Bone and joint suppurated

infection

The first affiliated hospital of zhengz

hou University
Wang Jue
 Suppurated osteomyelitis

【 definition 】 —— Osteomyelitis is an inflammati

on of bone

【 pathogen 】 Staphylococcus aureus （ 75%± ）

【 Infection approach 】
 hematogenous hematogenous osteomyliti

s
 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 is

chemic necrosis of the marrow and then bone, and subs
equent abscess formation abscess increases in size
intramedullary pressure increases more bone to
become ischemic eventually purulent material esca
pes through the cortex into the subperiosteal space
a subperiosteal abscess.
化脓性关节炎
Result:
When
(1) Body resistance strong mend
(2) bacteria virulence feebleness heal

(3) using antibiotic rightly local abscess

when periosteum ab
(1) Body resistance feebleness under scess

(2)bacteria virulence strong marrow cavity spread

(3) Using antibiotic unrightly go through
to be periosteum
parenchyma absce
s
 【 clinic behave 】

 Systemic symptoms
acute ， poisoning symptoms ： chill 、 high-fever 、 m
alaise 、 anorexia

 Local symptoms
suffering limp continue twinge ， local skin temperature high ， deep
press pain 。 When forming abscess under periosteum and parenchy
ma abscess ， local red 、 swell 、 hot 、 pain is evident 。
 If close to joint ， it is possible that is reactive joi
nt hydrops.

 pathology fracture.

 Course of disease 3 － 4weeks 。 When abscess g

o through bone ， pain ease immediately ， tem
perature 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, acut
e.
 Local persisted pain ， don`t like activity
 Metaphyseal has deeply press pain

Leccocyte 、 neutrophil count increase
 Local delamination puncture check （ + ）
 Differentiating dignosis

 acute cellulitis

 deep abscess

 Rheumatism and pyogenesis arthritis

 Bone marcoma and Ewing`s marcoma

 Parenchyma and deep abscess systemi
c symptoms gentle ， local red swell evident ， any part c
an be found 。 However acute osteomyelitis were found at
long bone metaphyseal.

 Rheumatism and pyogenesis arthritis pai

n place at joint ， may has joint hydrops

 malignancy commonl
y disease come on slowly ， place at backbone ， surfa
ce has varicose blood vessel ， can touch tumor ， if nece
ssary, biopsy
 Treatment principle

 Prevent poisoning shock and infection

 Local treatnent as early as possible ，
fend heal at acute period
 Prevent forming sequestrum→chronic
osteomyelitis
 Treatment
 Systemic sustainning therapy
 Applying antibiotics
 Local treatment
 Limb fixing
 Therapy

1 、 Applying antibiotics
 Forepart, unite, sufficiency
 Both systemic and local symptom are disappear before x-ray
change
 Both systemic and local symptom are disappear after x-ray ch
ange, that explains bone abscess were controlled basically
 Mentioned above need not operation ,but antibiotics should b
e used over 3 weeks continually
 Systemic symptoms disappear, but local sy
mptoms heave, that explains antibiotics don
ot perish bone abscess, need operation drain
age.
 Both systemic and local symptoms heave ex
plain that pathogen possess anti-drug; have
abscess-formed; form migrated bone absces
s.
二、 operation therapy
 objectiveness ： drainage abscess ， decrease
pyaemia symptom ； hinder change to chronic
osteomyelitis.
 After antibiotics therapy 48-72 hours donot co
ntrol 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.
 Only one closed suction drainage
 Wound doesn't sew ， fill iodoform voile strip ， after 5-1
0 days remake delay sew.
3 、 systemic assistant therapy
lower temperature 、 liquid transfusion 、
blood transfusion

4 、 local assistant therapy

skin traction or plaster fixing ； prevent join
t contracture malformation ； prevent pathol
ogy 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
 Spread by blood 通过血液途径
 Parenchyma infection Close to centrum infect dir
ectly to centrum 邻近脊椎的软组织感染直接
侵犯
 Spreaded by lymph 经淋巴引流蔓延至椎体
 The disease is most found in adult ， lumber is No
.1.

 Mostly pathological changes are located at centru

m, spread to intervertebral disc and close vertebral
. Mostly to be abscess beside vertebral, at lumber
be psoas major abscess, at cervical be pharynx ba
ck wall abscess. Pathological changes develop rapi
dly, and form ossify bone, at last fuse to be bone b
ridge.
Clinic behave

 Disease come on rapidly ， chill 、 high-fever ， pyaemi

a evident.

Lumbago backache or nape ache evident ， keep the bed
， don't turn over or turn neck.

Paraspinal muscle spasm ， knock ache.
 In forepart, x-ray hasn't change commonly, at least
after one month, vertebras appear destroyed.

 After x-ray change, disease develops very rapid, can

find abscess beside vertebral, and form ossify bone.

 CT and MRI can find destroy in advance and abscess

beside vertebral muscle.
 Treatment
 Applying sufficient 、 effective antibiotic
 Greater abscess beside vertebral——drain
age
 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
 Infecction approach
stain by operation instrument
Spreaded by blood
Vertebral gap infection stained by oper
ation 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 ， p

yaemia evident, waist-back ache heave, and exist ner
ve root excite symptom.
• Waist muscle spasm and tenderness ， restricted ran
ge of motion.
 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 lu

mbar. Disease come on slowly ， fever 、 inappetenc
e and so on ， lumbar pathology change exist both w
aist-back ache and sciatica.
 Waist muscle spasm and tenderness ， restricted rang
e of motion.
antibiotic 、 plaster bed treat——symptom decreas
e
Excess action 、 stop treatment——symptom recur
、 heave
Course of disease tend chronic.

During fever, leucocyte count increase.

Erythrocyte sedimentation rate(ESR) go up continu

ously that explain pathology change has not been co
ntrolled.
 X-ray show
1. During forepart 3 months, vertebral gap change nar
row
2. Next 3 months ， shows subchondral bone develop
ing ossify ， close vertebral density increase.
3. Close vertebral ossify developing, irregularly that
explains inflammation are developing.
4. Intervertebral show change like ballon and vertebra
l erosion ， and look out close vertebral density ch
ange.
 Half case pathology change was limited in i
ntervertebral
 Other half pathology change inflammation s
pread to close vertebral, show forming bone
bridge ， few happen bone fusion.
 Non-operation treatment 手术治疗
 Antibiotics and systemic sustaining therapy
 Patient who donot bear Nerve root exciting sympt
om can suck intervertebral or remain draining tub
e.
 Operation treatment
 Paraplegic patient 已出现截瘫的病人

 Vertebral excision decompression and intralesion

al resection. 椎体切除减压术和病灶清除术。