创伤后骨髓炎的诊治进展

Progress in diagnosis and treatment of post-traumatic osteomyelitis

创伤后骨髓炎(post-traumatic osteomyelitis,PTO)是骨感染最常见的形式之一,多继发于机械损伤、交通意外等造成的开放性骨折,也是开放性骨折术后感染的主要表现形式。创伤后,细菌侵入骨组织并大量繁殖,从而导致骨髓炎的发生。患者常表现为患肢疼痛、功能丧失,甚至可因病截肢,导致劳动能力丧失、生活质量降低。由于诊断与治疗的不及时,感染常常慢性化,从而加大了临床治愈的难度,也使得患者及其家庭背负沉重的经济负担。因此,该疾病的诊断与治疗是骨科医师关注的难点。近年来,CT、MRI等影像学手段与免疫学技术等结合运用,显著提高了诊断的准确性与早期诊断的能力。基因芯片、二代测序等诊断新技术的应用也使得诊断更为便捷且灵敏度高。Ilizarov技术、Orthofix LRS技术等重建修复手术方法的运用为骨科医师与患者提供了疾病治疗的方向。

Post-traumatic osteomyelitis is one of the most common disorders of bone infection,which is secondary to open fracture caused by machinery injury,traffic accident,and it is also the main manifestation in the postoperative infection of open fracture.After trauma,bacteria invade bone tissue and reproduce rapidly in large quantities,which easily leads to osteomyelitis.Patients are often complaint of pain at the affected limb,loss of function,or even amputation due to deteriorated infection,resulting in loss of labor capability and poor quality of life.Because the diagnosis and treatment are not timely and standard,the treatment for post-traumatic osteomyelitis is often delayed,resulting in the difficulty of clinical cure.It also makes patients and their families bear a serious financial burden.However,the diagnosis and treatment for this disease is difficult for orthopedic physicians.In recent years,imaging methods(such as CT and MRI)combined with immune techniques have significantly improved the diagnostic accuracy and early diagnosis ability.The application of new diagnostic technologies(such as gene chip and second-generation sequencing)also makes the diagnosis more convenient and sensitive.The novel reconstruction and repair surgery(such as Ilizarov technology and Orthofix LRS technology)provides new treatment direction for orthopedic surgeons and patients.