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Purulent Infection of Bone and Joint.ppt
- 1. Purulent Infection of Bone and Joint Li Qiang The Second Clinical College Hainan Medical College
- 3. Basic concepts Pyogenic osteomyelitis is a disease caused by pyogenic bacteria. suppurative osteomyelitis Bone tissue periosteum → bone → bone marrow
- 4. Classification Route of infection Hematogenous Traumatic Adjacent infection foci Clinical Acute Chronic suppurative osteomyelitis
- 6. • Prone age • 3-15 years old (< 10 years • old ↑) • Prone part • Long tubular bone, • metaphysis Acute hematogenous osteomylitis
- 7. pathogeny • pathogenic bacteria • Staphylococcus aureus, Streptococcus B, etc • Disease condition • Internal cause: decreased resistance (whole body, local) • External causes: strong cytotoxicity, large number, trauma, etc Acute hematogenous osteomylitis
- 8. Pathological characteristics • Bone destruction, resorption and new bone formation coexist. • Early destruction and late proliferation. Acute hematogenous osteomylitis
- 9. Spreading route • Bacteria reenter the blood • Spread to subperiosteal and soft tissue • Spread to the long bone end • Spread to joints Acute hematogenous osteomylitis
- 10. clinical manifestation Systemic symptoms of infection and poisoning Local signs: pain, fear of movement, refuse to press Tenderness and high skin temperature Redness, swelling, heat and pain Acute hematogenous osteomylitis
- 11. Laboratory examination: leukocytes and neutrophils increase Increased ESR blood culture Acute hematogenous osteomylitis
- 12. Imaging examination X-ray CT MRI Acute hematogenous osteomylitis
- 13. Diagnosis Early diagnosis: significant basis: History of local injury or infection elsewhere. The high heat pulse is fast and the white blood cell is increased. Limb pain, fear of movement and refuse to press. Local puncture, smear positive. Limb symptoms, positive blood culture. Acute hematogenous osteomylitis
- 14. Treatment Acute hematogenous osteomylitis Whole body support rational use Local braking surgical treatment
- 15. Treatment Whole body support Rehydration, cooling and heat supplement in high fever Correct acidosis Digestible, high calorie food If necessary, a small amount of multiple blood transfusions Acute hematogenous osteomylitis
- 16. Rational administration of drug Antibiotic application Principle: early and sufficient sensitivity Joint whole course Methods: Empirical medication Guiding medication Acute hematogenous osteomylitis
- 17. Local braking Objective: to relieve spasm and pain Prevent joint contracture and deformity shape Prevent pathological fracture Method: gypsum / brace Acute hematogenous osteomylitis
- 18. Surgical treatment Indication: local + poisoning symptoms Conservative treatment for 48-72h was ineffective Objective: decompression + drainage Timing: once determined, implement as soon as possible Methods: drilling decompression Fenestration and drainage Acute hematogenous osteomylitis
- 20. Turn • recovery • chronic • death Acute hematogenous osteomylitis
- 24. Pathological characteristics • Recurrent local inflammation • Sinus • Dead cavity • Dead bone • Neoosteogenesis Chronic osteomylitis
- 25. Clinical manifestation The disease may be asymptomatic at the inactive stage The bone loses its original shape, and the limbs can be thickened and deformed Skin discoloration, multiple scars, ulcer formation Sinus formation, granulation tissue protrusion, and outflow of foul smelling pus Deformity of adjacent joints caused by muscle twinning Chronic osteomylitis
- 26. Clinical manifestation Acute stage: local tenderness, high skin temperature, redness, swelling and heat pain Toxic blood symptom Sinus ostium is open and dead bone is discharged Course: recurrent attacks The acute attack may occur once every few months or years Chronic osteomylitis
- 27. Diagnosis • Recurrent attacks • Local features • X-ray findings Chronic osteomylitis
- 29. Treatment Treatment principle: surgical treatment Objective: to clear the focus and remove the dead bone Eliminate dead space and remove sinus tract Improve blood circulation and repair wound Chronic osteomylitis
- 30. Surgical indication • Dead bone, dead cavity, sinus • Local scars often break • Local soft tissue defect and bone exposure Chronic osteomylitis
- 31. Timing of operation: Paroxysmal interval Antibiotic application Formation of new bone shell Chronic osteomylitis
- 32. Surgical method Focal clearance + lavage Operation to eliminate dead space -Muscle flap packing -Cancellous bone filling -Bone cement filling -Vascularized bone graft Chronic osteomylitis
- 33. Surgical method • Orr operation • Excision of diseased bone • Amputation Chronic osteomylitis
- 34. Typical case
- 35. Typical case
- 38. Concept Septic arthritis: septic infection in joints caused by septic bacteria. Common in children; The knee joint and hip joint are the prone sites. suppurative arthritis
- 39. pathogeny • Pathogenic bacteria: Staphylococcus aureus, hemolytic streptococcus, etc • Infection condition • Route of infection: hematogenous • traumatic • the tendency to spread • Iatrogenic suppurative arthritis
- 40. Pathological process • Slurry exudation period (complete recovery) • Cellulosic exudation stage of slurry (partial recovery) • Purulent exudation stage (fibrous ankylosis or bony ankylosis) suppurative arthritis
- 41. clinical manifestation Systemic symptoms of infection and poisoning Local signs: pain, inconvenient movement Joint flexion tenderness Redness, swelling, heat and pain Pathological dislocation suppurative arthritis
- 42. clinical manifestation The white blood cells were increased by laboratory test Increased ESR Joint puncture smear Imaging examination: X-ray, CT, MRI suppurative arthritis
- 43. Diagnosis • Whole body + local • Puncture + assay • X-ray suppurative arthritis
- 44. Treatment • Systemic support therapy • Application of antibiotics Local treatment • Arthroscopic treatment • Joint puncture, pus aspiration and antibiotic injection • Incision drainage and antibiotic infusion suppurative arthritis
- 46. Preservation of joint function • Function position braking • Functional exercise Adjuvant therapy suppurative arthritis
- 47. Reconstruction of joint function • Osteotomy and orthopedics • Joint fixation • Arthroplasty • Arthrectomy suppurative arthritis
- 50. After class thinking questions Diagnosis and treatment of acute osteomyelitis and chronic osteomyelitis
- 51. Thank you