Tsukayama D T
Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Clin Orthop Relat Res. 1999 Mar(360):22-9. doi: 10.1097/00003086-199903000-00005.
Understanding the pathophysiology of posttraumatic osteomyelitis is crucial as researchers attempt to meet the challenge of developing more effective strategies for the management and prevention of this infection. Some aspects of pathogenesis have been well described, including the important roles of the extent of soft tissue injury, bacterial attachment to necrotic bone and fixation devices, and bacterial contamination at the time of injury. More recently, the importance of early wound coverage in preventing osteomyelitis has been emphasized. Now some of the cellular interactions that promote infection and tissue damage are beginning to be understood. Trauma can have deleterious effects on host response to infection through its activation of certain cytokines. These cytokines, mainly produced by cells of the immune system, regulate the action of polymorphonuclear leukocytes, macrophages, and lymphocytes. Bacteria have been shown to use diverse tactics to initiate and maintain infection that lead to host defense impairment, decreased efficacy of antibiotics, and direct tissue damage. New insights into the pathophysiology of osteomyelitis may lead to the innovative therapeutic approaches needed to improve the standard of care for this infection.
了解创伤后骨髓炎的病理生理学至关重要，因为研究人员试图应对开发更有效管理和预防这种感染策略的挑战。发病机制的一些方面已得到充分描述，包括软组织损伤程度、细菌附着于坏死骨和固定装置以及损伤时细菌污染的重要作用。最近，早期伤口覆盖在预防骨髓炎中的重要性得到了强调。现在，一些促进感染和组织损伤的细胞相互作用开始被理解。创伤可通过激活某些细胞因子对宿主对感染的反应产生有害影响。这些细胞因子主要由免疫系统细胞产生，调节多形核白细胞、巨噬细胞和淋巴细胞的作用。已表明细菌会采用多种策略引发和维持感染，导致宿主防御受损、抗生素疗效降低以及直接组织损伤。对骨髓炎病理生理学的新见解可能会带来改善这种感染治疗标准所需的创新治疗方法。
