Chronic hematogenous osteomyelitis

Introduction to chronic blood-borne osteomyelitis The pathogen of chronic osteomyelitis is often a mixed infection of a variety of bacteria, but Staphylococcus aureus is still the main pathogen, in addition, Gram-negative bacilli also account for a large proportion, Gentry in 1990 in an article entitled "Bone marrow In the antibiotic treatment of inflammation, it is pointed out that 50% of patients with chronic osteomyelitis are Gram-positive bacilli, and those caused by acne are mostly caused by various bacteria such as Staphylococcus, Escherichia coli, Pseudomonas aeruginosa and Proteus mirabilis. In the case of chronic osteomyelitis caused by artificial joint replacement or other foreign body retention, the pathogenic bacteria are mostly coagulasenegativestaphylococcus, which have been reported frequently in recent years. basic knowledge Sickness ratio: 1%-5% Susceptible people: no specific population Mode of infection: non-infectious Complications: Eczema, Eczema, Fibrosarcoma, Angiosarcoma, Rhabdomyosarcoma, Adenocarcinoma, Basal Cell Carcinoma, Plasmacytoma, Fracture

Causes of chronic blood-borne osteomyelitis

(1) Causes of the disease

Most chronic osteomyelitis (chronic osteomyelitis) is the result of improper or untimely treatment of acute osteomyelitis, such as the pathogenic bacteria of acute osteomyelitis, or the patient's resistance is strong, may also start at the beginning of the disease It is subacute or chronic, with no obvious acute phase symptoms. It evolved from acute blood-borne osteomyelitis to chronic in the 1960s and 1970s, accounting for about 1/3 of chronic osteomyelitis. In recent years, acute blood-borne bone marrow In the early stage, inflammation can be treated promptly and effectively, and the incidence of chronic osteomyelitis is significantly reduced. On the other hand, the osteoporosis of the bone and the osteomyelitis after the open fracture, the metal object is implanted into the bone such as the artificial joint. Intraosseous infections caused by replacement surgery, etc., are more common, other causes of diabetes, taking hormones, immunodeficiency and malnutrition.

(two) pathogenesis

In the acute phase of acute blood-borne osteomyelitis, if it is not completely repaired, it will evolve into chronic osteomyelitis, with congestion of surrounding tissues and decalcification of bones. The formation of granulation tissue brings osteoclasts and osteoblasts, necrotic osteoporosis. The quality is gradually absorbed and replaced by new bone. The necrotic bone dense junction is partially absorbed first, eventually falling off into a dead bone. It takes several months for the necrotic bone to fall off into a dead bone. The dead bone is exfoliated. As a result of synergy with proteolytic enzymes, the surface becomes irregular. Due to the lack of blood supply, the dead bone does not decalcify. On the contrary, it is denser than the adjacent bone tissue. In rare cases, the infection is completely controlled. The necrotic bone no longer falls off, but is gradually absorbed by the crawling replacement process. This process also takes several months. Once the dead bone falls off, it is in the completely free space around the bone. The dead bone is soaked in the pus and absorbed. Very slow, or even stop absorption, in order to limit the infection, the surrounding bones gradually become dense and hardened, and the periorbital periplasm also continuously forms new bones and become bone shells. In a few cases, the whole bones fall off. It is a dead bone, surrounded by a new bone shell. The bone shell gradually thickens and becomes dense. The bone shell usually has a plurality of pores. The pus and dead bone debris are removed through the pores to the surface of the body, and the soft tissue is severely damaged and scars are formed. The surface of the skin is extremely thin and vulnerable, and the sinus is not cured for a long time. The epidermis will grow into the sinus. The long-term drainage of the sinus will stimulate the skin of the sinus to become squamous cell carcinoma.

After the dead bone is removed, the sinus opening is closed, and the small cavity of the child case can be filled by new bone or scar tissue; in adult cases, pathogenic bacteria are inevitable in the cavity, and infection can be secondary at any time.

