Chronic osteomyelitis

Introduction to chronic osteomyelitis Most chronic osteomyelitis is the result of improper or untimely treatment of acute osteomyelitis. However, if the pathogenic bacteria of acute osteomyelitis are low in toxicity or the patient's resistance is strong, it may be subacute or chronic osteomyelitis from the beginning, and osteomyelitis infected by skin wounds is often chronic osteomyelitis from the beginning. . Chronic osteomyelitis pathogens are also mainly suppurative Staphylococcus aureus. There are chronic sinus, often mixed with a variety of bacteria. This disease is good for children with long tube backbone. Most have a history of acute osteomyelitis, a history of open fractures, repeated episodes of acute inflammation or long-term unhealed, recurrent sinus flow and a small piece of dead bone from the sinus. Clinically, it is characterized by sinus drainage, dead bone and dead space, and limb deformation. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: elbow joint rigidity

Causes of chronic osteomyelitis

In the acute phase, after timely and active treatment, most cases can be cured, but many patients still have chronic osteomyelitis. The common causes of chronic osteomyelitis are as follows:

Foreign body lesions (30%):

Due to the formation of dead bone, the larger dead bone can not be absorbed, become a lesion of foreign bodies and bacteria, and there are foreign bodies such as dead bones or shrapnel and the existence of dead space, causing peripheral inflammatory reaction and new bone hyperplasia, forming an envelope, so bone Thickening and rough, such as the formation of sinus, often unhealed years, such as poor drainage, can cause systemic symptoms.

Bacterial infection (30%):

Local extensive scar tissue and sinus formation, poor circulation, conducive to bacterial growth, and antibiotics can not be achieved, the formation of chronic osteomyelitis.

If the virulence of the bacteria is small, or the body's resistance is strong, the abscess is surrounded by the bone, which is a localized intraabdominal abscess, called Brodie abscess, which often occurs at the upper and lower ends of the humerus. Generally, there are no obvious symptoms. Only when the first attack occurs in a few months or years, there is local redness and pain. For example, the bone of the lesion has extensive hyperplasia, the medullary cavity disappears, the circulation is poor, and a solid diffuse bone marrow occurs. Inflammation, called Sclerosing osteomyelitis (Garre), occurs most often in the femur and tibia, with intermittent pain.

Other (30%):

After the symptoms of the acute phase disappeared, the general condition improved, but the lesion continued and turned into a chronic phase. In the acute phase, timely and appropriate treatment, a large number of dead bones formed, forming chronic osteomyelitis.

Chronic osteomyelitis prevention

Specifically, people have to eat and have a diet, have a regular life, but also appropriate physical training, remember:

First, during a cold fever, the body temperature can not exceed 38.5 degrees, at this time as soon as possible to use antibacterial, anti-inflammatory, antipyretic injection intravenous or intramuscular injection, or detoxification, sweating solution, Chinese medicine orally, may be infected with osteomyelitis The bacteria are killed in the bud.

Second, in traumatic fractures, or bruises, or infections after surgery, sores, swollen poisons, such as hemorrhoids and other diseases, must be timely and accurate symptomatic treatment, control the further invasion of bacteria, you can use large The dose of anti-infective, anti-viral, anti-inflammatory drugs intravenously (can also be used with large doses of heat-clearing and detoxifying, cooling blood and blood circulation, detoxification and poisoning Chinese medicine for external use) to cause the virus in the patient's body to be excreted or dissipated early.

Third, in daily life, it can not be excessive fatigue, too tired will cause the body's resistance to decline, immune function is low, at this time bacteria can take advantage of the virtual, leading to osteomyelitis and other diseases.

4. In daily life, if other diseases occur, it is not allowed to abuse or use hormone chemicals for a long time during treatment. If these drugs are used improperly, it is easy to accelerate the hardening of the bone, harden and block the bone marrow cavity, and cause bone cells. Normal metabolic dysfunction, and even cause osteonecrosis.

Chronic osteomyelitis complications Complications elbow joint rigidity

1 Malformation: As the epiphysis is stimulated by inflammation, the affected limb grows excessively and becomes long, or the bone plate is damaged, which affects the development. As a result, the limb is shortened, the side of the epiphyseal plate is damaged, the development is asymmetrical, and the joint is inversion or Eversion deformity; due to soft tissue scar contracture, it can also cause flexion deformity.

2 joint rigidity: As the infection spreads into the joint, the articular cartilage surface is destroyed, making the joint fibrotic or bony.

8 cancer: sinus ostium skin due to continuous stimulation, can be combined with cancer, commonly known as squamous epithelial ulcers.

Chronic myeloinflammatory symptoms Common symptoms Hand acute suppurative infection Skull hyperplasia Low fever bone marrow damage

Generally, after the acute phase, there are still low fever and local swelling and pain, or existing sinus, sometimes healed clinically, but after a few months or even years, suddenly the whole body is hot, the limb is painful, the original sinus is red and swollen, and then Broken, after rest or treatment; the above symptoms subsided, but more still left the sinus, so repeated attacks.

Chronic osteomyelitis

1. Sputum smear examination: bacterial culture and drug sensitivity test.

2.x-ray film: manifested as irregular thickening and hardening of the bone, residual bone resorption area or cavity, which may have dead bones of different sizes; sometimes no bone marrow cavity, small bone cavity and small dead bone Some of the hardened bones cannot be developed, so the actual number is often more than that shown on the photo. In order to clarify the relationship between the dead bone or the bone cavity and the sinus, iodized oil or 12.5% sodium iodide solution can be used as the sinus. Contrast imaging.

3. If the skin is suspected of being malignant, pathological examination should be performed.

Diagnosis and diagnosis of chronic osteomyelitis

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

Differential diagnosis

Osteoid osteoma, sometimes difficult to distinguish from osteomyelitis, osteoid osteoma, X-ray, often occurs in the long bone of the long bone (ie occurs in the center of the upper or lower) X-ray shows a high periosteal reaction and cortical bone Hypertrophy, if carefully observed, it can be seen in the bones of the lesions.

Ewing sarcoma, often difficult to distinguish with osteomyelitis, Ewing sarcoma is located in the bones of the limbs; sometimes there is severe pain, accompanied by fever and local heat; elevated erythrocyte sedimentation; elevated white blood cells; CR positive, inflammatory reaction.

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