2 English reference suppurative osteomyelitis [Chinese medicine terminology examination and approval Committee. Terminology of Traditional Chinese Medicine (2004)]
Attached bone abscess [Chinese medicine terminology review Committee] Terminology of traditional Chinese medicine (20 13)]
Suppurative osteomyelitis [Chinese medicine terminology Committee]. Terminology of traditional Chinese medicine (20 13)]
3. Summarize bone adhesion abscess, bone carbuncle and necrotic bone. It refers to a purulent disease in which toxic pathogens invade deeply and attach to bones [1]. This is headless gangrene. It is characterized by long bones in limbs, local swelling, tendons attached to bones, not pushing straight, painful bone marrow, pus after collapse, difficult closure, sinus formation, muscle injury and bone movement. "Prepare for a thousand gold prescriptions" says: "Because it is not broken, it is attached to the bone and becomes pus, so it is named attached to the bone."
Attached gangrene has different names according to the location of the disease: if it is born outside the thigh, it is called attached gangrene; Born in the inner thigh, called osteonecrosis; Only those born in femur are called gangrene of femur and tibia. Although the name of the disease is different, the location of the disease is long bones in limbs, and the etiology, syndrome and treatment are basically the same.
It is equivalent to purulent osteomyelitis in western medicine [1].
4. The etiology and pathogenesis of gangrene caused by improper treatment and nursing after furuncle, furuncle and carbuncle; Or measles, scarlet fever, typhoid fever and other diseases, patients with liver and kidney deficiency, qi and blood deficiency, damp-heat toxicity, deep into the human body, stranded bones and muscles, blocked meridians, qi and blood disharmony, blood coagulation, toxin accumulation to form gangrene.
Or because of trauma, especially open fracture, local bone injury, secondary infection with pathogenic toxin and heat, resulting in meridian obstruction. Blood puts bones and muscles in trouble.
"Treatise on Febrile Diseases" Volume 32: "Carbuncle attached to bone is also caused by body heat and wind cooling. Wind-cold is in tendons, competing with hot air, and close to bones, resulting in carbuncle. Its shape is headless, but it is swollen and wide, and its skin is thin and shiny, which is called bone carbuncle. " It is caused by pathogenic factors that go deep into the bone [2].
Conclusion of Pathogenic Qi Depression (Volume 33): "Those who are attached to bone gangrene will get rid of the wind, and wind and heat will struggle with each other, and they will encounter cold and dampness, or they will lie in cold in summer and autumn, and wind and heat will stagnate, and gangrene will occur with bone attached. I am happy in the big festival. My husband and mother are happy with the xx head and xx knee of the mouse. The baby is tender and awkward. "
The volume of Essentials of Surgery says: "gangrene is deeper than poison gas. Attached to the bone. "
The symptoms of bone gangrene are: sudden onset, general weakness and fatigue, followed by chills, high fever and sweating, but the fever does not decrease, eating less, yellow and greasy fur, red pulse, even nausea and vomiting, the pain in the affected area is like a cone, redness and swelling, and activity is limited. [2].
5. 1 acute osteomyelitis is the name of the disease [3]. Refers to acute onset, chills and high fever, local swelling and pain, or gangrene in the abscess formation stage [1]. Acute gangrene often occurs in the long bones of limbs, local swelling, sticking the bones with tendons, pushing them, hurting the bone marrow, dripping pus after ulceration, which is not easy to close, and can become a sinus and damage the bones and muscles [3].
5.2 Chronic pyogenic osteomyelitis is the name of the disease [4]. Refers to the gangrene attached to bone caused by acute extension or open fracture poisoning, which is characterized by sinus formation, pus discharge or dead bone [1]. Chronic gangrene often occurs in the long bones of limbs, local swelling, sticking the bones with tendons, pushing them, hurting the bone marrow, dripping pus after ulceration, which is not easy to close, and can become a sinus and damage the bones and muscles [4].
Diagnosis of adnexal gangrene
Osteogangrene is common in boys aged 2 ~ 10. It is more common in long bones of limbs, and the main site of disease is tibia, followed by femur, humerus and radius.
Sudden onset, first general malaise, chills, high fever of 39℃-40℃, dry mouth, redness and constipation; At first, the pain in the affected limb was biting, and he could not move for 1-2 days. Followed by skin redness and slight fever, fat swelling and bone swelling. If it occurs in the thigh, the swelling is not easy to detect, and there is deep tenderness and tapping pain at the diseased bone end, which can be used as an important basis for early diagnosis of this disease. About 3-4 weeks after the onset of suppuration, at this time, the body heat continues, the local color is red and swollen, and the bone swelling is obvious. After suppuration, the pus is concentrated first and then diluted, and it keeps dripping. If it is not closed well, it becomes a sinus. The affected part can touch the rough and uneven bone, and it can often touch the rough and dead bone when it is explored with medical thread or probe. It will turn into chronic gangrene at this time. After that, it often recurs, suppurates, the fistula does not heal for a long time, or it heals for a long time, and there are often wet sores, pustules and pigmentation around the sinuses. Sinus is sunken, and the dead bone may be a large piece or a few small pieces. The small ones can often be discharged by themselves, and the big ones can't be discharged by themselves. The wound can only heal after the dead bone is discharged.