Chronic blood-borne osteomyelitis prevention

In the acute suppurative osteomyelitis period, complete and thorough treatment can reduce the occurrence of chronic osteomyelitis.

Chronic blood-borne osteomyelitis complications Complications Eczema, eczema, fibrosarcoma, angiosarcoma, rhabdomyosarcoma, adenocarcinoma, basal cell carcinoma, plasmacytoma

The skin and soft tissues near the sinus of chronic osteomyelitis are stimulated by continuous drainage and inflammatory secretions. The surrounding skin can undergo eczema-like changes, the skin becomes thinner, the epidermis falls off, and it is susceptible to injury. Resnick reported that about 5% of patients Can be published with skin-like cancer, a small number of patients can be complicated by other tumors such as fibrosarcoma, angiosarcoma, rhabdomyosarcoma, adenocarcinoma, basal cell carcinoma and plasmacytoma (plasmacytoma), because chronic osteomyelitis is a long-term wasting disease, patient liver , spleen, kidney and other organs can occur amyloidosis, occasionally pathological fractures.

Chronic blood-borne myeloinflammatory symptoms Common symptoms Muscle contracture joint deformity limb growth, thickening excessive bone joint contracture ulcer

In the inactive stage of the disease, it can be asymptomatic, the bone loses its original shape, the limb is thickened and deformed, the skin of the affected part is thin, the color is dark, there are many scars, and a slight damage causes a long-lasting ulcer; or there is a sinus crossing, Long-term non-healing, sinus granulation tissue bulges, out of odor pus, muscle fibrosis can lead to joint contracture, acute infection episodes show pain, surface skin turns red, swollen, hot and tender; body temperature can be increased 1 ~ 2 ° C; the original occlusion of the sinus can be opened, discharge a lot of pus, sometimes falling out of the dead bone, after the discharge of the dead bone, the sinus ostium is automatically closed, the inflammation gradually subsides, the acute attack is about several months, several years, the body is not Acute or physical weakness can induce acute attacks.

Long-term multiple attacks make the bones twist and deform, thicken, the skin of the affected area is pigmented, and adjacent joint deformities appear due to muscle contracture. The skin of the sinus is repeatedly stimulated by pus to cause cancer. Children often affect bone growth and development due to destruction of the bone. To shorten the deformity of the limbs.

Examination of chronic blood-borne osteomyelitis

When the sinus ostium is occluded, the white blood cells may increase when the drainage is not smooth.

In the early stage, there were worm-like bone destruction and sparse bone, and the hardened area gradually appeared. The periosteum was picked up and new bone formed. The periosteal reaction was layered, partially triangular, like a bone tumor, and the new bone gradually became thicker and denser. Necrotic shedding becomes a dead bone. Because the surrounding bone is dense, the dead bone may not be displayed on the regular positive and lateral X-ray films. It is necessary to change the position examination. On the X-ray film, the dead bone appears as a completely isolated bone piece. The trabecular structure is thick and dense, the edges are irregular, and there are gaps around. The CT piece can show the abscess and small dead bone. In some cases, the iodine water contrast agent can be injected through the sinus cannula to show the abscess.

Sinus angiography: the sinus tract that has not healed for a long time must be removed after the dead bone or dead bone of the diseased bone. Therefore, it is necessary to understand the depth of the sinus, the distribution of the sinus, the distribution range and its relationship with the dead space. Using sinus angiography, the contrast agent (12.5% sodium iodide solution, lipiodol or barium sulfate glue) is injected into the sinus to observe and observe the sinus, so that the dead space and sinus can be completely removed. The road prompted him to heal soon.

Diagnosis and diagnosis of chronic hematogenous osteomyelitis

According to the medical history and clinical manifestations, the diagnosis is not difficult, especially when there are sinus and sinus discharge through the dead bone, the diagnosis is easier, X-ray film can confirm the presence or absence of dead bone, and understand its shape, quantity, size and location, As well as the growth of the surrounding capsule, the general case does not need to do CT examination, because the bone is thick and difficult to show the dead bone can do CT examination.

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