chronic osteomyelitis foci resection

Chronic osteomyelitis resection is used for the surgical treatment of chronic osteomyelitis. Surgical treatment of chronic osteomyelitis includes two types, one is acute exacerbation of chronic osteomyelitis and abscess formation, and incision and drainage. The other is a thorough treatment of chronic osteomyelitis, which should include the following parts: 1. Resection of the sacral and bone scars. 2. Complete removal of granulation tissue and dead bone in the destruction area of osteomyelitis. 3. Removal of the hardened bone in the medullary cavity and opening of the medullary cavity. 4. Fill the bone cavity to remove the inflammatory zone. 5. Soft tissue coverage with good blood flow. The purpose of this operation is to remove osteomyelitis granules, dead bones and hardened bones, fill the bone dead space and cover the tissue defects with blood-stained tissue, improve blood supply, heal and cure osteomyelitis. Surgical removal of the lesion must be combined with limb fixation, effective antibiotics and systemic support therapy to improve patient resistance. Treatment of diseases: chronic osteomyelitis in children with chronic osteomyelitis Indication 1. Chronic osteomyelitis with dead bones and fistulas, long-term unhealed. 2. Chronic osteomyelitis, although there is no sacral or sacral closure, but often repeated acute authors. 3. Chronic sclerosing osteomyelitis, although there is no sputum, but often acute attacks, fever pain, chronic pain in the affected limbs. Contraindications In the acute exacerbation of chronic osteomyelitis, only incision and drainage are performed, which is not suitable for lesion removal. Preoperative preparation 1. Systemic preparations include: Strengthening nutrition and increasing resistance to malnourished people. If the hemoglobin is below 100g/L, blood transfusion should be performed to achieve hemoglobin of 100g/L or more. 2, the results of bacterial culture of the sputum do not necessarily represent the bone-infected bacteria, and the results of the cultures taken from the bone lesions are not always consistent, indicating that the sacral can have mixed infection, and the results are only for reference before surgery. Bacterial culture of bone lesions during surgery is the basis for postoperative medication. 3, there should be clear local X-ray film, CT before surgery to reveal the extent of the lesion and the dead bone. For lesions with deep parts, sacral angiography should be performed to observe the sacral tract and the site of arrival. 4, the preoperative plan should include: 1 incision selection. 2 lesion clearance range. 3 Fill the bone cavity with muscle tissue. 4 skin coverage. Surgical procedure Incision Incision selection should pay attention to the following factors: 1 sacral and scar sites, it is best to remove. 2 The exposure should be sufficient to completely remove the lesion. 3 Incision with appropriate tissue (muscle) for bone cavity filling. For the upper or lower end of the femur, an external posterior incision can be used. For humeral osteomyelitis, such as the sacral and scar on the medial side, the medial incision is used, otherwise the anterior lateral incision may be used. 2. revealing the lesion After the fistula was removed, the diseased bone was reached through the healthy muscle space, and the total length of the bone lesion on the X-ray film was separated under the periosteum, and the contralateral periosteum was not peeled off. 3. Lesion removal (1) Drilling open bone groove: In the range of scheduled removal of lesions, drill holes at the four corners, and then drill several holes along the front and rear sides. The hole spacing cannot be >2cm to prevent splitting when chiseling, use bone cutting or air saw Saw open, remove the cortical bone, and make a bone groove. (2) removal of lesions: in the bone groove with bone knife, goose chisel, round chisel and curette to remove the lesions in the medullary cavity, including dead bones, granulation, hardened bone, etc., all inflammatory tissues in the medullary cavity need to be removed However, in general, the cortical bone has little residual inflammatory tissue, and the upper and lower ends of the scraping area should be to the normal medullary cavity or cancellous bone. For smaller lesions, there is no need to remove the open bone groove, but the direct disc-shaped chiseling, the operation should pay attention to the chiseling part within 1/2 of the diameter of the backbone, more than 1/2 of the fracture Danger, external fixation is required after surgery. 4. Bone cavity treatment After the lesion is removed, the bone cavity is generally filled with tissue, and then the incision is closed. The treatment without filling is as follows: 1 The wound is open, and the dressing is healed. This is only used for small lesions and superficial findings. For large lesions, completely remove and make a good bone groove, generally not applicable. 2 antibiotic blood clot filling, that is, intraoperative intravenous antibiotics, so that the blood in the bone cavity contains antibiotics. Close the incision. This method is not as reliable as the muscle flap filling method. complication The main complication of lesion removal is local infection and even sepsis. The removal of lesions from chronic osteomyelitis, although it is possible to completely remove the lesions, can not rule out the presence of pathogenic bacteria. Mainly emphasize the following points: 1 The bone cavity is filled with blood-rich muscles, leaving no dead space and improving blood supply in the bone cavity. 2 External use of bone tissue covered with healthy tissue. 3 Apply effective antibiotics to maintain effective concentration. 4 local drainage or irrigation drainage. 5 limbs fixed. 6 systemic support therapy enhances resistance. After the above measures, most of the chronic osteomyelitis lesions can be cured after being cleared. However, if it is limited to the general condition or local conditions of the patient, or if the treatment is inappropriate and the wound is infected, the wound should be opened to control inflammation.