Bone marrow damage

Introduction Osteomyelitis is a bone infection and destruction. Caused by aerobic or anaerobic bacteria, mycobacteria, fungi. Osteomyelitis occurs in the vertebrae, in the feet of diabetic patients, or in areas of penetrating bone damage caused by trauma or surgery. The most common site for children is long bones with good blood supply (such as the metaphysis of the tibia or femur). Bone infection and vascular occlusion can cause osteonecrosis and local infection spread. The infection can spread through the cortical bone to the subperiosteum and form a subcutaneous abscess. The latter spontaneously penetrates the skin for drainage.

Cause

Proliferative osteomyelitis is mainly caused by local bone hyperplasia, which is caused by chronic inflammation stimulating the periosteum. In the acute phase of infection, there is an exudative change in the lesion area, and there is exudate and inflammatory cell infiltration in the bone marrow cavity. After entering the chronic phase, exudative changes are gradually replaced by repair changes, fibroblasts and osteoblasts appear in the lesion, forming granulomas and dense new bone.

an examination

Related inspection

Bone marrow imaging analysis of bone marrow imaging

Patients with localized bone pain, fever and discomfort suggest that osteomyelitis may be. The white blood cell count can be normal, but the ESR and C-reactive protein are almost always increased. X-ray changes occurred 3 to 4 weeks after infection, showing bone destruction, soft tissue swelling, erosion of subchondral bone plate, narrowing of intervertebral disc space and bone destruction with shortening of vertebrae. If the X-ray findings are not clear, a CT scan may be performed to determine the lesioned bone and to show the formation of a paraspinal abscess. Radiation bone scans are reflected in the early stages of the lesion, but they are indistinguishable from infections, fractures and tumors. Bacterial culture and drug susceptibility testing are feasible through needle biopsy and surgical biopsy of the intervertebral disc space or infected bone. The results of specimen culture obtained from the sinus are unreliable for the diagnosis of osteomyelitis.

Differential diagnosis

Bone marrow damage needs to be identified as follows.

1. Sclerosing osteomyelitis

Sclerosing osteomyelitis is an inflammatory change of progressive, extensive hyperplasia and sclerosis of a segment of the backbone or the entire diaphysis. Due to the stimulation of the inflammatory reaction, extensive fibrosis occurs in the bone marrow cavity, and even the marrow cavity disappears, blood circulation is impeded, and sinus formation occurs.

2, acute blood-borne osteomyelitis

Acute blood-borne osteomyelitis is inflammation caused by the infection of the other parts of the body into the bloodstream and localization to the bone tissue. Its pathological features are bone destruction, necrosis and reactive bone hyperplasia. More than 80% is caused by Staphylococcus aureus.

3, chronic suppurative osteomyelitis

Chronic suppurative osteomyelitis is generally the result of improper treatment or delay in treatment of acute hematogenous osteomyelitis. It has a typical history of acute hematogenous osteomyelitis, the formation of dead bones, dead space, and sinus.

4. Traumatic suppurative osteomyelitis

Traumatic suppurative osteomyelitis is often secondary to developmental fractures. It is on the rise with current traffic accidents and work-related injuries in large buildings, and is a common complication after high-energy fractures. It is characterized in that the infected lesion is always centered on the fracture site, spreading to both ends, and at the same time forming a dead space at the fracture site. In the bone and soft tissue, an abscess is formed, which often breaks repeatedly and becomes a long-term unhealed sinus. This is also a sign of the beginning of chronic osteomyelitis.

5, iatrogenic osteomyelitis

Most of the iatrogenic osteomyelitis occurs during surgery. Because the medical staff relies too much on antibiotics to relax the aseptic operation, the patient's resistance is low, causing bacterial invasion. The implementation of complex major surgery gives the affected part an opportunity to contact the bacteria, and the intra-osseous infection caused by the incorrect use of antibiotics and the untimely and effective treatment is iatrogenic osteomyelitis.

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