Bone And Joint Suppurated Infection

Bone and joint suppurated infection

The first affiliated hospital of zhengzhou University Wang Jue

Suppurated osteomyelitis 【 definition 】—— Osteomyelitis inflammation of bone

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【 pathogen 】 Staphylococcus aureus （ 75%± ） 【 Infection approach 】  hematogenous→ hematogenous osteomylitis  exogenous→ trauma, surgery (iatrogenic)  contiguous infection

ACUTE HEMATOGENOUS OSTEOMYELITIS 【 Pathology 】 other part infective focus in body ↓

pathogen （ Staphylococcus aureus ） ↓

bloody circulation→blood poisoning ↓bacterium bolt long bones metaphyses capillary vessel→resorting → osteomyelitis

【 pathology 】—— acute inflammation of bone  骨质破坏、吸收、死骨形成  骨膜新生骨形成骨性包壳

The infection causes an inflammatory reaction, local ischemic necrosis of the marrow and then bone, and subsequent abscess formation abscess increases in size intramedullary pressure increases more bone to become ischemic eventually purulent material escapes through the cortex into the subperiosteal space a subperiosteal abscess.

化脓性关节炎

Result: When

(1) Body resistance strong (2) bacteria virulence feebleness (3) using antibiotic rightly when (1) Body resistance feebleness (2)bacteria virulence strong (3) Using antibiotic unrightly

mend heal local abscess periosteum under abscess marrow cavity spread go through periosteum to be parenchyma abscess

【 clinic behave 】 

Systemic symptoms

acute ， poisoning symptoms ： chill 、 high-fever 、 malaise 、 anorexia 

Local symptoms suffering limp continue twinge ， local skin temperature high ， deep press pain 。 When forming abscess under periosteum and parenchyma abscess ， local red 、 swell 、 hot 、 pain is evident 。

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If close to joint ， it is possible that is reactive joint hydrops.

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pathology fracture.

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Course of disease 3 － 4weeks 。 When abscess go through bone ， pain ease immediately ， temperature drops gradually ， after forming antrum ， switch to chronic stage.

Assistant check      

Blood routine examination Blood germiculture Puncture check X-ray check Isotope check CT 、 ultrasound 、 MRI

isotope

Forepart dignosis According as ：     

Systemic poisoning symptoms are evident, acute. Local persisted pain ， don`t like activity Metaphyseal has deeply press pain Leccocyte 、 neutrophil count increase Local delamination puncture check （ + ）

Differentiating dignosis 

acute cellulitis

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deep abscess

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Rheumatism and pyogenesis arthritis

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Bone marcoma and Ewing`s marcoma

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Parenchyma and deep abscess

systemic symptoms gentle ， local red swell evident ， any part can be found 。 However acute osteomyelitis were found at long bone metaphyseal. 

Rheumatism and pyogenesis arthritis pain place at joint ， may has joint hydrops

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malignancy

commonly disease come on slowly ， place at backbone ， surface has varicose blood vessel ， can touch tumor ， if necessary, biopsy

Treatment principle 

Prevent poisoning shock and infection

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Local treatnent as early as possible ， fend heal at acute period

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Prevent forming sequestrum→chronic osteomyelitis

Treatment 

Systemic sustainning therapy

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Applying antibiotics

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Local treatment

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Limb fixing

Therapy 1 、 Applying antibiotics 

Forepart, unite, sufficiency

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Both systemic and local symptom are disappear before x-ray change

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Both systemic and local symptom are disappear after x-ray change, that explains bone abscess were controlled basically

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Mentioned above need not operation ,but antibiotics should be used over 3 weeks continually

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Systemic symptoms disappear, but local symptoms heave, that explains antibiotics donot perish bone abscess, need operation drainage. Both systemic and local symptoms heave explain that pathogen possess anti-drug; have abscess-formed; form migrated bone abscess.

二、 operation therapy 

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objectiveness ： drainage abscess ， decrease pyaemia symptom ； hinder change to chronic osteomyelitis. After antibiotics therapy 48-72 hours donot control symptoms, can think operation. Punch drainage and windowing decompression.

