chronic suppurative osteomyelitis
Introduction
Introduction to chronic suppurative osteomyelitis Chronic suppurative osteomyelitis is a continuation of acute suppurative osteomyelitis. The general symptoms are limited to local, often stubborn and difficult to treat, and even can not be cured in years or decades. For the treatment of chronic suppurative osteomyelitis, surgery and drug combination therapy are generally used to improve the general condition, control infection and surgical treatment. Due to serious illness and prolonged bed rest, especially after a blood-borne acute attack, it is extremely necessary to improve the general condition. In addition to the use of antibacterial agents to control infection, nutrition should be promoted, if necessary, blood transfusion, surgical drainage and other treatment. basic knowledge The proportion of illness: 0.3% Susceptible people: no special people Mode of infection: non-infectious Complications: anemia, fracture, nonunion, septic arthritis, arachnoiditis
Cause
Causes of chronic suppurative osteomyelitis
Reduced resistance (35%)
Disease treatment is not timely or incomplete, once the body's resistance is low, inflammatory suppuration can still develop, and then cause an acute attack. The lesion can be prolonged for several years, dozens of years or even decades, local extensive scar tissue and sinus formation, poor circulation, which is conducive to bacterial growth, and antibiotics can not be achieved. The local sinus is pus, when it is good or bad, the sinus does not heal for a long time.
Disease factor (25%)
Chronic suppurative osteomyelitis is a treatment of acute osteomyelitis that is not timely or incomplete, resulting in poor drainage, a large number of dead bones formed in the body, leaving infected lesions in the bone.
Trauma (15%)
Comminuted fractures or severe trauma caused foreign bodies to enter the body and failed to be removed in time, resulting in the formation of dead bodies, dead bodies or shrapnel and other foreign bodies and dead space.
Prevention
Chronic suppurative osteomyelitis prevention
(1) Early application of antibiotics after trauma
The main purpose of systemic antibiotics is to prevent the spread of infection and sepsis, and early topical medication has a positive effect on preventing wound infection. There are reports that during the Second World War, Japanese soldiers who attacked Pearl Harbor had a very high infection rate after injury. Low, the reason is that debridement and topical application of sulfa drugs in a timely manner; in the Vietnam War, there are statistics showing that the total traumatic infection rate is 40%, and the wounded in the local spraying 100mg oxytetracycline in time after injury, infection The rate is only 17%. Experimental studies have also shown that in the wounds that have been polluted, the application of oxytetracycline within 5 minutes after the injury is much more effective than the prevention of infection after 4 hours or 4 hours. Before the firearm wounds are wounded, the antibiotics should be applied as early as possible. Some people advocate the use of kanamycin, gentamicin, tobramycin and other aminoglycoside antibiotics.
(2) Points for attention in debridement
Should strive for early thorough debridement, if antibiotics are applied early, no obvious signs of infection should be debrided for 24 to 48 hours. Infected wounds should only be drained, and clear foreign bodies and necrotic tissues should be removed by simple methods. Etc., the characteristics of firearm injuries should be taken into account during surgery. You should not only see the primary injury, you should enlarge the incision, fully remove the primary injury and surrounding tissue depression area, and try to remove foreign objects when possible. As far as possible reset, large bone fragments should not be taken out, fractures should not be fixed in a period, completely stop bleeding, repair large blood vessel damage, tendon nerve injury can be repaired in the second phase, because it is difficult to thoroughly debride in the field conditions, wounds Generally, no suture is performed for one period. The first-stage suture or the second-stage suture can be postponed as appropriate. The first-stage suture is delayed for 4 to 7 days after the injury. The wound has no infection, and the local smear is not sutured before the granulation tissue is proliferated. It has the advantages of one-stage suture, and it is safer. It also pays attention to personal hygiene, taking a bath and preventing skin scabs.
Complication
Chronic suppurative osteomyelitis complications Complications anemia fracture nonunion septic arthritis arachnoiditis
Complications of chronic suppurative osteomyelitis include systemic complications and local complications.
Systemic complications
(1) anemia, hypoproteinemia, chronic suppurative osteomyelitis, prolonged course, long-term repeated acute attacks, low fever and discharge of purulent discharge in the sinus, chronic consumptive damage to the whole body, anemia and hypoproteinemia are chronic Common complications of 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, Correction of anemia and treatment of low protein disease in the treatment of chronic suppurative osteomyelitis is very important.
(2) Systemic amyloidosis amyloidosis is pathologically degenerative, species, systemic and localized, systemic amyloidosis complicated by long-term recurrent purulent inflammation such as chronic suppurative osteomyelitis Pathology is the intercellular space of the whole body organs, the deposition of amyloid on the vascular basement membrane, and the sediment is actually a kind of proteinaceous substance, but it has the property of iodine and blue, and the diseased organs often occur seriously. Functional damage, fortunately, the disease is rare in China.
