Osteomyelitis is a common orthopedic disease, which is an infection and destruction of bone caused by aerobic or anaerobic bacteria, mycobacteria, and fungi. It occurs in the vertebrae, the foot of diabetic patients; the site of penetrating bone injury due to trauma or surgery; the most common site in children is the long bone with good blood supply (such as the epiphysis of the tibia or femur); it can also occur in the sternum, skull and other parts of the body.
1, the pathogenesis of osteomyelitis and clinical classification
The pathogenesis of osteomyelitis has three routes.
(1) Hematogenous infection: most of them have a septic infection lesion that has not been properly treated before the onset of the disease, such as abscess, furuncle, tonsillitis, etc. It accounts for about 51% of clinical cases.
(2) Traumatic infection: such as knife wound, bullet wound, open fracture or closed fracture, or aseptic operation during joint surgery, etc., pathogenic bacteria directly invade bone tissue from the wound, causing osteomyelitis. It accounts for about 33.3%.
(3) spread of infection: that is, directly from the adjacent septic lesions spread to the bone tissue and cause osteomyelitis, such as finger (toe) infection caused by finger (toe) osteomyelitis. It accounts for about 15%.
According to the different clinical manifestations can be divided into the following five categories.
(1) Sclerosing osteomyelitis: Sclerosing osteomyelitis manifests as progressive, extensive hyperplasia and sclerotic inflammatory changes in a segment of the diaphysis or the entire diaphysis.
(2) Acute hematogenous osteomyelitis: Acute hematogenous osteomyelitis is an inflammation caused by septic bacteria that enter the bloodstream from an infected site elsewhere in the body and localize in bone tissue.
(3) Chronic septic osteomyelitis: Chronic septic osteomyelitis generally occurs as a result of improper or delayed treatment of acute hematogenous osteomyelitis.
(4) Traumatic septic osteomyelitis: traumatic septic osteomyelitis is often secondary to developmental fractures and is on the rise with the current trend of traffic accidents and work-related injuries in large buildings, and is a common complication following high-energy fractures.
(5) Medically-derived osteomyelitis: Medically-derived osteomyelitis mostly occurs after surgery, due to the over-reliance of medical personnel on antibiotics and relaxation of aseptic operation, coupled with the low resistance of patients, incurring bacterial invasion.
3, the clinical manifestations of osteomyelitis
The symptoms of acute osteomyelitis are painful bones, fever, severe wasting and fatigue, and also localized redness, swelling and pain. In severe cases, there may be chills, chilling fever of 39-41℃, even delirium, coma and other septic phenomena, and meningeal irritation symptoms may occur. It is often accompanied by anemia, dehydration and acidosis, or even life-threatening.
Spinal osteomyelitis usually has limited back pain with paravertebral muscle spasm, which cannot be relieved by rest, heat therapy and analgesics and is aggravated by activity, and the patient is usually not febrile.
4. Chronic osteomyelitis can develop when acute osteomyelitis is not treated. It usually causes intermittent (months to years) bone pain, pressure pain and sinus drainage, and occasionally small pieces of dead bone are discharged. Sometimes the wound heals temporarily, but the presence of an infected lesion and the spread of inflammation can cause an acute attack with generalized chills and fever, localized redness and swelling, and after incision and drainage, or self-penetration, or drug control, the generalized symptoms disappear and the local inflammation gradually subsides and the wound heals, and so on repeatedly. When the whole body health is poor, it is also easy to cause attacks.
5. Due to repeated inflammation and multiple sinus tracts, there is a greater impact on limb function with muscle atrophy. If pathological fractures occur, there may be limb shortening or angular deformity; if the onset is close to the joint, there are more joint contractures or stiffness. At this time, chronic osteomyelitis is usually accompanied by a variety of microbial infections.
6. Chinese medicine’s understanding of osteomyelitis
Osteomyelitis belongs to the category of “bone gangrene” and “multiple bone gangrene” in Chinese medicine, which is caused by internal injuries or dietary strains, as well as external factors such as six external injuries and external injuries. Gangrene can be caused by excessive emotions or the consumption of fatty foods or weak kidney energy, as well as by external influences such as wind, cold, dampness, and fire, as well as gold trauma and carbuncles. According to the different clinical symptoms and pathological characteristics, it can be divided into three types of evidence: heat and poison injected bone, wound into carbuncle, and positive deficiency of evil invasion.
7. Combined treatment of Chinese and Western medicine can be effective
Western medicine treatment: mainly symptomatic treatment, including: infection control, lesion removal and defect repair. In other words, according to the culture and drug allergy, sensitive antibiotics should be used systemically or locally to control the infection; thoroughly remove the dead bone and the surrounding inflammatory scar and fibrotic tissue with poor blood flow, and remove the inflammatory tissue in the bone marrow cavity; use skin flap, musculocutaneous flap, musculocutaneous flap, etc. to fill and repair the defect, or use heavy combination of artificial bone (such as calcium phosphate bone cement containing tobramycin sulfate, etc.) to fill and repair the bone after the lesion is cleared. The defective area can be repaired with the use of recombined artificial bone (such as bone cement containing tobramycin sulfate).
Chinese medicine treatment: Based on the theory of diagnosis and treatment in Chinese medicine, we adopt the methods of clearing heat and detoxification, activating blood stasis, removing pus and tonifying qi and blood to treat the clinical evidence of “poisonous heat”, “blood stasis”, “pus decay” and “qi and blood weakness”. Commonly used internal sutra prescriptions include: Xianfang Livelihood Drink, Huanglian Detoxification Tang, Tori Disinfection Drink, Bajhen Tang, and Ten Quan Da Tonic Tang. External medicine includes: Jinhuang San (paste), Shuangbai San, Jiuyi Dan, Wuwu Dan, and Shengmu Yan (paste).
The combination of Chinese and Western medicine, the combination of disease and evidence, the combination of local and overall, the treatment of osteomyelitis can achieve good results.
8.Conditioning and diet
Patients with osteomyelitis should elevate the affected limb to help reduce swelling; limit the activities of the affected limb, use external fixation support or brace if necessary to prevent pathological fracture or abnormal activity of the fracture end; for those with wounds, dressings should be changed in a timely manner to keep drainage open; for those with systemic symptoms, corresponding treatment should be carried out in a timely manner.
In terms of diet, we advocate a light and tasty vegetarian diet. Vegetarian food can provide the most natural and easily digested and absorbed nutrients. A reasonable vegetarian diet can provide enough sugar, fat, protein and other nutrients required by the body. Fresh cereals, vegetables and fruits provide plant hormones and fiber to create an alkaline physiological environment for tissue repair. A diet of large fish and meat often makes the blood acidic, leading to impaired circulation in the affected tissues and disruption of bone metabolism, resulting in decalcification or osteoporosis.