Chronic osteomyelitis in children

Introduction to chronic osteomyelitis in children Chronic osteomyelitis in children is a kind of bone infectious disease caused by purulent bacteria invading bone tissue. It often recurs for many years and sometimes causes lifelong disability due to complications. Chronic osteomyelitis in children is often caused by improper treatment or delayed diagnosis and treatment of acute hematogenous osteomyelitis, and a small number of open fractures are caused by concurrent infection. The body's resistance is reduced, and soft tissue swelling and even skin ulceration may occur at the lesion, that is, an acute attack. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: muscle atrophy

Causes of chronic osteomyelitis in children

Blood-borne infections (25%):

Before the onset of the disease, there is a lesion of purulent infection that has not been properly treated, such as abscess, sputum, tonsillitis, etc. The bacteria are brought to the bone tissue through the blood circulation and osteomyelitis occurs. It is the most common and the most important infection route. Clinically, osteomyelitis, which occurs from a blood-borne infection pathway, is called blood-borne osteomyelitis.

Traumatic infections (30%):

Such as knife wound, bullet wound, open fracture or closed fracture, or aseptic operation during joint surgery, the pathogen directly invades the bone tissue from the wound, causing osteomyelitis clinically called traumatic osteomyelitis.

Spread infection (30%):

Directly from the adjacent suppurative lesions to the bone tissue to cause osteomyelitis, such as finger (toe) osteomyelitis caused by infection, known clinically as infectious osteomyelitis. The incidence of blood-borne osteomyelitis is the highest in the infection route, and the location of the disease is mostly in the long bone, especially the lower limb bone, such as the upper end of the humerus and the lower end of the femur. The order of incidence is from high to low: humerus, femur, tibia , humerus, humerus, vertebrae, etc.

Pathogenesis

Generally, acute osteomyelitis has not healed after more than 3 weeks of treatment, or after acute inflammation has subsided, dead bones appear, and sinus is converted to chronic osteomyelitis.

The pathological changes are more complicated, including dead bone, the formation of new bone, and a large amount of inflammatory granulation tissue and pus around the dead bone. When the pus spreads to the soft tissue, the skin collapses to form the sinus, and the pus and small are discharged. After the dead bone, the acute inflammation can gradually subside, and the sinus crossing is temporary.

Prevention of chronic osteomyelitis in children

Prevention of general infectious diseases: sputum, sputum, sores, sputum and upper respiratory tract infections are the most common infectious diseases, and the most common secondary infection causes blood-borne osteomyelitis, thus preventing sputum, sores, sputum And the occurrence of upper respiratory tract infection is very important to prevent the occurrence of osteomyelitis. The main measures for prevention are:

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

2. During puberty, eat more fruits and vegetables, and use less oil to moisturize the skin to prevent accumulation of sebaceous glands or blockage of the gland.

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

4. The author of repeated tonsillitis should be actively prevented and treated, and surgical removal should be considered if necessary.

(2) Prevention of traumatic infection: Trauma infections include infection after tissue injury and infection after bone injury, and are also common causes of osteomyelitis. Therefore, active prevention should also be taken into account in daily life.

Pediatric chronic osteomyelitis complications Complications muscle atrophy

There may be malformations in adjacent joints, muscle atrophy and dysfunction. It is easy to relapse, complicated with complications such as septic arthritis, pathological fracture, large segmental bone defect and bone growth plate injury.

Septic arthritis is an infection caused by purulent bacteria at the joints. More than 85% of the common pathogens are Staphylococcus aureus. Most of the infection routes are blood-borne, and a few are direct spread of infection. The disease is common in children around 10 years old. Most often occurs in the hip and knee joints. Single-shot joints. The joint of the hip joint is often missed due to deep relationship or obscuration due to infection symptoms in other parts of the body.

Chronic myeloinflammatory symptoms in children Common symptoms Loss of appetite, fever, joint deformity, chills, muscle atrophy, back sinus, dead bone

In the acute attack, the patient has fever, chills, loss of appetite and other systemic symptoms, local redness, pain, pus, or a small piece of dead bone discharged from the sinus. There may be no systemic symptoms during the stationary phase of the lesion, but it has been repeatedly acute. Attacks, bone ends and adjacent joints may have deformities, muscle atrophy or contractures and dysfunction.

Examination of chronic osteomyelitis in children

1, blood test at the time of acute attack

(1) The white blood cell count is increased, except for critically ill patients and small infants.

(2) The proportion of neutrophils increased and the nucleus shifted to the left.

(3) The erythrocyte sedimentation rate is accelerated.

2, bacterial culture inspection

Blood culture check: can be positive. Sampling before administration in high fever, the positive rate is extremely high.

Sinus secretion culture: positive.

3, pus smear examination and drug sensitivity test.

4, X-ray film

Irregular thickening and hardening of the bone, general looseness, and soft tissue swelling. There is a clear periosteal reaction.

There are residual bone resorption areas or voids, which may have dead bones of different sizes.

Use iodized oil or 12.5% sodium iodide solution for sinus angiography to confirm the relationship between dead bone or bone cavity and sinus.

The crust formed by the new bone, the band between the dead bone and the new bone has a reduced density.

5, the skin is suspected of malignant transformation, pathological examination.

Diagnosis and diagnosis of chronic osteomyelitis in children

diagnosis

The disease can be suspected when the following symptoms occur.

1, persistent fever for unknown reasons, local pain, heat, redness, swelling.

2, when the baby changes the diaper, the hip joint is afraid of movement, the hip joint is flexed, adducted, and externally rotated, sometimes causing pathological dislocation, and the disease should be suspected.

3, white blood cells increased, ESR hyperthyroidism, CRP positive, periosteal delayed 1-2 weeks after onset, local puncture has pus.

Differential diagnosis

1, bone tuberculosis

There is a history of exposure to tuberculosis or tuberculosis, which generally invades the joints. The incidence is slow, the course of disease is long, and local symptoms and dysfunction are not as obvious as suppuration.

Joint bone destruction: marginal small defects with upper and lower symmetry, obvious osteoporosis, and slow and narrow joint space.

Late stage: the bone end is severely damaged, the joint is subluxated or fully dislocated, and bony rigidity rarely occurs.

X-ray film: more common bone destruction, less new bone formation.

2, Brucella osteomyelitis and other infections

Ask about the medical history, observe the clinical manifestations, and check the pathogens.

3, osteoid osteoma

Frequent pain, frequent pain at night, local tenderness is obvious.

No redness and swelling, and few systemic symptoms.

4, rheumatoid arthritis, rheumatoid arthritis and other non-infectious arthritis

More common in adults or young people.

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