone formation and new bone formation. The pathogens are mainly Staphylococcus aureus, followed by Streptococcus B, Staphylococcus aureus, and occasionally Escherichia coli, pneumococcal, Pseudomonas aeruginosa, Haemophilus influenzae and the like. The route of infection is bloody, invasive and traumatic. Blood-borne pathogens infect the bone from distant lesions through the blood, occur in the metaphysis of the long tubular bone, form an abscess, form a subperiosteal abscess through the cortical bone, and enter the medullary cavity through the Haval's tube, blocking the blood. Transport, forming a dead bone. basic knowledge The proportion of illness: 0.003% Susceptible people: good for children Mode of infection: non-infectious Complications: anemia, fracture
Cause
Cause of suppurative osteomyelitis
Pathogenic bacteria infection (36%):
Hemolytic Staphylococcus aureus is the most common pathogen, and Streptococcus B is the second. Generally, the pathogenic bacteria are infected by the skin or mucous membrane, and enter the blood circulation when the primary tumor is improperly treated or the body's resistance is decreased. The bacillary dysentery is blocked by the capillaries of the long bone metaphysis, where it deposits and causes infection.
Local trauma (25%):
Local trauma can be an inducement. Direct infection, open fracture caused by firearm wounds or other trauma, wound contamination, infection without timely and thorough debridement, that is, traumatic osteomyelitis. When the bones and joints are masters, the aseptic operation is not strict, and it can also cause purulent infection.
Prevention
Suppurative osteomyelitis prevention
Firearm injuries cause damage and contamination of soft tissues and bones, and the possibility of infection is high. Therefore, after trauma, it is necessary to timely debride and prevent infection, enhance the body's resistance, and make open fractures into closed fractures. Replace the wound, maintain drainage, enhance the body's resistance and use antibacterial drugs to prevent infection. For open fractures caused by trauma, it must be thoroughly debrided, and the wounds should not be sutured for drainage.
For non-firearm fractures, if debridement can be performed in time, the wound should be sutured, and the drainage strip should be placed for 48 hours, and the wound should be healed in one stage to make the fracture become closed. If the infection has occurred, the wound should be enlarged as soon as possible to facilitate drainage and to strengthen systemic supportive therapy and anti-infective treatment.
There is also a focus on personal hygiene and bathing to prevent the occurrence of skin scabs.
Complication
Suppurative osteomyelitis complications Complications anemia fracture
Complications of suppurative osteomyelitis include systemic complications and local complications.
First, systemic complications
(1) Anemia, hypoproteinemia: prolonged course of chronic suppurative osteomyelitis, long-term repeated acute attacks, low fever and discharge of purulent secretions in the sinus, chronic consumptive damage to the whole body, anemia and hypoproteinemia Common complications of chronic suppurative osteomyelitis, the existence of these complications, can not reduce the systemic and local disease resistance, and add a disadvantage to the treatment of chronic suppurative osteomyelitis, thus forming a vicious circle, therefore, Correcting anemia and treating low protein disease in the treatment of chronic suppurative osteomyelitis is very important.
(B) systemic amyloidosis: amyloidosis is a pathological tissue degeneration, divided into systemic and localized two, systemic amyloidosis complicated by long-term recurrent purulent like chronic suppurative osteomyelitis Inflammation, pathology is the intercellular space of the whole body organs, the deposition of amyloid on the vascular basement membrane. The sediment is actually a protein substance, but it has the property of iodine and blue, and the diseased organs often occur seriously. The damage to the function, fortunately, the disease is rare in our country.
Second, local complications
(1) Pathological fracture: When the bone destruction is serious and extensive, and the bone capsule has not yet formed, or the bone capsule is not strong, even under a slight external force, even a slight external force can cause a fracture--a pathological fracture. Therefore, during this period, the affected limb should be braked and fixed with plaster or traction to prevent the occurrence of pathological fracture. After the bone capsule is completely formed and firm, it can be removed and fixed.
(2) Nonunion: After the pathological fracture occurs, the correct treatment is not performed in time, and nonunion can occur. In addition, the surgery should be performed before the bone crust is completely formed, and the large dead bone can be removed, which can also cause bone defect or The bones are not connected. Due to the poor local blood circulation, the destruction of the diseased bone is still going on. This fracture healing is very difficult and will form a pseudo joint for a long time.
Symptom
Suppurative myeloinflammation symptoms Common symptoms High heat and severe pain, body discomfort, cold, fatigue, abscess, weight loss, nausea, night sweats, urinary redness
Acute osteomyelitis
Age and location: more common in children, the most common in the upper part of the humerus and the lower part of the femur.
There is often a history of trauma before the onset of the disease, but the primary infection is rarely found.
The onset is rapid.
Symptoms of systemic poisoning are severe: chills, high fever to over 39oC, with obvious symptoms of toxemia.
