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The treatment of chronic osteomyelitis Osteomyelitis of Treatment of Chrohic
Treatment of acute osteomyelitis is not the time, more prolonged unhealed development of chronic osteomyelitis. With disasters in recent years, the increase in traffic accidents, secondary infections in open fractures and surgical patients is increasing rapidly. Mostly gold grape pathogens, trauma, mostly caused by Escherichia coli, Proteus and gram-negative bacteria. Interruption of chronic osteomyelitis of bone nutrients, resulting in bone necrosis, easy to form a sequestrum, more than just medicine and antibiotics can not be cured, most should be surgery. Abscess formation in bone marrow, increased pressure within the bone marrow, bone marrow blood flow interruption Erzhi subperiosteal abscess formation of bone necrosis, pathological fractures, or even have large bone necrosis caused by the corresponding bone defect. Most clinical sinus secondary to repeated abscess. Such as sinus occlusion; local'll fever, swelling, pain, swollen lymph nodes corresponding to the Ministry, general fever, increased white blood cells and erythrocyte sedimentation rate to speed up and so on. Sinus is not as close for many years, is likely to occur sinus zone of cancer, and amputation. Surgical treatment should be actively following: (a) local conditions: 1. Abscess formation, including subperiosteal abscess, cellulitis, soft tissue, bone marrow cavity abscess; 2. Fistula hole; 3. Sequestrum; 4. Nonunion and ps


eudoarthrosis ; 5. bone marrow inflammatory granulation; 6. malformation; 7. foreign objects such as plates, intramedullary nails and other remains. (B) the general condition: septicemia, malignant change, repeated attack. Treatment of chronic osteomyelitis due to different methods in different conditions, debridement, continuous irrigation is the basic method of stereotypes, where inflammation of the full grasp on the basis of cure can be a bone graft to repair bone defects; an osteotomy; a Arthroplasty, both internal and external fixation, the bone to repair. Joint disease of the merger should be a joint function simultaneously to retain as much as possible, Chinese medicine has important therapeutic value, can improve the poor milling, enhance immunity, has a good effect on the resistant, can not rely on antibiotics. Overof local blood supply as well, even if there is infection, the body has a defensive function against bacteria, inflammation can also be quickly dissipated. Antibiotics can easily reach into the Ministry of the effectiveness of bone lesions. Pathological features of chronic osteomyelitis, local lack of blood supply is, therefore, antibiotics can not completely treat inflammation. Although the clinical application of antibiotics, the treatment of acute osteomyelitis is very effective, but whether it is oral or intravenous antibiotics for chronic osteomyelitis is not so obvious. Bone lesions due to chronic osteomyelitis damage, necrosis, scar the surrounding tissue, the lack of local blood supply, antibiotics can not reach the lesion, which is the cause of refractory osteomyelitis. Therefore, surgical removal of disease must be to improve the local blood supply, can the effectiveness of antibiotics. First, from the fistula holes or surgical wound bacterial culture within the organization to determine the types of bacteria and bacterial sensitivity. General penicillin family, cefotaxime and aminoglycoside family of antibiotics. Resistant MRSA has been a recent increase, forced to also use Tetracycline. However, many cases of pathogens can not be determined, if not cultivated bacteria resistant to drugs by. It is noteworthy that, the weak germs infection also tended to increase. And use a variety of antibiotics, and a large number of applications of broad spectrum antibiotics, a synergistic effect indeed, but considering the increase in side effects and resistant as possible to avoid multiple and use, such as the best choice to and use of antibiotics with bactericidal action. Reach the bone is generally believed that low concentrations of antibiotics, it should be a better choice Speranskia absorption of antibiotics. I believe that after 4-6 weeks of antibiotics and chronic osteomyelitis in the use of antibiotics for 6 weeks after surgery, the general ESR, CRP, white blood cells has been normalized, if the repeated recurrence of fistula hole persists, the input can not be endless antibiotics. Should carefully study the cause of the wound is not closed, decided to re-operation. Topical antibiotics, and surgery must be combined to be effective. Continuous irrigation and gentamicin, Pioneer CTC, Chinese chain beads are effective because the local high concentration of antibiotics. Intraoperative wound should also be thrown into the antibiotics. Sometimes intermittent injection of antibiotics from the wash tube, but the injection should pay attention to retrograde infection. The majority of surgical therapy of chronic osteomyelitis