Auxiliary examination: white blood cell count is as high as 30X 1, neutrophils are 80%-90%, erythrocyte sedimentation rate is accelerated, and blood bacterial culture is often positive. 99m technetium -—MDP,'? Gallium bone imaging is helpful for the early diagnosis of the disease. About 2 weeks after the onset, X-ray films often show the vague area of epiphysis and obvious periosteal reaction, and cystic soft tissue shadow can be seen. After several weeks, images of bone destruction, peripheral bone atrophy, formation of dead bones and empty shells can appear, and then hardened dead bone shadows can be seen. Compared with X-ray examination, CT examination can obviously find the focus earlier, and can clearly show the changes of soft tissue and determine the location of inflammation.
6. Diseases that need to be differentiated from gangrene 6. 1. The flow occurs in deep muscles, and there is no tendon attached to the bone; It has the characteristics of not healing in one place and rising elsewhere; Generally, the bones will not be damaged after ulceration, so the course of disease is shorter and the healing is faster.
6.2 Phlegm usually occurs between bones and joints; At first, local and systemic symptoms were not obvious; Slow suppuration, about 6 months to 1 year or more; After the collapse, the pus is clear and thin, and there are flocculent substances in it. It often leads to disability.
Treatment of gangrene in the early stage of gangrene, if pus is not exhausted, it should be mainly eliminated. It is advisable to clear heat and detoxify, promote blood circulation and dredge collaterals, and choose Xianfang Huosheng Decoction, Huanglian Jiedu Decoction, or Wuwei Disinfection Drink. , apply gold powder or cypress powder locally; If the pus has developed but not festered, it should be supported mainly, and Tory should penetrate the pus. You can only add or subtract Tori Disinfection Drink, partially cut pus and discharge it, or treat it by other methods [2].
If cold and heat come and go, it is advisable to clear away heat and dry dampness, remove blood stasis and dredge collaterals, and you can choose Xianfang Huosheng Decoction or Hexingxiao Pill for oral administration.
If purulent or mature, it is advisable to clear away heat and dry dampness, help poison and nourish the stomach, and take Huanglian Jiedu Decoction orally to add flavor; If patients see the symptoms of deficiency of both qi and blood, they should replenish blood and qi, and then choose Bazhen Decoction or Shiquan Dabu Pill. If pus is produced, it should be cut and drained; If you see dead bone forming in the sore, take out the rotten bone with surgical forceps; If the sinus is formed, it is advisable to expand the wound by surgery, remove the hard wall of the sinus and drain it with medicine twist; If the wound is ruddy and the pus will be exhausted, apply Shengji powder instead and shut up.
8. 1 Damp-heat stagnation syndrome refers to damp-heat stagnation, characterized by chills and high fever, bone pain in the affected limb, immobility, followed by local swelling, skin color unchanged, burning, obvious bone tenderness and percussion pain in the affected limb, yellow tongue coating and rapid pulse.
8. 1. 1 Symptoms include: sudden onset, biting pain in the affected limb, fat swelling, bone swelling, reddish and slightly hot skin, and burning sensation according to it; Chills and high fever, headache, loss of appetite, dry mouth and red face; Red tongue, yellow greasy fur and slippery pulse.
8. 1.2 Dialectical analysis: Damp-heat pathogen is contained in bone, which makes meridians impassable and qi and blood stagnate. If it is impassable, it will be painful, and the pain will be fatal, and the bone swelling will be swollen; Damp-heat toxin is depressed in bones and muscles, and the disease is deep, so the skin is reddish and slightly hot; Damp-heat stagnation, the dispute between good and evil, so I am afraid of cold and high fever; Headache, anorexia, dry mouth, dark blue tongue, red tongue, yellow greasy fur and slippery pulse are all symptoms of damp-heat and blood stasis.
8. 1.3 Treatment of clearing heat and promoting diuresis, removing blood stasis and dredging collaterals.
8. 1.4 Prescription treatment of Xianfang Huoming Decoction and Wushen Decoction.
8.2 Bone-attached deprivation with excessive heat toxicity refers to excessive heat toxicity, which usually occurs about 1 ~ 2 weeks after onset, and is characterized by persistent high fever, swelling of limbs, severe pain, redness of skin, burning, pus discharge, yellow and greasy tongue coating and rapid pulse.
8.2. 1 Symptoms begin about 1 ~ 2 weeks later, with persistent high fever, swelling and redness of the affected limb, severe pain, redness and burning of the skin, and a sense of fluctuation; Red tongue, yellow fur, and rapid pulse.
