Ochsner Peter E, Hailemariam Seife
Orthopädische Klinik, Kantonsspital, Liestal, Switzerland.
Injury. 2006 May;37 Suppl 2:S49-58. doi: 10.1016/j.injury.2006.04.009.
The introduction to this paper summarizes the small amount of information currently published on the histological changes that accompany posttraumatic osteomyelitis in man in addition to other information to aid understanding of this topic. The development of three cases of posttraumatic osteomyelitis and the histological analysis of important tissue areas harvested during debridement are described in detail. Two of the patients suffered from diaphyseal fractures, one of which was nailed and the other plated. The third patient had an epi-metaphyseal fracture, which was later plated with the additional use of an autogenous bone graft. The histological examination consisted of embedding the undecalcified tissue specimens in methylmethacrylate and cutting with a diamond saw or a special microtome. Bone necrosis, damaged soft tissue around it, and penetration of bacteria are the prominent etiological features for the onset of osteomyelitis. The distribution of bone necrosis depends mainly on trauma, the care of the surgeon, and the type of osteosynthesis. Loose dead bone and bone pieces demarcated by osteoclastic activity are transformed into sequestra surrounded by tissue that exhibits different infection activities according to the state of spontaneous development or treatment. Remodeling of bone necrosis from the living bone is slow and depends on many factors. New bone formation is mainly subperiosteal, embedding osteomyelitic areas if the periosteum is not destroyed.
本文引言部分总结了目前已发表的关于人类创伤后骨髓炎伴随的组织学变化的少量信息，以及有助于理解该主题的其他信息。详细描述了三例创伤后骨髓炎的发展过程以及清创术中采集的重要组织区域的组织学分析。其中两名患者患有骨干骨折，一名采用髓内钉固定，另一名采用钢板固定。第三名患者患有骨骺 - 干骺端骨折，后来采用钢板固定并额外使用了自体骨移植。组织学检查包括将未脱钙的组织标本嵌入甲基丙烯酸甲酯中，并用金刚石锯或特殊切片机进行切割。骨坏死、其周围受损的软组织以及细菌的侵入是骨髓炎发病的突出病因特征。骨坏死的分布主要取决于创伤、外科医生的护理以及骨固定的类型。由破骨细胞活动界定的松散死骨和骨碎片会转变为死骨片，其周围组织根据自发发展或治疗状态表现出不同的感染活动。来自活骨的骨坏死重塑缓慢，且取决于多种因素。新骨形成主要在骨膜下，如果骨膜未被破坏，会包埋骨髓炎区域。
