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病例报告:手术治疗骨折后颅面骨骼广泛骨髓炎

Case Report: Extensive Osteomyelitis of the Craniofacial Skeleton Following Operative Fracture Treatment.

作者信息

Jovanović Anđelina, Valjarević Svetlana Z, Vučić Sanja, Jovanović Milan B

机构信息

Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center "Zemun", Vukova 9, Belgrade, Serbia.

Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

出版信息

Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3703-3706. doi: 10.1007/s12070-024-04707-7. Epub 2024 Apr 26.

Abstract

Osteomyelitis is a bone inflammation caused by an infectious microorganism, which may lead to complete structure decay. Over time, along with the discovery and usage of powerful antibiotics, it became a rare occurrence in modern practice. In this paper, we will present a case of a patient with craniofacial osteomyelitis, which occurred as a complication of previous trauma and incomplete surgical treatment, due to lack of compliance. Chronic diseases in the non-cooperative patient led to the development of a severe clinical state. We believe that the existence of communication between defects on the anterior wall of the frontal sinus and corresponding subcutaneous and cutaneous tissue may have prevented further complications, in particular endocranial. Despite of a severe local finding, there was no dramatic increase in inflammatory parameters in laboratory analysis, as expected in such cases. A careful diagnostic procedure, identification of causative agent, adequately applied antibiotic therapy followed by surgical treatment debridement, improved the general condition of the patient as well as local finding. A severe form of osteomyelitis of the facial bones can be a complication after facial bone osteosynthesis. The absence of endocranial complications can be explained by drainage of purulent content through defects in the skin of the face. Quick and precise diagnostics, followed by treatment that includes a combination of surgery and conservative treatment, give the best results in such complex conditions.

摘要

骨髓炎是由感染性微生物引起的骨炎症,可能导致结构完全破坏。随着时间的推移,随着强效抗生素的发现和使用,它在现代医疗实践中已很少见。在本文中,我们将介绍一例颅面骨髓炎患者,该病例是先前创伤和手术治疗不彻底的并发症,原因是患者依从性差。该不合作患者的慢性病导致了严重临床状态的发展。我们认为,额窦前壁缺损与相应皮下和皮肤组织之间存在连通可能预防了进一步的并发症,尤其是颅内并发症。尽管局部症状严重,但实验室分析中的炎症参数并未如预期那样显著升高。仔细的诊断程序、确定病原体、充分应用抗生素治疗,随后进行手术清创,改善了患者的总体状况以及局部症状。面部骨骼骨髓炎的严重形式可能是面部骨骼骨合成后的并发症。没有发生颅内并发症可通过面部皮肤缺损处的脓性分泌物引流来解释。快速而精确的诊断,随后采用手术和保守治疗相结合的治疗方法,在这种复杂情况下能取得最佳效果。

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本文引用的文献

1
Osteomyelitis of flat bones: A report of 20 cases and review of the literature.扁骨骨髓炎:20例报告及文献复习
J Clin Orthop Trauma. 2019 Nov-Dec;10(6):1116-1120. doi: 10.1016/j.jcot.2019.03.022. Epub 2019 Mar 30.
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Cranial Osteomyelitis: A Comprehensive Review of Modern Therapies.颅骨骨髓炎:现代治疗方法的全面综述
World Neurosurg. 2018 Mar;111:142-153. doi: 10.1016/j.wneu.2017.12.066. Epub 2017 Dec 15.
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