Punch drainage and windowing decompression

Treat with wound ： 

Closed suction-irrigation drainage drainage duct remains 3 weeks ， or temperature down ， drained liquid cultures 3 times (-) ， can remove drainage duct.

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Only one closed suction drainage

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Wound doesn't sew ， fill iodoform voile strip ， after 510 days remake delay sew.

3 、 systemic assistant therapy lower temperature 、 liquid transfusion 、 blood transfusion 4 、 local assistant therapy skin traction or plaster fixing ； prevent joint contracture malformation ； prevent pathology fracture.

急性血源性骨髓炎的手术治疗

化脓性脊椎炎 suppurative spondylitis 1.

Centrum suppurative osteomyelitis

2.

Centrum gap infection 椎间隙感染

椎体化脓性骨髓炎

Centrum suppurative osteomyelitis 

Staphylococcus aureus is most to be found 金黄 色葡萄球菌最多见

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Spread by blood 通过血液途径

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Parenchyma infection Close to centrum infect directly to centrum 邻近脊椎的软组织感染直 接侵犯

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Spreaded by lymph 经淋巴引流蔓延至椎体

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The disease is most found in adult ， lumber is No.1.

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Mostly pathological changes are located at centrum, spread to intervertebral disc and close vertebral. Mostly to be abscess beside vertebral, at lumber be psoas major abscess, at cervical be pharynx back wall abscess. Pathological changes develop rapidly, and form ossify bone, at last fuse to be bone bridge.

Clinic behave 

Disease come on rapidly ， chill 、 high-fever ， pyaemia evident.

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Lumbago backache or nape ache evident ， keep the bed ， don't turn over or turn neck.

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Paraspinal muscle spasm ， knock ache.

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In forepart, x-ray hasn't change commonly, at least after one month, vertebras appear destroyed.

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After x-ray change, disease develops very rapid, can find abscess beside vertebral, and form ossify bone.

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CT and MRI can find destroy in advance and abscess beside vertebral muscle.

Treatment 

Applying sufficient 、 effective antibiotic

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Greater abscess beside vertebral—— drainage

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Sleeping plaster bed

Vertebral gap infection 椎间隙感染 

pathogen 致病菌： • Staphylococcus aureus 金黄色葡萄球菌 • White grape cocci 白色葡萄球菌

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Infecction approach stain by operation instrument

Spreaded by blood

Vertebral gap infection stained by operation instrument 手术污染所致的椎间隙感染 

Caused by Staphylococcus aureus 溶血性金黄色葡萄球菌所致的感染 • Disease come on rapidly ， chill 、 high-fever ， pyaemia evident, waist-back ache heave, and exist nerve root excite symptom. • Waist muscle spasm and tenderness ， restricted range of motion.

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Caused by White grape cocci 白色葡萄球菌所致的感染 • Disease come on slowly ， symptom and sign tender • Course of disease tend chronic

Hematogenous vertebral gap infection 血源性椎间隙感染 

Commonly exist in young adult ， mostly found at lumbar. Disease come on slowly ， fever 、 inappetence and so on ， lumbar pathology change exist both waist-back ache and sciatica.

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Waist muscle spasm and tenderness ， restricted range of motion.

antibiotic 、 plaster bed treat——symptom

decrease Excess action 、 stop treatment——symptom

recur 、 heave Course of disease tend chronic. During fever, leucocyte count increase. Erythrocyte sedimentation rate(ESR) go up

continuously that explain pathology change has not been controlled.

X-ray show 1. During forepart 3 months, vertebral gap change 2.

3. 4.

narrow Next 3 months ， shows subchondral bone developing ossify ， close vertebral density increase. Close vertebral ossify developing, irregularly that explains inflammation are developing. Intervertebral show change like ballon and vertebral erosion ， and look out close vertebral density change.

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Half case pathology change was limited in intervertebral

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Other half pathology change inflammation spread to close vertebral, show forming bone bridge ， few happen bone fusion.

 Non-operation treatment 手术治疗 

Antibiotics and systemic sustaining therapy

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Patient who donot bear Nerve root exciting symptom can suck intervertebral or remain draining tube.

 Operation treatment 

Paraplegic patient

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Vertebral excision decompression and intralesional resection. 椎体切除减压术和病灶清除术 。

已出现截瘫的病人