localized bone abscess
Introduction
Introduction to localized bone abscess Localized bone abscess usually occurs in the metaphysis of long bones, and is more common in the tibia, femur and tibia. The main cause of localized abscesses is that when the infection is low and the body's resistance is relatively strong, the infection can be confined to the metaphysis of the bone, forming a localized bone abscess. The cause was first reported by the British doctor Brodie (1880), so it is also called Brodie abscess. The abscess is yellow-white thick pus or granulation, and the pus culture can be free from bacterial growth. The middle part of the abscess is replaced by inflammatory granulation tissue, and in the later stage, infectious scar tissue is formed. basic knowledge The proportion of illness: 0.001%-0.002% (more common in older men over 50 years old) Susceptible people: mostly occur in young adults Mode of infection: non-infectious Complications: osteoarthritis
Cause
The cause of localized bone abscess
(1) Causes of the disease
At present, most of the localized bone abscesses are considered to be caused by bacterial embolism staying at the metaphysis through blood circulation, forming local lesions, and the condition is stable for a long time. Tiredness or minor trauma can cause disease.
(two) pathogenesis
At the time of infection, when the bacteria's virulence is low and the body's resistance is relatively strong, the infection can be confined to the metaphysis of the bone, forming a localized abscess.
Prevention
Localized bone abscess prevention
The disease occurs mostly in young adults, more common in the upper end of the humerus, the lower end of the femur and the upper end, the upper end of the humerus and other long bones, the disease is mainly caused by infection, so pay attention to the usual physical exercise, increase the body's resistance, is conducive to the disease Prevention.
Complication
Localized bone abscess complications Complications osteoarthritis
Complications of this disease are less common, in addition to causing systemic fever, local pain, swelling, heat, such as abscess area destruction and destruction of the area involved in the edge of the bone or cortex, adjacent to the strip periosteal reaction, occasionally dead bone, In some cases, it can also cause osteocortical hyperplasia and osteoarthritis.
Symptom
Localized bone abscess symptoms Common symptoms Abscess bone pain Osteochondral bone sacral cyst
The patient presented with local pain, swelling, heat, and sometimes no discomfort. Once the constitution was poor, it could be a local exacerbation. The X-ray showed a dry cystic lesion, and the surrounding bone was hardened, ranging from 1 to 7 cm in diameter, sometimes in the lesion. There may be small dead bone fragments inside, which can be improved by antibiotic treatment and rest, but can not be cured, easy to relapse, the patient usually has no history of acute hematogenous osteomyelitis, the course of disease is often migratory, lasting for several years, when tired or slight After trauma, local pain and skin temperature rise, rare skin redness, inflammation changes quickly after the use of antibiotics, a small number of cases of inflammation can not control the pus.
Examine
Local bone abscess examination
There is no relevant laboratory examination. The auxiliary examination for this disease is mainly X-ray examination and CT examination:
1, X-ray examination: the performance of the long bones of the metaphysis has an elliptical density reduction area, the edge has a clear bone sclerosis, the lesion and the adjacent normal bone marrow cavity boundary is clear, need to identify with the bone cyst, only a thin layer around the bone cyst Hardened bone.
2. CT examination: CT scan showed that the ward was an oval-shaped low-density shadow with a bone-hardening ring at its boundary.
Diagnosis
Diagnosis and diagnosis of localized bone abscess
diagnosis
According to the clinical manifestations and typical X-ray film performance, the diagnosis can be confirmed.
Differential diagnosis
The disease needs to be differentiated from osteoid osteoma, non-ossifying fibroma and bone cyst:
1, osteoid osteoma
Osteoarthritis is more common in adults aged 20 to 40 years. It occurs in the long bones of the tibia femur, which is similar to that of the backbone cortex. However, osteoid osteoma has persistent localized pain, and its pain is more obvious than that of benign tumors. Ascending pain at night, aspirin can be relieved, check local tenderness, long-term muscle atrophy, X-ray see hardened cortical bone has an oval light shadow - called "sick nest", its long axis usually < 2. 0cm.
2, non-ossifying fibroma
Non-ossifying fibroids are more common in adolescents, but also in long bones such as the femur and tibia. Local pain is generally mild. These are similar to this disease. Non-ossifying fibroids can be located at the metaphysis and also in the cortical bone. In the latter case, the outer shell protrudes thinner, and the base has osteosclerosis thickening, and the tumor area is low-density, and its range is large and small, which is obviously different from the hardening and thickening of the bone infection lesions. .
3, bone cyst
Bone cyst is a common benign bone tumor-like lesion, which is more common in adolescents and children. It occurs in the distal end of the long tubular trunk. The most common site is the femur, the upper end of the humerus, followed by the proximal humerus, the lower end of the femur, the humerus and the ulna. The humerus, calcaneus, talus, humerus, etc., the cause is unclear, most patients have no obvious symptoms, sometimes local pain or local swelling of the limbs, most patients have a pathological fracture after treatment, X-ray lesions are mostly located in the long tubular bone The metaphysis, the medullary cavity presents a central, single-atrial, elliptical translucent area, the edges are clear and hardened, the cortical bone is expanded and thinned to varying degrees, and the closer the cortical bone is to the center of the cyst, the thinner it is.