with surgical indications, should be treated in accordance with its policy of development of pathological conditions, in the role of antibiotics, aggressive surgical treatment. Chronic blood-borne osteomyelitis of the pathological features: 1. Sequestrum; 2. Granulation; 3. Dead space, empty; 4. Bone cladding; 5. Sinus; 6. Subperiosteal abscess, soft tissue abscess; 7. New bone generation; 8. trabecular bone changes; 9. ankylosis; 10. soft tissue defects, scar; 11. traumatic bone defects and other patients with chronic osteomyelitis; 12. Bone defect; 13. pseudoarthrosis, fracture; 14. malformation; 15. foreign and internal fixation. The formation of blood-borne chronic osteomyelitis features: the extensive application of antibiotics, acute sepsis-like disease less, and the formation of atypical cases of increasing number of new bone sequestrum surrounded by cladding, sequester a small amount of , trabecular disappearance of bone sclerosis. X ray showed bone destruction and reduce the area of high-density mixed appear. Indications for surgery (a) Local symptoms abscess formation (subperiosteal abscess, cellulitis and soft tissue, bone abscess) hole fistula formation; sequestrum; granulation bone marrow; nonunion; pseudarthrosis; deformity ; foreign body (nail and plate fixation, etc.) (b) of the systemic symptoms of sepsis malignant transformation (sinus cancer, sarcoma). Depending on the sick, the development of different surgical methods. MRI was performed before surgery and disposal of cases of chronic inflammation symptoms dramatically, according to treatment of acute osteomyelitis, the local fixed-line, application of antibiotics and traditional Chinese medicine, can relieve symptoms in a short time. However, if many long-term recurrent fistula hole, or inflammation of recurrence should be actively surgery. The believes that the symptoms should not be dissipated and other soft tissue, normal body temperature before surgery, and emergency surgery should be handled. To cure, you must carefully the piece, to grasp the extent of bone lesions and soft tissue lesions in scope, design surgical incision. Incision should avoid the nerve, large vessels and fistula hole. Check the body, including blood: white blood cell number and classification, C-reactive protein, erythrocyte sedimentation rate, serum total protein, A / G ratio, blood glucose. X-ray examination: plain film, tomography, sinus imaging. CT, MRI as possible, but not as a routine. bone scan. septic sinus bacterial culture, susceptibility testing. Surgical treatment of chronic osteomyelitis treatment principles: adequate debridement, curettage of intramedullary inflammatory granulation tissue and sclerotic bone wall, removal of sequestrum, fresh, an organization filled with blood of dead space, closed wounds. Continuous lavage of the lesion. If pseudarthrosis and nonunion, external fixation feasible, can also be cast immobilization and skeletal traction treatment. Different symptoms of chronic osteomyelitis, therefore, must be based on the treatment of pathological changes in different ways. No sinus, or is temporarily closed but recurrent sinus, bone marrow and soft tissue abscess formation, even the inflammation of acute exacerbation of chronic symptoms, in order to prevent the spof inflammation to be the early incision decompression. Always remember, chronic osteomyelitis only do the abscess, no cure. Pus METHODS: puncture incision drainage a. window of cortical bone puncture used for bacterial culture and sensitivity test. To understand the tumor size, and sometimes injection of contrast agent. However, chronic osteomyelitis, bone sclerosis, puncture difficult to succeed. b. cut and puncture, compared to fully removing the abscess. Deep abscess and bone marrow of the abscess, debridement must be wide open in parallel. Recurrence of chronic osteomyelitis by a simple cut no cure and no different from a simple puncture. c. early acute osteomyelitis, cortical window approach, even in the chronic pain of the abscess within the bone marrow, cortical bone must also be open the window, open the window for the conduct of radical debridement should be large. If possible long-segment lesions fenestration. Window, the diameter of 0.8-1.0CM, too broad and prone to pathological fracture. d. drainage and debridement of bone window, must drain, drainage is the most thorough washing pipe into the continuous multi-washing. Bone lesions and soft tissue lesions should be placed within the wash pipe. Such as lesion length, add fluid and effective antibiotics or traditional Chinese medicine preparations. Osteomyelitis surgical debridement is the basic technology, including bone lesions and soft tissue debridement, such as the removal of necrotic tissue, poor granulation, sequestrum, foreign body scar and so on. Note that the lesion cleared as far as possible without breaking the continuity of bone, as far as possible the protection of normal bone. Prediction by preoperative range of debridement, abscess through the fistula