外科-骨和关节的感染性疾病PPT.ppt

Contraindication Active tuberculosis Secondary bacterial infection Poor body condition Operative Technique (1) Arthrotomy (2) Curettage (3) Resection of joints (4) Resection of bones (5) Excision of abscesses, (6) Arthrodesis. Spinal tuberculosis Account for bone tuberculosis 50 % Often occur in children and teenagers Common in thoracolumbar Complication Pathological fracture Sinus canceration Treatment Use antibiotics in acute attack Surgical indications: Sequestrum formation,dead space and sinus suppurate Contraindication： 1. Don’t debride in acute attack, incise and drain only. 2. Large sequestrum forms and bony shell doesn’t form completely. Surgical purposes: clear lesions、eliminate dead space and close wound Preoperative Filling with muscle flap Postoperative Bone graft and fixation Brodie’s abscess Often occur in the metaphysis of long bones（Tibia, femur and humerus） Bacterial virulence is not strong enough and patients are in a high resistance Migratory course of disease ,local pain after exertion or minor trauma and elevated skin temperature X-ray：Metaphyseal cystic changes，sclerosing bone area around（Identification with bone cyst ） treatment：Lesion curettage、bone graft with antibiotic Garré’s Osteomylitis Low venenosus infection of bone tissue and a strong osteogenic response Often occur in the backbone of long tubular bones, especially tibia Chronic episode, local pain and elevated skin temperature X-ray：large areas of dense white shadow.It is difficult to see the narrow bone marrow cavity treatment：window drainage, rinse and debridement and antibiotic beads Osteomylitis after trauma after open fracture, infection after fractures or other bone and joint surgery Acute or chronic Lesions in the vicinity of fracture Acute period：high fever, chills，chronic, nonunion or defect treatment： acute——open wound and drain, debridement, antibiotic , plaster external fixation chronic——drilling ,bone graft and external fixation Pyogen