Local complications
(1) Pathological fractures When the bone destruction is severe 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 fracturea 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) Non-continuous pathological fractures are not treated promptly and correctly, and nonunion can occur. In addition, surgery should be performed before the bone crust is fully formed, and large bones can be removed, which can also cause bone defects or bone. If the local blood circulation is poor, the destruction of the diseased bone is still going on. This fracture is healed and difficult to form. It will form a pseudo joint in a long time, making the whole treatment more complicated and difficult. There are two kinds of pseudo joints, the other is The contact type is a large bone defect type, and the latter is more difficult to treat.
(3) septic arthritis metaphyseal suppurative osteomyelitis, abscess can enter the joint cavity and septic arthritis through two ways, is through the vascular communication branch of the epiphyseal, the abscess penetrates the articular cartilage directly into the joint, forming a suppuration Arthritis, this condition is more common in infants and adults with suppurative osteomyelitis. In another case, when the metaphysis is located in the joint capsule (such as the femoral neck is located in the hip capsule), the abscess can be worn and broken. The cortical bone enters the joint, and the pus in the joint destroys the articular cartilage, invading the subchondral bone, seriously affecting the joint function, and even completely stiff.
(4) spinal or cauda equina compression of suppurative spondylitis, especially the vertebral arch, after laminar destruction, abscess, necrotic tissue and new fibrous tissue can compress the spinal cord or cauda equina nerve causing paraplegia or nerve root compression, this situation is more Found in the cervical and thoracic spine, infection can also affect the arachnoid caused by arachnoid.
(5) malignant chronic septic osteomyelitis malignant transformation is more common in the elderly, commonly seen in middle-aged and elderly men.
Symptom
Chronic suppurative myeloinflammation symptoms Common symptoms Muscular atrophy Joint contracture Bone marrow damage Dead bone
Clinically, when entering the chronic inflammatory phase, there is local swelling, thickening of the bone, rough surface, tenderness. If there is sinus, the wound is not healed for a long time, occasionally a small piece of dead bone is discharged, sometimes the wound is temporarily healed, but due to the infection Lesions, inflammation spread, can cause acute attacks, systemic chills and fever, local redness, after incision and drainage, or self-piercing, or drug control, systemic symptoms disappear, local inflammation also gradually subsides, wound healing, so recurrent When the whole body is poor, it is easy to cause seizures. Due to repeated attacks of inflammation, multiple sinus tracts have great influence on limb function and muscle atrophy. If pathological fracture occurs, limb shortening or angular deformity may occur; Close to the joints, more joint contracture or stiffness.
Examine
Chronic suppurative osteomyelitis
The auxiliary examination of this disease mainly relies on X-ray examination, which can be confirmed according to the clinical manifestations of patients and the results of X-ray examination.
X-ray performance: X-ray photos can show dead bones and a large number of dense new bone formation, sometimes with cavities, such as war wounds, there may be shrapnel, Browder's abscess X-ray picture shows long bones In the sparse area, the bone around the abscess is dense, and the bone of the Gary's osteomyelitis is generally thicker and thicker, with no obvious dead bones, and the marrow cavity disappears.
Diagnosis
Diagnosis and diagnosis of chronic suppurative osteomyelitis
diagnosis
History
Pay attention to the cause and process of the disease, whether there is broken bone piece discharged from the sinus, whether there is a history of repeated ulceration and pus, and understand the time and course of the last attack and what kind of treatment.
2. Physical examination
Pay attention to the presence or absence of limb deformity, joint contracture and dysfunction, pay attention to the presence or absence of sinus and its number, location, secretion properties, surrounding scars, and acute inflammation.
3. Laboratory test
Wound secretions should be smear and bacterial culture, and antibiotic sensitivity should be determined.
4. X-ray inspection
X-ray of the lateral side of the affected area, if necessary, CT or tomography can be used to identify the location of the dead bone and the cavity. If there is a sinus, sinus angiography should be performed to understand the direction, extent and depth of the sinus. .
The disease mainly needs to be differentiated from joint tuberculosis and other non-infectious arthritis. The incidence of joint tuberculosis is slow, the course of disease is long, local symptoms and dysfunction are not as good as suppuration, and the diseased joint bone is often marginal small defect, and often symmetrical. There is obvious osteoporosis, the joint space is slowly narrowed, the bone hyperplasia is not as serious as suppuration, the late bone end can be severely damaged, the joint is subluxated or dislocated, and the bony ankylosis rarely occurs.
Other non-infectious arthritis (such as rheumatoid arthritis, rheumatoid arthritis, etc.) are more common in adults or young people, and most of them lack acute course and severe bone destruction. Laboratory tests can assist in the identification of intra-articular joints. Puncture and liquid sampling can quickly make a correct diagnosis.
