Ochsner P E
Abteilung für Orthopädie und Traumatologie, Kantonsspitals Liestal.
Ther Umsch. 1990 Jul;47(7):597-605.
The chronic infection following internal fixation may develop in a different pattern, according to the risk factor involved. There is no doubt that direct trauma on bone and soft tissue is an important risk factor. The pattern of each infection may differ according to the technique of internal fixation used, i.e. external fixator, plate or intramedullary nailing. The damages are minimized by using the appropriate technique. While bone necrosis in osteomyelitis is present, the pattern of it may be changing. An infected non-union may occur in osteomyelitis (osteitis) when present before bone-healing took place. Should infection overlast the bone-healing period, the localization of the main focus is determinant for the outcome of the infection. The assessment of an osteomyelitis consists in the evaluation of the patient's general aspect and the extension of the infectious disease. Assessing it by plain radiographs, it might be accompanied by leucocyte scanning, CT-scan or MRI. The indication of a more aggressive treatment of chronic osteomyelitis is given in all cases of infected nonunion, chronicle fistulation and in presence of pain and contractures. Antibiotics should only be used in addition to a surgical procedure.
内固定术后的慢性感染可能会根据所涉及的风险因素呈现出不同的模式。毫无疑问，骨骼和软组织的直接创伤是一个重要的风险因素。每种感染的模式可能因所使用的内固定技术而异，即外固定器、钢板或髓内钉固定。通过使用适当的技术可将损伤降至最低。虽然骨髓炎中存在骨坏死，但其模式可能会发生变化。在骨愈合之前就存在骨髓炎（骨炎）时，可能会发生感染性骨不连。如果感染持续超过骨愈合期，主要病灶的定位将决定感染的结局。骨髓炎的评估包括对患者总体状况和传染病范围的评估。通过X线平片进行评估时，可能还需要进行白细胞扫描、CT扫描或MRI检查。对于所有感染性骨不连、慢性瘘管形成以及存在疼痛和挛缩的病例，均需采取更积极的慢性骨髓炎治疗措施。抗生素仅应在手术治疗的基础上使用。
