外科-骨和关节的感染性疾病课件

InfectiondiseasesofBoneandJoint

LecturecontentPyogenicinfectionofBoneandJointsuppurative

osteomyelitis25’acutehematogenic

osteomyelitis

（keypoint:etiology,diagnosis,treatment）

chronichematogenic

osteomyelitis（keypoint:typicalX-ray,Surgicalindications,contraindication）Brodie’sabscess,Garré’s

Osteomylitis,Osteomylitisaftertrauma（acquaintance）5’infectiousspondylitis（acquaintance）5’Suppurativearthritis（acquaintance）5’TuberculosisofbonesandjointsIntroduction（Masterkey:clinicalfeatures,treatment）15’Spinaltuberculosisandcomplications10’Jointtuberculosis（acquaintance

）5’ABarthrocleisis

LimbshorteningDefinitioninfection

Theprocessofmicrobialmultiplicationwithinhosttissuesleadingtotissuedamageandinflammation.Colonisation

harmlessContamination

Theabnormalpresenceofmicrobesderivedfromtheexternalenvironmentinasite,tissue,structureorsample.InfectionsofBoneandJointPyogenicinfectionSuppurative

osteomyelitispyogenicarthritisSpecialInfection：tuberculoussyphilitic

suppurative

osteomyelitis

refertoperiosteum,compactbone,spongybone,myeloidtissue

AcutechronicPyogenic

osteomyelitis

haematogenous

complicatingopenfractureorsurgeryspreaddirectly

Acutehematogenic

osteomyelitis

Occurmainlyinchildren,adultsrarely

Prognosisisconcernedwithtreatment.EtiologyHemolyticStaphylococcusaureusOthers：betastreptococcus,Escherichiacoli,pneumococcusB

epiphysealplatepusepiphysialcartilageisabarrier,inhibitingthespreadofinfectionJointsarepartiallyorcompletelyinthejointcavityTheinfectionwillbecontrolledearlyinadequatetreatmentclinicalfeaturesChildrenTibia,femur,humerusRapid-onsetmegalgiaHistoryoftraumafeverLocaltendernessElevatedskintemperatureJointeffusionAgoodrangeofmotioninjointX-rayNormalearly2-3weeklater，metaphysealbonebecomesraritas,andlayeredperiostealreactionemergesRadioisotopescanning“cold”lesion：Earlyonset“hot”lesion：afewhoursoraday

PositivebloodculturesThenumberofwhitebloodcellsincreasesESRincreasesLaboratoryExaminationDiagnosisChildren，rapidonsetPaininmetaphysisHighfeverPositivebloodculturesLayeredpuncture*DifferentialDiagnosisPyogenicarthritisRheumaticfeverSyphiliticmetaphysitisBonetumor

Complicationsepticaemia

pyogenicarthritisEpiphysealplateinjuryABAnkylosisLimbshorteningTreatmentTreatmentassoonaspossibleSystemictreatmentLyinginbedAnti-infectiveSurgicalpurposesApocenosis

PainreliefReducetheriskofbonenecrosisPreventthedevelopmentofthechronic*ChronicosteomyelitisAcuteosteomyelitisisoutofcontrolAsinfectionwithlowtoxicity,itisperformedassub-acuteorchronicattheoutsetEtiology*staphylococcusstreptococci,pneumococci,typhoidbacilliPathology

OccurofteninlongbonesBonethickeningLiquorpus,deadboneinthedeadspaceUnhealedsinusinlongterm

ClinicalfeaturesSinussuppuratepainRecurringsinusBonethickeningMultiplesinusorcrustingImageology

X-ray:Bonethickening,Deformityandhardening,

Sequestrumappearstobecompleteisolatedbonepiece,containingirregularborderandsurroundedbydeadspace.Complication

PathologicalfractureSinuscancerationTreatmentUseantibioticsinacuteattackSurgicalindications:Sequestrum

formation,deadspaceandsinussuppurateContraindication：

1.Don’tdebrideinacuteattack,inciseanddrainonly.2.Largesequestrumformsandbonyshelldoesn’tformcompletely.Surgicalpurposes:clearlesions、eliminatedeadspaceandclosewoundPreoperativeFillingwithmuscleflapPostoperativeBonegraftandfixationBrodie’sabscessOftenoccurinthemetaphysisoflongbones（Tibia,femurandhumerus）BacterialvirulenceisnotstrongenoughandpatientsareinahighresistanceMigratorycourseofdisease,localpainafterexertionorminortraumaandelevatedskintemperatureX-ray：Metaphysealcysticchanges，sclerosingboneareaaround（Identificationwithbonecyst）treatment：Lesioncurettage、bonegraftwithantibiotic

