Lazzarini Luca, De Lalla Fausto, Mader Jon T.
*Division of Infectious Disease, Department of Internal Medicine, New Trauma Building, Hyperbaric Facility, University of Texas Medical Branch, Galveston, TX 77555-1115, USA.
Curr Infect Dis Rep. 2002 Oct;4(5):439-445. doi: 10.1007/s11908-002-0012-4.
Osteomyelitis is a complex disease that is often associated with high morbidity and considerable health care costs. Bacteremia, contiguous focuses of infection, penetrating trauma, or surgery are the major predisposing factors for this infection. Bone necrosis and bone destruction occur early in the course of osteomyelitis, leading to a chronic process and eliminating the host's ability to eradicate the pathogens. The presence of poorly vascularized tissues, the adherence to bone structures and implants, and a slow bacterial replication rate are recognized as important factors for the persistence of the infection. Treatment of osteomyelitis is particularly challenging and involves adequate antimicrobial therapy and surgical debridement of all necrotic bone and soft tissues. Antibiotic treatment is usually started on an empiric basis and then modified according to the results of cultures and sensitivity tests. Surgical treatment consists of debridement, obliteration of dead space, adequate soft tissue coverage, restoration of blood supply, and stabilization.
骨髓炎是一种复杂的疾病，常伴有高发病率和高昂的医疗费用。菌血症、邻近感染灶、穿透性创伤或手术是这种感染的主要诱发因素。骨髓炎病程早期会出现骨坏死和骨质破坏，导致病程迁延，并使宿主清除病原体的能力丧失。血管化不良组织的存在、对骨结构和植入物的黏附以及细菌复制速度缓慢被认为是感染持续存在的重要因素。骨髓炎的治疗极具挑战性，包括充分的抗菌治疗以及对所有坏死骨和软组织进行外科清创。抗生素治疗通常基于经验开始，然后根据培养和药敏试验结果进行调整。手术治疗包括清创、消除死腔、充分的软组织覆盖、恢复血供以及固定。
