Sternal osteomyelitis

Introduction to sternal osteomyelitis The incidence of sternal osteomyelitis is low, especially blood-borne osteomyelitis is very rare, and it is a very difficult disease in the field of orthopedics. Common in sternal infection, elderly and patients with systemic diseases with diabetes. The clinical manifestations are multiple sinus tracts, and symptoms of infection and poisoning occur in severe cases. Thorough debridement, unobstructed drainage, and establishment of local blood supply are the key to successful treatment. basic knowledge Sickness ratio: 0.00015% Susceptible people: more common in the elderly Mode of infection: non-infectious Complications: anemia

Cause of sternal osteomyelitis

(1) Causes of the disease

The sternal osteomyelitis is mainly seen in the infection of the transverse sternum and the sternal median incision, especially in elderly patients with systemic diseases such as diabetes.

(two) pathogenesis

Bacteria spread through the blood to the bone: the most common infections in other parts of the body, such as pneumonia or urinary tract infections, spread through the blood circulation to the bones.

Open wound bone exposure: peripheral blood vessels, neurological diseases, or diabetes, open fractures.

Recent surgery or injection around the bone.

Combine other diseases or take drugs: such as cancer, long-term use of hormones.

Prevention of sternal osteomyelitis

Prevention of osteomyelitis should start from the prevention of sputum, sores, sputum and upper respiratory tract infections. At the same time, attention should be paid to maintaining air circulation in the living environment, paying attention to environmental hygiene and personal hygiene, strengthening physical exercise and enhancing physical fitness. In addition, traumatic infections should be prevented, and infections should be detected and treated as soon as possible.

In daily life, if other diseases occur, it is forbidden to abuse or long-term use of hormonal chemical drugs during treatment. If these drugs are used improperly, it is easy to accelerate the hardening of bone, harden and block the bone marrow cavity, and cause normal metabolism of bone cells. Dysfunction and even osteonecrosis.

During a cold and fever, the body temperature should not exceed 38.5 degrees. At this time, use antibacterial, anti-inflammatory, antipyretic injections intravenously or intramuscularly, or detoxification, sweating and disintegration of Chinese patent medicines, which may cause infection of osteomyelitis bacteria. Stifle in the bud.

Complications of sternal osteomyelitis Complications anemia

1. Anemia, hypoproteinemia: prolonged course of chronic suppurative osteomyelitis, long-term repeated acute attacks, low fever and discharge of purulent secretions in the sinus will cause chronic wastage damage to the whole body. Anemia and hypoproteinemia are common complications of chronic suppurative osteomyelitis. The existence of these complications has not reduced the systemic and local resistance to disease. The treatment of chronic suppurative osteomyelitis adds a disadvantage to the formation of a vicious circle. Therefore, it is important to correct anemia and treat low protein disease in the treatment of chronic suppurative osteomyelitis.

2. Systemic amyloidosis: amyloidosis is a kind of pathological tissue degeneration,

Both systemic and limited. Systemic amyloidosis occurs in long-term recurrent purulent inflammation such as chronic suppurative osteomyelitis. The pathology is characterized by the intercellular space of the whole body organs and the deposition of amyloid on the basement membrane of the blood vessels. The sediment is actually a proteinaceous substance, but has the property of iodine and blue. Severe functional damage often occurs in diseased organs.

3. Nonunion: After the pathological fracture occurs, the correct treatment is not performed in time, and nonunion can occur. In addition, surgical treatment is performed before the bone capsule is completely formed, and large bones are removed, which may also cause bone defects or nonunion. Due to the poor local blood circulation, the destruction of the diseased bone is still going on. This fracture healing is very difficult, and the pseudo joint will be formed over a long period of time, making the whole treatment more complicated and difficult. There are two kinds of pseudo joints, one is contact type and the other is large bone defect type, the latter is more difficult to treat.

4. Septic arthritis: dry sputum septic osteomyelitis, abscess can enter the joint cavity and septic arthritis through two ways. First, through the vascular communication branch of the tarsal plate, the abscess penetrates the articular cartilage directly into the joint to form septic arthritis.

Symphysis of sternal bone marrow syndrome Common symptoms Systemic infection symptoms Symptoms of sinus scapula fissure

The sternal infection after sternal surgery, the wound sinus is long-term unhealed, and multiple sinus can be formed under the sternum or rib arch. In severe cases, systemic infection can occur.

According to the history of sternal surgery in patients, the incision sinus formation after long-term unhealed. Combined with X-ray examination can confirm the diagnosis.

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 sternal osteomyelitis

X-ray examination showed osteomyelitis such as sternal bone destruction, and sinus angiography can understand the depth and extent of sinus.

Isotope bone scan: Isotope bone scan is very useful for the diagnosis of acute osteomyelitis, but it is not useful for chronic osteomyelitis, because the acute osteomyelitis plain film generally has no abnormal performance. Areas with increased intra-osseous blood flow or areas with increased osteogenic activity showed increased absorption on the 99 bone scan, but no specificity. However, this test has a large negative exclusion, although there are also false negative reports. Gallium scans show increased absorption in leukocytes or bacterial accumulation areas. If the gallium scan is normal, then there is no osteomyelitis, and it is useful to follow up with a gallium scan after surgery. Indium 111-labeled leukocyte scans are more sensitive than sputum scans and gallium scans and are very useful in identifying chronic osteomyelitis and diabetic neuropathy.

CT: CT can clearly show the cortical bone, which can observe the surrounding soft tissue well and is especially useful for examining dead bone. MRI examination of soft tissue is better than CT, and shows that the edema area of the bone is very effective. Chronic osteomyelitis can show a well-defined high-signal area on MRI slices with active lesions (circular signs). Sinus and cellulitis are shown as high signal regions on T-2 weighted images. Disadvantages of MRI include: high price, undetectable areas around the metal inside the plant, and unclear cortical bone.

Diagnosis and differentiation of sternal osteomyelitis

Osteoid osteoma, sometimes difficult to distinguish from osteomyelitis. Osteoarticular 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 osteocortical hypertrophy, if careful observation, which can see the bone translucent of the lesion image.

Ewing sarcoma is often difficult to distinguish from osteomyelitis. The pathogenesis of Ewing sarcoma is in the bones of the extremities; sometimes there is severe pain, accompanied by fever and local heat; elevated erythrocyte sedimentation rate; elevated white blood cells; CR-positive, inflammatory reaction.

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