慢性骨髓炎概要课件

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1、慢性骨髓炎的外科治疗流行病学发病特点----创伤后慢性骨髓炎成为病人的主体，急性血源性骨髓炎转变为慢性者越来越少----但是没有大规模的流行病学资料细菌种类的变化治疗方法和治疗效果的变化临床分类Cierny-MaderClassificationsystemMAYCLASSIFICATIONGENERALPRINCIPLESOFTREATINGPOSTTRAUMATICOSTEOMYELITISFirsttheremustbeadequatedebridementofallinfectedandnecroticsoftandoss

2、eoustissues.Secondantibioticsareusedatthetimeoffracturetopreventinfection,andwheninfectionisestablished,tocontrolinfection.ThethirdprincipleisstabilizationofthefractureThefourthprincipleisablationofdeadspaceThefinalprincipleissofttissuecoverageandbonereconstruction.清创

3、术Debridement术前检查了解病灶范围死骨的范围----MRI放射性同位素----目前尚无一种很好的方法在术前清晰的判定死骨的范围----术中判定----Paprikasign、术中多普勒清创的内容窦道、炎性肉芽组织、脓汁、异物*瘢痕组织（iftissueisofinsufficientvascularityandcannotcontributetowoundhealing,itmustbeconsideredanimpedimenttosuccessandshouldberemovedduringthecourseofde

4、bridement)*死骨对骨的血运的保护，清除死骨的同时不要产生新的死骨*死骨清除必须彻底（Simpson2001APRILJBJS-B）最好应用高速磨钻*对于感染性骨不连采用段截的方法较好抗生素的应用抗生素的选择依据细菌培养的结果----经窦道采集的标本结果不准确，应以术中采集的深层标本为准如细菌培养为阴性，则可选用妥布霉素和万古霉素联合应用，试验治疗抗生素剂量要大，如有条件进行血药浓度监测来指导治疗给药方式：静脉给药4-6周，口服给药4-6周静脉给药1周，口服给药6周（JBJS-B1999november)TheCierny

5、-Maderstagingsystemprovidesanantibiotictreatmentguideline.ForStage1osteomyelitis,a4-weekcourseofantibioticsdatedfrominitiationoftherapyorafterlastmajordebridementsurgeryisused.Stage2osteomyelitisusuallycanbearrestedwhentreatedwitha2-weekcourseofantibioticsaftersuperfi

6、cialdebridementandlocalormicrovascularsofttissuecoverage.Stages3and4osteomyelitisaretreatedwith4weeksofparenteralantimicrobialtherapydatedfromthelastmajordebridementsurgery.Insomeinstitutions,thepatientistreatedwith2weeksofparenteralantibioticsfollowedby4weeksoforalan

7、tibiotictherapy.Withoutadequatedebridement,mostantibioticregimensfailnomatterwhatthedurationoftherapy.FIXATIONPRINCIPLES:Theneedforstabilizationofboneafteradequatedebridementissometimesdifficulttodetermineintraoperatively.Asageneralrule,when70%ormoreoftheoriginalcorti

8、calvolumeremainsintactatthelevelofdebridement,theriskofiatrogenicfractureislowandstabilizationisnotnecessary.1Iftheextentofd