Osteomyelitis

Introduction to osteomyelitis Osteomyelitis is an infection and destruction of bone caused by aerobic or anaerobic bacteria, mycobacteria and fungi. Osteomyelitis occurs in the vertebrae, the foot of a diabetic patient or a penetrating bone injury caused by trauma or surgery. The most common part of the child is a long bone with good blood supply; such as the metaphysis of the tibia or femur. Osteomyelitis can be acute or chronic depending on the condition. From acute osteomyelitis to chronic inflammation is a process of gradual development that cannot be mechanically divided by time. After the acute inflammation subsides, if there is a dead bone, a sinus, and a dead cavity, it is chronic osteomyelitis. Acute osteomyelitis includes acute suppurative osteomyelitis, subacute osteomyelitis, acute sacral osteomyelitis, and acute vertebral osteomyelitis. Chronic osteomyelitis includes chronic suppurative osteomyelitis, localized osteomyelitis, sclerosing osteomyelitis, and tuberculous osteomyelitis. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: spinal deformity

Cause of osteomyelitis

Urinary tract infection (30%):

More than 95% of urinary tract infections are caused by a single bacterium. Among them, 90% of outpatients and about 50% of inpatients, the pathogen is Escherichia coli, the serotype of this strain can reach 140, the urinary Escherichia coli and the large intestine Esch separated from the patient's feces Bacillus is the same type of bacteria, more common in asymptomatic bacteriuria or uncomplicated urinary sensation; Proteus, Aerobacter, Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus faecalis, etc. found in reinfection, indwelling Urinary tract, urinary tract with complications; Candida albicans, Cryptococcus neoformans infection is more common in patients with diabetes and glucocorticoids and immunosuppressive drugs and after kidney transplantation; Staphylococcus aureus is more common in skin trauma and drug users Bacteremia and sepsis; although viral and mycoplasma infections are rare, there has been an increasing trend in recent years.

Peripheral blood vessels (25%):

Theories of vascular neuromodulation dysfunction, hypercoagulable state, and adrenal hyperfunction. Over the past decade or so, immune factors have received attention. Through the observation of humoral immunity, cellular immunity and immunopathology of this disease, many scholars believe that this disease is an autoimmune disease.

Diabetes (30%):

Eating too much, obesity caused by reduced physical activity is the most important environmental factor for type 2 diabetes, making individuals with genetic susceptibility to type 2 diabetes prone to disease. Patients with type 1 diabetes have abnormalities in the immune system, causing autoimmune reactions and destroying insulin beta cells after infection with certain viruses such as Coxsackie virus, rubella virus, and sputum adenovirus.

Osteomyelitis prevention

First, the prevention of general infectious diseases: sputum, sputum, sores, sputum and upper respiratory tract infections are the most common infectious diseases, and the most likely secondary infections cause blood-borne osteomyelitis, so prevent sputum, sores The occurrence of sputum and upper respiratory tract infection is very important to prevent the occurrence of osteomyelitis. The main measures for prevention are:

1. Keep the indoor airflow, pay attention to environmental hygiene and personal hygiene, and keep the skin clean.

2, puberty should eat more fruits and vegetables, use less oil to moisturize, to prevent sebaceous gland secretions or glandular obstruction.

3. Strengthen physical exercise, enhance physical fitness, and prevent colds from occurring.

4, the author of repeated tonsillitis, should be actively preventive and treatment, if necessary, consider surgical removal.

Second, the prevention of traumatic infection: traumatic infections including infection after tissue injury and bone injury after infection, is also a common cause of osteomyelitis, therefore, should also pay attention to active prevention in daily life.

Strengthen labor safety management to prevent skin abrasions and accidents. In case of trauma, seek medical attention immediately. Do not seek medical advice, massage, squeezing, etc. to prevent delay of disease, such as skin abrasions, and prevent soil pollution.

Correct treatment of soft tissue injuries and fractures, and found that infections should be actively treated.

Third, early detection and timely treatment of infection: regardless of the cause of the infection, its severity, the extent of the impact, and the systemic and local conditions are closely related, and sooner or later, the treatment is too late or not There is also a very big relationship. Therefore, for infectious diseases, early detection and timely treatment should have a positive effect on the prevention of osteomyelitis. Superficial infections, local manifestations are obvious, easy to find, deep infections are often Difficult to diagnose, in addition to abnormal body temperature and blood, as well as the pain of the affected area, the local skin does not necessarily show inflammation infiltration, but there is significant swelling, the clinical must be carefully examined, comprehensive analysis, in order to find and deal with,

Fourth, the treatment of open fractures: open fractures, first of all to prevent infection, we generally do not advocate internal fixation, due to local soft tissue injury after fracture, congestion and edema, if the internal fixation, the use of steel needles and other foreign objects continue to stimulate local , may become an important factor in secondary infections, so we often use hemostasis, debridement, bone replacement, topical self-made hemostasis and other drugs, fixed with small splints to reduce the chance of infection, open fractures have been fixed Once the infection occurs and spreads to the medullary cavity, the inflammatory infection often spreads along the intramedullary needle to the two ends. Under the subcutaneous insertion or penetration of the intramedullary needle, infection may also form. Once it occurs, special attention should be paid. Remove the internal fixation to control the infection.

Osteomyelitis complications Complications spinal deformity

The possible complications of chronic osteomyelitis are as follows:

(1) Malformation: As the epiphysis is stimulated by inflammation, the affected limb grows excessively and becomes longer, 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, and the development is asymmetrical, so that the joint is inside. Folding or valgus 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.

(3) Carcinogenesis: The skin of the sinus ostium can be cancerous due to continuous stimulation, and it is often squamous cell carcinoma.

