Osteomyelitis
Osteomyelitis (こつずいえん) is inflammation of the marrow. Almost none of the things due to the bacterial infection. A pathogen includes a staphylococcus, Pseudomonas aeruginosa, Staphylococcus epidermidis, MRSA. I am said to be purulent osteomyelitis. I am divided chronically if acute.
Table of contents
Summary
The microbes such as bacteria infect the organization of the bone and fester, and are an intractable disease.
Bacteria reach the marrow to a case and bloodstream that bacteria are in the marrow by the injuries (open fracture, compound fracture, comminuted fracture, surgery, bone marrow aspiration, injury with the gun) of the bone and multiply, and to wake up inflammation and do an increase (hematogenous infection), and it may be osteomyelitis.
In addition, the skin which is a barrier is destroyed for the ulcer of the occurring skin by a local blood circulation disorder (diabetes, bedsore), and the infection to a bone may happen.
Inspection and diagnosis
A blood test and X-ray check become basic. By the blood test, I often make the increase of the white blood-cell count, the sthenia of the blood sedimentation rate, an inflammatory change including the positive of the C-reactive protein (CRP) an index. Furthermore, I may examine bone metabolism with bone metabolism markers such as the alkaline phosphatase. A change is hard to appear with the radiographic appearance, and, in that case, at the initial stage of acute purulent osteomyelitis, image inspection by MRI and the bone scintigraphy is effective. For chronic purulent osteomyelitis, I confirm the range of the lesion by X-ray check, MRI, bone scintigraphy, fistula contrasting (I inject contrast media from the hole where the sea appears). In addition, I gather a bone and the sea of the problem point and perform wound culture and blood culture and identify causative bacteria.
Condition of a patient
Acute purulent osteomyelitis
It is frequent, but is seen in an adult for the newborn baby period and the schoolchild period when it is traumatic. Most happen to thighbone and tibia. It was a disease to die, but ceased to almost die by the development of the antibiotic now once. However, in late years MRSA is transmitted and may become sick and, depending on correspondence of the treatment, falls into a serious state and it becomes chronic and may repeat a recurrence. Problems such as transformation or shortening of lower limbs may happen with growth. Chills, high heat, local sharp pain are main symptoms. I have the slow symptom to be invited to if subacute. The affected part swells up and cannot be going to move hands and feet in the infants. A change does not appear even if I do X-ray check at the initial stage, and image inspection by MRI and the bone scintigraphy is validated. It is important that I make start of therapy as soon as possible.
Chronic purulent osteomyelitis
I become sick for a chronic form from a beginning that an acute thing becomes chronic, and there are a bone tumor and a doubted thing. The chronic form repeats a recurrence and may follow throughout the life.
Method of the treatment
Generally, I rest quietly in bed and do an intravenous injection with an antibiotic for 4-8 weeks. The antibiotic performs an examination of drug sensitivity for the pathogen and uses a drug with the sensitivity. However, resistant bacteria (MRSA) which got the tolerance to a drug may appear. In that case, I change the system of the antibiotic and continue giving it. As a result of such repetition, the situation that most antibiotics do not work for comes out. In that case, the decreases in neutrophils are rarely possible when immunity decreases and becomes dangerously ill. In the case of chronicity, I may give hyperbaric oxygen therapy.
As for the surgical management, 掻破 removes the alien substance of the infection department and skin, the sequestrum organization which necrotized. (デブリドマン), with a wound as an opening state, may perform sustained perfusion (じぞくかんりゅう) for an affected part without sewing it up then. With the sustained perfusion, I drain a saline into the affected part and wash it and perform it for the purpose of exhausting the organization which fell into necrosis. With progress of the time, the granulation tissue of the loss department swells naturally, but removes 掻破 again when an infection sign is not settled.
When a bone defect department is widespread, I transplant a bone from other parts (ilia) and may extend a bone by イリザロフ wound external fixation art when transformation and shortening happen. In this case there is not that a treatment period becomes the unit for several years unusually.
This article is taken from the Japanese Wikipedia Osteomyelitis
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