化脓性关节炎（Purulent arthritis）.docVIP

化脓性关节炎（Purulent arthritis） Septic arthritis is a septic infection of the joint. More common in children, good hair in the hip and Qi joints. Etiology: the most common pathogenic bacteria are Staphylococcus aureus, accounting for about 85%; followed by white staphylococcus, Neisseria gonorrhoeae, pneumococcus and enteric bacilli. The bacteria enter the way joint: hematogenous spread: purulent lesions in other parts of the body through the blood circulation to the spread of bacteria in the joint; the nearby adjacent joint purulent lesions spread directly to the joint cavity, such as femoral or iliac bone osteomyelitis spread to hip joint; the open joint injury infection; the iatrogenic infection: infection after joint surgery and after intra-articular injection of corticosteroid. This chapter describes only hematogenous purulent arthritis. Pathology: the development process of septic arthritis can be divided into three stages. These three stages sometimes evolve slowly, and sometimes develop rapidly and are difficult to distinguish. 1. serous exudate stage: when the bacteria enter the joint cavity, the synovial membrane is obviously hyperemia and edema, with white blood cell infiltration and serous exudate. The exudate contains large amounts of white blood cells. There is no destruction of articular cartilage in this period. If the treatment is in time, the exudate can be completely absorbed without leaving any joint dysfunction. The pathological change of this period is reversible. 2. serous fibrinous exudate stage: the lesion continues to develop, the exudate becomes cloudy, the number increases, and the cell increases. Synovitis occurs because of the presence of enzymes in synovial fluid and increases the permeability of the blood vessels. A large amount of fibrin appeared in the synovial fluid. Fibrin deposition on articular cartilage can affect cartilage metabolism. White blood cells release a large number of lysosomes, which can destroy the cartilage matrix and