Symptoms of myeloinflammation Common symptoms Miao Gong depression bone destruction bone pain high fever children do not dare to sleep supine soft tissue swelling bone marrow edema heart tingling dead bone bacterial infection

The symptoms of osteomyelitis patients vary widely, and in children, the incidence is fast. Bone pain, difficulty walking, fever or chills, local redness and so on. In adults, the incidence is relatively slow, fever, chills, local swelling and so on.

Acute osteomyelitis develops rapidly, accompanied by pain, fever, and joint stiffness. Usually secondary to traumatic skin damage, surgery or post-traumatic ulcers.

Chronic osteomyelitis is slowly attacking or latent. May be the recurrence of previous osteomyelitis, the symptoms include fever, pain, redness or local pus.

Examination of osteomyelitis

1, laboratory inspection

The white blood cell count can be normal, but the ESR and C-reactive protein are almost always increased.

2, X-ray inspection

X-ray changes appear 3 to 4 weeks after infection, manifested as irregular thickening and hardening of the bone, residual bone resorption areas or cavities, which may have dead bones of varying sizes, sometimes no bone marrow cavity, small bones Cavities and small dead bones are not developed in hardened bone, so the actual number is often more than shown on the photo.

3, CT examination

If the X-ray findings are unclear, a CT scan may be performed to determine the lesioned bone and the formation of a paraspinal abscess. The radial bone scan is reflected in the early stage of the lesion, but the infection cannot be distinguished.

4, biopsy

For fractures and tumors, needle biopsy and surgical biopsy can be performed through the intervertebral disc space or infected bone. It is feasible to culture and susceptibility test. The specimen culture results obtained from the sinus are unreliable for the diagnosis of osteomyelitis.

5, lipiodol angiography

In order to clarify the relationship between dead bone or bone cavity and sinus, iodized oil or 12.5% sodium iodide solution can be used for sinus angiography.

Diagnosis and diagnosis of osteomyelitis

diagnosis

Patients with this disease often have localized bone pain. Fever and discomfort suggest osteomyelitis. The white blood cell count can be normal, but ESR and C-reactive protein are almost always increased. X-ray changes appear 3 to 4 weeks after infection. Bone destruction, soft tissue swelling, subchondral bone plate erosion, intervertebral disc space narrowing and bone destruction with vertebrae shortening, if the X-ray findings are not clear, CT scan can be performed to determine the lesion bone and the formation of paraspinal abscess, radial bone scan In the early stage of the lesion, it is reflected, but it is impossible to distinguish between infection, fracture and tumor, through the intervertebral disc space or infected bone biopsy and surgical biopsy, feasible bacterial culture and drug susceptibility test, specimen culture results obtained from the sinus to diagnose osteomyelitis It is not reliable.

Differential diagnosis

1, for blood-borne osteomyelitis, clinically divided into three types

(1) Acute blood-borne osteomyelitis, characterized by systemic symptoms, no change in X-ray examination within 10 days of onset, and most cases have no history of previous episodes.

(2) Subacute blood-borne osteomyelitis, which is characterized by no systemic poisoning symptoms, X-ray changes have occurred at the time of onset, the course of disease is more than 10 days, and there is no history of previous episodes.

(3) Chronic blood-borne osteomyelitis, characterized by changes in systemic symptoms depending on the condition, X-ray changes are common, and there is a history of previous infection episodes.

2, osteomyelitis X-ray shows periosteal reaction, bone destruction of this type of the most, generally change to diffuse, acute process cases will not be difficult to diagnose, but subacute or chronic onset, mild pain, systemic and local symptoms of mild inflammation It is very difficult to distinguish from bone tumor diseases. In general, the X-ray film of osteomyelitis has a slight change in the bone marrow cavity. The periosteal reaction is full-circumferential and wide-ranging, and sometimes part of the cortical bone is whitish. Hardening, into a dead bone image, this is a feature that can not be seen in neoplastic diseases.

3, acute osteomyelitis from the whole body, should be identified in acute rheumatic fever, acute leukemia, from local and X-ray findings, should be associated with osteosarcoma, Ewing sarcoma, bone cytosis:

(1) Osteosarcoma usually occurs at the age of 10 years, and most of the bones in the limbs occur in the metatarsal epiphysis; occasionally in the backbone, showing a full-circumference change from the beginning, (case 4), in this case Next, if the bone destruction, the extent of periosteal reaction is limited compared with the osteomyelitis that should be identified, but sometimes X-ray identification is difficult; identification by CT, MRI and biopsy is necessary.

(2) Ewing sarcoma, often difficult to distinguish from osteomyelitis, the incidence of Ewing sarcoma in the bones of the limbs; sometimes severe pain, accompanied by fever and local heat; elevated erythrocyte sedimentation; elevated white blood cells; CRP positive, inflammatory reaction X-ray, early periosteal reaction, lack of changes in the bone marrow, difficult diagnosis, periosteal reaction compared with osteomyelitis, the rule, mostly the onion-like periosteal reaction, which is characteristic (case 3), if in doubt, A biopsy must confirm the diagnosis.

(3) Osteoblastosis, according to the site of the disease, shows various X-ray images, which occur in the long bones of the extremities, have high bone destruction and significant periosteal reaction, due to local and systemic mild inflammation symptoms The identification of osteomyelitis is a problem, but the extent of bone destruction and periosteal reaction are limited compared with osteomyelitis; as seen from the dead bone, sometimes there is no sclerosis, bone Osteosarcoma, sometimes difficult to distinguish from osteomyelitis, 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 hypertrophy, if carefully observed, It can be seen that the bone of the lesion is translucent, but sometimes the periorbital cortical hypertrophy occurs, and the lesion is not obvious.

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