holes and dead space imaging to understand the scope, but the dead space was filled with granulation tissue, it can not be clearly depicted, but as can clearly describe all the CT of long bone thickness, the tubular structure and soft tissue damage location and size of the abscess. Tomography can observe the size of bone abscess, sequestra and periosteal reactions. Particularly traumatic bone soft tissue fixation device used in cases of external fixation and effective. Internal fixation material cases MRI can not be applied. A fistula into the hole from the blue hole fistula, the necrotic tissue staining, to avoid surgery in the remaining lesions, it should be noted, the range of staining is generally less than the actual range of lesions. Open or closed therapy treatment, the removal of the scope of their inequality; Open treatment of bone resection range, the separation of bone and soft tissue must be removed to retain the bone is not free. 1. Long bone along the bone long axis of the excision were created, not to the destruction of tubular structure of bone affects bone strength. 2. Sequestrum sequestrum can be removed with surgical treatment. Removal of a large sequestrum must open the window. Recent large sequestrum of the rare blood-borne chronic osteomyelitis. For traumatic osteomyelitis, sequestrum surrounded by new bone, cut easily. I practice: Only completely free sequestrum removal of ischemia, but not the naked eye can not see the separation of sequestrum bleeding (also called ischemic bone) mercy, be retained. Had such a case: intramedullary inflammatory granulation tissue filled with pus, a large section of cortical bone and periosteal separation, large bone ischemia and necrosis, but not free, inside and outside their place of irrigation pipe, wait for intramedullary extramedullary inflammation removed, but large segments of bone necrosis of the resurrection. To avoid large bone defects caused permanent disability. 3. Fistula hole cut holes I generally do not cut fistula, or drainage from the fistula hole and placed drainage tube. Because the removal of fistula hole separation is unclear, could easily lead to skin defects. As long as the removal of intramedullary inflammation, fistula hole through the scraping, is generally time to heal. 4. Bone resection including part of the normal bone lesions together with removal of bone is a good solution, but can cause a wide range of large segment of bone defect, and reconstruction difficult. Bone excision repair methods are: 1) with vascular bone graft 2) callus lengthening; 3) Papineau Act I, after limited debridement, a free bone graft at the same time, the main use of autogenous fetal bone and artificial bone. Postoperative continuous irrigation, oral medicine, were successful. Another paper reported the problem. 5. Amputated because the progress of medicine, very few indications for amputation, but to be amputated the following conditions: . Sepsis death to save lives . Amyloid disease and fistula hole, skin cancer can not be treated . Traumatic osteomyelitis , soft tissue defects can not be repaired, perceived can not be restored, and the inflammation is not treated; . cachexia, the economy is extremely difficult, and difficult to treat . pinkie ring finger distal osteomyelitis knuckle necrosis, not treatment, be cut after the non- influence function; . the symptoms of severe diabetic osteomyelitis of non-weight-bearing limb. 6. Foreign body removal of the bone marrow cavity of the foreign body, in principle, to remove, traumatic osteomyelitis, removal of fixation, and more able to debridement, the removal of bone has not healed after internal fixation dislocation occurs, correct way is to In addition to steel, intramedullary nailing after external fixation or external fixation not do anything, only skeletal traction, according to new fractures. For the fracture (pathological fractures) heal the symptoms occur, do the local fixed, fixed form of multi trauma fixation, the effect is not bad. Recent joint Ministry of extensive osteoporosis and bone can not be fixed, often with traction, but also to cure inflammation, bone healing purposes. Because muscles and joints to adapt to training early, does not affect the treatment of inflammation and bone healing. Advantage of the above two fixed: activities can be as early as possible in patients with major joint and muscle. Closure of dead space 1.Saucerization (butterfly of) but the damage of bone fractures caused by Big Easy. Brodie abscess and joint infections can not be taken past. 2. Closed continuous irrigation locally. Washing, by granulation tissue and hematoma machine of, filling dead space 3. Dead space filling method bone graft autogenous bone graft b.Papinean a. Act (Canada) c.Jadet the decortication method (France) soft tissue graft such as vascular pedicled and free muscle flap, omentum transplantation. mixed antibiotic bone cement bead filling technique and method of gentamicin chains. Next


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