Garré’s

OsteomylitisLowvenenosusinfectionofbonetissueandastrongosteogenicresponseOftenoccurinthebackboneoflongtubularbones,especiallytibiaChronicepisode,localpainandelevatedskintemperatureX-ray：largeareasofdensewhiteshadow.Itisdifficulttoseethenarrowbonemarrowcavitytreatment：windowdrainage,rinseanddebridementandantibioticbeadsOsteomylitisaftertraumaafteropenfracture,infectionafterfracturesorotherboneandjointsurgeryAcuteorchronicLesionsinthevicinityoffractureAcuteperiod：highfever,chills，chronic,nonunionordefecttreatment：

acute——openwoundanddrain,debridement,antibiotic,plasterexternalfixationchronic——drilling,bonegraftandexternalfixationPyogenic

spondylitis1、PyogenicvertebralosteomyelitisPathway：blood,adjacentsofttissueandlymphaticdrainageOfteroccurinadult，especiallylumbarspineAcuteonset，toxemia，lumbodorsalpainandparaspinalmusclespasmtreatment：anti-infectionandlyingingypsumbedVertebralspaceinfection

Pathway：surgicalinstrumentsandblood（urinaryinfection）Oftenoccurinadult,especiallylumbarspineChroniconset,fever,lossofappetite、lumbodorsalpaintreatment：*

Nonsurgicaltreatmentmainly（antibiotic、Systemicsupporttherapy）

Operation（resectionanddecompressionofvertebralbody,debridement）Suppurativearthritis

bacterialinfectioninjointOftenoccurinchildrenandteenagerEtiologyCommonpathogens:staphylococcusaureus

Predilectioninjoint：Knee,hipjointHematogenousThespreadofadjacentosteomyelitisJointInjuryIatrogenic：jointsurgeryorjointpuncturePathologyserousperiodserofibrinousperiodpurulentperiodClinicalfeatureChillandhighfeverSwelling,painanddysfunctioninjointJointinasemi-flexionSigns:heat,paininjointandjointeffusionLaboratoryexamination

Leukocytosis，ShifttotheleftPositivebloodculturesBacteriainsynovialfluidcanbeseenbymicroscopicexaminationESRincreasedX-rayEarly：Softtissuearoundthejointisswelling,jointspacebecomeswidenedLate：osteoporosis,destructionofsubchondralbone,jointspacebecomesnarrowDifferentialDiagnosistuberculosisacuterheumaticarthritisrheumatoidarthritistraumaticarthritiscrystalarthropathies(gout)Treatmentbroad-spectrumantibioticinhighdoseIntra-articularinjectionofantibioticJointlavage

IncisionanddrainageofjointContinuouspassivemotionofthejointJointorthopedicsurgery*Tuberculosisofbones

andjoints80%age<30yearsoldSecondarytopulmonarytuberculosis50%occurinspinaltuberculosisPathologySynovialmembranebecomeshyperemia,andthickeningearly.Advanced

articularcartilagedamageClinicalfeatureFever,cough,emaciated,poorappetiteSinglelesion“NightCry”Jointispain,swellingandactivityconfinedColdabscessesMixedinfectionSpinalcordcompression,paralysisPathologicaldislocationandfractureLaboratoryexamination

ESR,WhitebloodcellcountCultivationofMycobacteriumtuberculosisImageology

X-ray:normalearlybonescanning:sensitive,non-specificMRIandCT：EarlydiagnosisSystemictreatmentSupportivecareAnti-TBdrugtherapyLocaltreatmentBrakingLocalinjectionSurgicalIndicationsLargeabscessSustainedsinusIntramedullarypressureistoohighProgressofthediseaseSpinalinvolvementandspinalcordcompressionContraindicationActivetuberculosisSecondarybacterialinfectionPoorbodyconditionOperativeTechnique(1)Arthrotomy

(2)Curettage(3)Resectionofjoints(4)Resectionofbones(5)Excisionofabscesses,(6)Arthrodesis.SpinaltuberculosisAccountforbonetuberculosis50%OftenoccurinchildrenandteenagersCommoninthoracolumbarPathologyCentraltypePeripheraltypeParavertebralabscessesMetastaticabscessesClinicalfeaturePainRigidityMalformationColdabscessParaplegiaX-ray:EarlyintervertebralspacebecomesnarrowingDestructionofadjacentvertebralbodyVertebralcollapse

ParavertebralabscessPeripheraltypeCentraltypeDifferentialDiagnosisAnkylosing

spondylitisPyogenicvertebralinfectionsHerniaofintervertebraldiscTumorEosinophilic

granulomaDegenerativespinaldiseasesTreatmentRestinbedAnti-tuberculosistreatmentLieingypsumbed3monthsSurgicaltreatmentAbscessdrainageDebridementCorrectionofdeformitySpinaltuberculosiswithparaplegiaIncidence10%CommoninspinaltuberculosisPathogenesisEarlyparaplegiaabscess,granulationtissue,compressionofspinalcordbynecrotictissue,arterialembolismLateparaplegiaScartissue,deformity,dislocationClinicalfeatureInstabilityofgaitKneereflexincreasesAnklespasmsTreatmentanteriordebridement,decompressionandfusion

HipjointtuberculosissecondonlytovertebralcolumnPredilectionforchildrenClinicalfeatureLowfever,Lossofappetite,emaciationKneePain、swelling、ClaudicationNightcryColdabscessPathologicaldislocationLowerlimbshortening“4”sign,ext