8.2.2 According to dialectical analysis, damp-heat toxin accumulates for a long time and turns into heat, and heat toxin accumulates in bones, and local qi and blood stagnate, so the limb is swollen, red and burning; Heat is better than rotten meat, and rotten meat is pus, so the local pain is intense and there is a sense of fluctuation; Heat toxin is blazing, so it is high fever; Red tongue, yellow fur and rapid pulse are signs of excessive heat toxicity.
8.2.3 Method of clearing heat, promoting diuresis and nourishing poison.
8.2.4 Prescription treatment of Huanglian Jiedu Decoction and Wushen Decoction.
8.3 Septic bone-attached abscess refers to the bone erosion caused by sepsis. After collapse, the acute symptoms are gradually relieved, and the muscles of the affected limb atrophy for a long time, and the thick bones can be touched. When examining with a probe, you can often feel thick dead bones, which may be accompanied by fatigue, mental fatigue, dizziness, palpitations and so on.
8.3. 1 Symptoms: leakage after collapse, pus dripping endlessly, persistent healing, sometimes healing, muscle atrophy of the affected limb, touching thick bone, and probe examination often touching thick dead bone; Accompanied by mental fatigue, pallor, dizziness, palpitation, low fever; The tongue is red, the fur is thin and white, and the pulse is thin.
8.3.2 Dialectical analysis shows that pus is produced from qi and blood, and the pus flows for a long time, but the evil toxin stays for a long time, which consumes qi and blood, leading to the loss of vital qi and lingering evil toxin, so the pus will not heal for a long time and drip endlessly; Deficiency of qi and blood, weakness of spleen and stomach, qi deficiency and fatigue, so mental fatigue, pale face, dizziness and palpitation; Pale red tongue, thin white fur and thin pulse are signs of qi and blood deficiency.
8.3.3 Treatment method regulates qi and blood, detoxifies and eliminates dampness,
8.3.4 Prescription treatment of Tory disinfectant powder.
8.4 Deficiency of vital qi and stagnation of toxin and blood stasis type of bone attachment is to correct deficiency and stagnation of toxin and blood stasis, so as to burst or cut pus by itself, and the pus becomes thick, rancid, with slow fever and pain, or pus is persistent. The common symptom of gangrene is the formation of dead bone, which is difficult to escape, accompanied by asthenic heat, night sweat, soreness of waist and knees, pale tongue, white tongue coating and thready pulse [1].
In the early stage of external treatment, the affected limb was fixed with splint by external application of golden cream or jade ointment to relieve pain and prevent pathological fracture. Early incision and drainage should be performed in suppurative stage, and drainage should be done with Qisandan or yk Dan thread, and red ointment or Chonghe ointment should be used externally. Purulent dressing was changed with Shengji powder and Baiyu ointment.
Those who have formed sinus are corroded with Qianjin powder or wudan thread, and after the wound is enlarged, the wound is covered with Baldan thread, Taiyi ointment or Hongyou ointment, which can also be used for surgical debridement.
10 Western Medicine Treatment 10. 1 Antibiotics Give sufficient and effective antibiotics according to the patient's condition. Penicillins are the first choice, and then effective antibiotics are selected according to the results of blood culture or puncture fluid bacterial culture and drug sensitivity test. Antibiotics should continue to be used for about 2 weeks after hypothermia.
10.2 support therapy and appropriate fluid replacement; Supplementing multivitamins; According to the needs of the disease, a small amount of multiple blood transfusions can be given to enhance the body's disease resistance.
10.3 patients with persistent sinus, abscess formation in bone, too large dead bone or unable to be discharged by themselves were treated by surgery, such as simple focus removal, butterfly surgery, bone cavity filled with pedicled muscle tissue after focus removal, bone skin transplantation with vascular pedicle or anastomosed blood vessels, etc. On the basis of lesion clearance, closed continuous irrigation and suction therapy can also be selected as appropriate.
1 1 Daily health care for gangrenous patients 1. Patients in acute stage should stay in bed, and the affected limb must be supported and fixed with splint or plaster to prevent pathological fracture and relieve pain.
2. Strengthen nutrition and quickly remove fishy hair.
12 About headless gangrene (headless gangrene; Suppurative osteomyelitis and arthritis are the names of this disease [5]. Refers to purulent diseases between bones and joints [1]. Equivalent to suppurative osteomyelitis and suppurative arthritis [1]. Most of them are caused by toxic pathogens, cold coagulation and qi stagnation [5].
Headless gangrene (headless gangrene; Suppurative osteomyelitis and arthritis are the names of this disease [5]. Refers to purulent diseases between bones and joints [1]. Most of them are caused by toxic pathogens, cold coagulation and qi stagnation [5]. Headless gangrene can form fistula; If it happens in long bones, it will damage more bones; It occurs at the joints and is easy to cause deformity.
"The Complete Book of Surgical Treatment Based on Syndrome Differentiation" says: "Vulvar gangrene is the most dangerous disease in surgery, with hard roots and the same skin color, whether it hurts or not."
Clinical common adnexal gangrene and annular gangrene are the representative diseases of headless gangrene.
Headless gangrene is equivalent to suppurative osteomyelitis and suppurative arthritis in western medicine [1].