外科學(xué)課件-骨與關(guān)節(jié)化膿性感染

外科總骨與關(guān)節(jié)化膿性感染Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL教學(xué)大綱1.掌握骨與關(guān)節(jié)急性化膿性感染的發(fā)病機(jī)理、早期診斷及治療原則。2.熟悉化膿性關(guān)節(jié)炎的病理、臨床表現(xiàn)和鑒別診斷。3.了解慢性血源性骨髓炎的病理、診斷、手術(shù)適應(yīng)癥和禁忌癥。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL()化膿性骨髓炎(osteomyelitis化膿性致病菌引起骨組織的炎癥常見致病菌:金黃色葡萄球菌(75%)、溶血鏈球菌(10%)常見感染途徑:血源性感染、創(chuàng)口感染、軟組織蔓延localspreadfromadjacenttissuesTeethandgumsUpperrespiratorytGastrointestinaltractsynovium-septicarthritisDirectinoculationdirectinoculationenetratinginjuryValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL急性血源性骨髓炎acutehematogenousosteomyelitis好發(fā)部位:長骨干骺端,股骨、脛骨最常見好發(fā)年齡:15歲以下兒童病因:常見致病菌:G+金黃色葡萄球菌、乙型溶血性鏈球菌VascularanatomyhematomaHostdefense骨養(yǎng)organismvirulence圖73-1小兒長骨干暫端直管分布示意圖Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLHostdefenseOrganismNormalvirulentImpairedMetaphysealNormalbacteria●High米米米米SpontaneousresolutionBoneabscessDefenseVirulenceDefenseVirulenceTime↑∠ClassicacuteosteomyelitisOsteomyelitis-impairedhostDefensevirulentDefenseNonvirulentpathogenTimeTimeValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL急性血源性骨髓炎acutehematogenousosteomyelitis病理:入膿液擴(kuò)散入骨質(zhì)破壞、死骨形成入骨膜增生、新骨形成joint膿液形成與擴(kuò)散metaphysisMedullarySubperiosteumspac●cavityValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL圖73-4血源性骨髓炎常見的病灶部位圖73-3長骨血管正常類型a.嬰兒期:b.兒童期:①骺板位于關(guān)節(jié)囊外者穿破骨皮質(zhì)形成a.嬰兒期;b.兒童期;c.成年期膜下膿腫;②骺板位于關(guān)節(jié)囊內(nèi)者易進(jìn)入關(guān)節(jié)腔;c.成年期EarlyinfancyChildhood膿液形成與擴(kuò)散:不同年齡的差異cmValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL急性血源性骨髓炎acutehematogenousosteomyelitis骨質(zhì)破壞、死骨形成原因:骨膜血供或滋養(yǎng)血管破壞、細(xì)菌毒力與炎癥破壞死骨轉(zhuǎn)歸:竇道口排出、手術(shù)清除、長期存留體內(nèi)骨膜增生、包殼骨形成骨膜的反應(yīng)增生包殼骨上可再破壞——骨瘺孔圖73-5死骨與包殼形成Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL急性血源性骨髓炎acutehematogenousosteomyelitis臨床表現(xiàn)年齡:兒童多見部位:脛骨上段、股骨下段多見誘因:常有外傷史原發(fā)性病灶多找不到起病急驟全身表現(xiàn):全身感染表現(xiàn)局部癥狀與體征:取決于所處階段自然病程:3-4周Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL急性血源性骨髓炎acutehematogenousosteomyelitis膿腫不同時期局部表現(xiàn)(骨內(nèi)膿腫形成期)紅↓腫↓熱↑痛↑壓痛↑(骨膜下膿腫形成期)紅↑腫↑↑熱↑痛↑↑壓痛↑↑(軟組織深部膿腫期)紅↑↑↑腫↑↑↑熱↑↑↑痛↓壓痛↑↑↑髓腔擴(kuò)散:腫脹與疼痛更明顯破入關(guān)節(jié):關(guān)節(jié)腫脹與活動受限更明顯病理骨折:骨折的局部表