suppurative cranial osteomyelitis
Introduction
Introduction to suppurative skull osteomyelitis Suppurative skull osteomyelitis mostly comes from direct infection, such as open skull fracture, craniotomy or skull drilling, infection after skull traction, as well as radiotherapy, skin graft failure, etc., causing the skull to be exposed and infected. Skull osteomyelitis can occur in any part of the skull, but the forehead and parietal bone are the most common. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: meningitis, brain abscess, epilepsy, hydrocephalus, hydrocephalus, skull defect
Cause
Causes of suppurative skull osteomyelitis
(1) Causes of the disease
Suppurative skull osteomyelitis is a non-specific inflammatory reaction caused by pathogenic bacteria invading the skull through various ways. Staphylococcus aureus, streptococcus, and Escherichia coli are common. Others include Pseudomonas aeruginosa and Staphylococcus aureus. , anaerobic bacteria, etc., there are also a variety of pathogenic bacteria mixed infection, often due to head and face bloated, paranasal sinusitis, oropharyngeal inflammation and other parts of the body and head wounds purulent infection, bacterial Spread and blood spread to invade the skull, and then enter the barrier to form thrombus and suppuration through the guiding vein, blocking the blood supply of the inner and outer plates and the barrier. The further development of inflammation causes the pressure inside the barrier to increase and expand to the surrounding, causing the bone plate to collapse and collapse. The formation of dead bone, so that the inflammation spread to the subperiosteal and intracranial, causing inflammation under the scalp, further development of abscess formation, formation of chronic sinus after rupture and intracranial invasion caused by intracranial complications, but the most clinical reasons It is caused by incomplete debridement after cranial open injury and contamination of the wound during or after craniotomy.
(two) pathogenesis
Morphologically, it can be divided into two types: destructive and proliferative, fulminant and localized. The local scalp is swollen, the scalp abscess and the chronic sinus are fluctuating, and there are single or adjacent areas. There are multiple skull defects of different shapes and sizes. Among them, there are free broken bone fragments, and the skull is also unevenly deformed by insects. The lesion skull is grayish yellow, dull, soft and contains pus, sinus There are a lot of yellow sticky pus in the tract and the epidural, granulation tissue hyperplasia and dural thickening and embrittlement. Under the microscope, there are a lot of puncture exudation and leukocyte infiltration in the diseased tissue, fibrous connective tissue and vascular proliferation, trabecular bone destruction. The normal structure is ambiguous.
Prevention
Suppurative skull osteomyelitis prevention
For infectious diseases, early debridement and effective antibiotic treatment can help prevent suppurative skull osteomyelitis.
Complication
Suppurative skull osteomyelitis complications Complications meningitis brain abscess epilepsy hydrocephalus hydrocephalus skull defect
The most common complications of suppurative cranial osteomyelitis are purulent meningitis, epidural or subabdominal abscess and brain abscess. The symptoms, signs and treatments have been described above. These complications are life-threatening, even if they are positive. Treatment and rescued life, but still have some nervous system dysfunction after surgery, such as mental retardation, limb paralysis and seizures, hydrocephalus and other sequelae, but simple suppurative skull osteomyelitis such as timely treatment, in addition to postoperative In addition to the skull defect, other sequelae rarely occur.
Symptom
Suppurative skull osteomyelitis symptoms common symptoms leukocytosis high fever fatigue drowsiness heat coma low fever convulsion wound infection
Skull osteomyelitis can occur in any part of the skull, but the amount of the skull is the most common, the top bone is the most common, the onset is acute and slow, the acute phase is mostly caused by pathogenic bacteria with strong virulence, can be violent, The onset is rapid, the patient suddenly has a high fever and chill, the body temperature can be as high as 40 °C, the symptoms of systemic poisoning are serious, such as apathetic, sore body, fatigue, lethargy, increased white blood cells in peripheral blood, of which polymorphonuclear leukocytes account for more than 90%, and At the same time, the local skull has an inflammatory infiltration, and the corresponding scalp can be characterized by redness, swelling and heat pain, and then there is a fluent subarachnoid abscess. After the ulceration, it often forms a thick or thin yellow, gray, green, etc. The pus and small dead bones enter the sinus tract that has been recurring for a long time and gradually turn into a chronic process. After the pathogenic bacteria with weak virulence invade the skull, the systemic and local reactions of the patients are lighter. Chronic development process, can show low fever, moderately elevated white blood cells in peripheral blood, mainly neutral polymorphonuclear cells, local scalp with moderate redness and heat pain, and gradually developed into fluctuations The abscess forms a chronic sinus after its rupture. In patients with head trauma and craniocerebral surgery, the wound infection spreads, causing inflammation of the skull, and the lesion develops further. The wound collapses and pus forms a chronic sinus. This disease is usually seen after the formation of sub-abdominal abscess or sinus, usually more than one month after onset, even months and years, if the inflammation can not be controlled in time, you can wear the dura mater to the intracranial expansion Delayed, causing intracranial complications, according to the literature reported that about 30%, mainly brain abscess, the rest of the epidural and subdural abscess and meningitis, may be caused by the location, extent and severity of the invasion Different symptoms and signs of the nervous system, such as headache, vomiting, high fever, convulsions, convulsions, coma, meningeal irritation and increased intracranial pressure, limb paralysis, aphasia and other manifestations, severe cerebral palsy and life-threatening, so should be different The situation is promptly diagnosed and treated.