Local symptoms:
1. Early: severe pain in the affected area, local skin temperature increased, limited tenderness, swelling is not obvious.
2. Late stage: local edema, tenderness is more obvious that subperiosteal abscess has formed here. The pain is relieved in the future, and the abscess becomes a deep abscess of the soft tissue after being worn, but it is partially red.
Swelling, heat, and tenderness are more obvious. Each joint may have a reactive effusion. If it is spread to the medullary cavity, the symptoms are more serious, and after the bone destruction of the entire backbone, pathological fractures may occur.
3. The natural course of acute osteomyelitis can be maintained for 3 to 4 weeks. After the abscess, the sinus is formed, the pain is relieved, the body temperature gradually decreases, and the lesion is transferred to the chronic stage.
4. Part of the low-toxic infection, the performance is atypical, the signs are lighter, and the diagnosis is more difficult.
Chronic osteomyelitis
1. Systemic manifestations: The stage of inactive disease can be asymptomatic, and the body temperature can rise by 1~2 °C during the onset of acute infection. Acute attacks occur for several months and several years, and can be induced due to poor physical fitness or low body resistance.
2. Local manifestation: The bone loses its original shape, the bone is twisted and deformed, thickened, the skin is pigmented, there are many scars, and a slight damage can cause ulcers that have not healed for a long time. Due to muscle contracture, adjacent joint deformity, local sinus ostium, long-term non-healing, local redness, clinical manifestations of swelling, heat, pain during the onset of acute infection, the sinus ostium that has been occluded can be opened, discharge a lot of pus, fall out The back of the bone is closed. The skin of the sinus can be cancerous. Children may affect bone development due to destruction of the epiphysis, occasionally pathological fractures.
3. Radiological changes: early worm-like bone destruction and sparse bone, and hardened areas appear. There is a layered periosteal reaction, the new bone gradually becomes thicker and denser, and the necrotic shedding becomes a dead bone. The dead bone on the X-ray film showed a completely isolated bone piece, no bone trabecular structure, dense white, irregular edges, and gaps around. The CT piece can show the abscess and small dead bone. In some cases, the abscess can be seen by sinus catheterization.
Examine
Examination of suppurative osteomyelitis
Clinical examination can be seen:
1, white blood cell count increased, above 10 × 10 / L, neutrophils can account for more than 90%.
2. Blood culture results and drug susceptibility experiments.
3, local abscess stratified puncture.
4, X-ray examination: difficult to display 1cm bone abscess. There is no obvious change in the early stage of acute blood-borne osteomyelitis. There may be decalcification, destruction, a small amount of periosteal hyperplasia, and soft tissue swelling shadows around 3 weeks after onset.
5, CT examination: subperiosteal abscess can be found in advance.
6. There was a positive result 48 hours after the onset of radionuclide bone imaging.
7, laboratory tests: in acute blood-borne osteomyelitis, the early blood culture positive rate is higher, local pus culture has purulent bacteria, should be used for bacterial culture and drug sensitivity test, in order to timely select effective drugs, blood tests for white blood cells and Neutral multinucleated white blood cells are increased, generally anemia, blood myelitis should be diagnosed as soon as possible, in order to timely treatment, early diagnosis is mainly based on clinical manifestations and blood culture, if necessary, local puncture to extract pus for bacterial culture, trauma caused by bone marrow Inflammation can be diagnosed based on the history of trauma and local symptoms.
Diagnosis
Diagnosis and differentiation of suppurative osteomyelitis
Diagnosis of acute suppurative osteomyelitis
1. Rapid hyperthermia and toxemia performance.
2. The long bones are painful and do not want to move the limbs.
3. There is an obvious tenderness area in the area.
4. White blood cell count and neutrophil increase.
5. Local stratified puncture.
6. Etiology diagnosis: Obtain pathogenic bacteria, that is, blood culture and stratified puncture culture positive. A clear diagnosis and appropriate treatment should be made early in the onset of illness to avoid the development of chronic osteomyelitis.
Differential diagnosis
1. Cellulitis:
(1) Systemic symptoms are different.
(2) The parts are different.
(3) Signs are not the same, part of the identification is difficult, small incision drainage, osteomyelitis can be found subperiosteal abscess.
2. Rheumatism and septic arthritis: all joint diseases, pain in the joints, superficial joints can quickly appear swelling and effusion.
3. Osteosarcoma and Ewing's sarcoma: The onset is slow, mostly with the backbone, especially the Ewing's tumor. It does not interfere with the adjacent joint activity in the early stage. The surface has varicose blood vessels and can touch the mass. It is difficult to identify a feasible biopsy.
Diagnosis of chronic osteomyelitis
According to the medical history and clinical manifestations, especially those with sinus and sinus passages, it is easy to diagnose. X-ray films can confirm the presence or absence of dead bones and understand the shape, quantity, size and location. And the growth of the surrounding cladding. Generally no CT examination is required.