Examine
Examination of suppurative skull osteomyelitis
Peripheral blood leukocyte counts are increased, generally above 10 × 109 / L, neutrophils can account for more than 90%, pus smear staining can find purulent bacteria, culture can find the growth of purulent bacteria.
In the acute phase of more than 2 weeks, it can be found that there are single or multiple small-sized irregularly low-density bone defects or circles on the X-ray film, or elliptical or map-like, or worm-like low-density areas. About 50% of them have small dead bones or high-density osteosclerosis with obvious reactive bone hyperplasia at the edge of the damaged skull. CT examination can be found earlier than X-ray plain film, showing local skull low Density, also found intracranial complications, such as epidural or lower half-moon high-density foci and round or elliptical border high-density ring, central low-density area, surrounded by low-density edema brain abscess, midline structure Contralateral shift, MRI can not show the skull, but can be found in the epidural, lower and brain parenchyma lesions, CT and MRI can quickly make a diagnosis, is the best non-invasive diagnostic method.
Diagnosis
Diagnosis and diagnosis of suppurative skull osteomyelitis
Diagnostic criteria
The diagnosis of typical skull osteomyelitis is not difficult. In patients with contaminated open brain injury or craniocerebral wounds, the postoperative temperature rises, the peripheral blood seems to have leukocytosis, the wound is red and swollen, or the crack is open. The more he has a head and face bloated or other parts of the body, the suppurative infection increases with the body temperature, accompanied by limited redness and swelling of the head, gradually becoming a volatility of the sub-abdominal abscess, and then rupture and often discharge yellow or Yellow-green sticky pus and small dead bones, supplemented by X-ray film of the skull, CT, MRI, pus smear staining, microscopic examination can find purulent bacteria, can be found in the development of purulent bacteria Combined with medical history, course of disease and clinical manifestations and cranial imaging examination, more can be clearly diagnosed. When inflammation invades the brain and causes purulent meningitis, subdural or external abscess and brain abscess, it can show corresponding neurological symptoms and Signs, such as headache, vomiting, high fever, convulsions, coma, increased intracranial pressure, limb paralysis, etc., cerebrospinal fluid pressure is normal or increased, leukocytosis is polymorphonuclear leukocytes In concurrent purulent meningitis, cerebrospinal fluid pressure can be significantly increased, color turbidity, as many as hundreds or thousands of white blood cells per cubic millimeter, protein is significantly increased, sugar and chloride are reduced, combined with lumbar puncture and imaging examination, mostly A clear diagnosis can be made.
Differential diagnosis
Clinically, it should be differentiated from simple subcutaneous abscess. The pus is mainly under the aponeuric aponeurosis rather than under the periosteum. It should also be differentiated from the skull tuberculosis. The patient has no contact history with tuberculosis patients, and there is no tuberculosis in the whole body. It was found that there was no cheese-like substance in the pus discharged from the sinus, no smear microscopy and animal inoculation were found without tubercle bacilli. If the brain abscess was complicated, it should be differentiated from the tuberculosis. Brain abscess can be displayed on CT and MRI. The circular high-density ring has a low-density area in the center, while the tuberculous spheres show a uniform density of high-density shadows or circles in the circle or ellipse. The lesions can be significantly enhanced after intravenous injection of contrast agents.
