骨髓炎的临床表现及中医调治
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在急性血源性骨髓炎，全身症状严重。前躯症状有全身倦怠，继以全身酸痛，食欲不振，畏寒，严重者可有寒战，多有驰张性高热达39～41℃，烦燥不安，脉搏快弱，<span style="color: black;">乃至</span>有谵妄，<span style="color: black;">晕倒</span>等败血症现象，<span style="color: black;">也</span>可<span style="color: black;">显现</span>脑膜刺激症状。此病人<span style="color: black;">常常</span>有贫血脱水和酸中毒。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">（一）发病年龄与部位</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急性血源性化脓性骨髓炎可<span style="color: black;">出现</span>在任何年龄，但以学龄儿童及青少年为多见，新生儿<span style="color: black;">也</span>可<span style="color: black;">出现</span>。男孩较多，可能<span style="color: black;">因为</span>活动多易受外伤<span style="color: black;">导致</span>。以胫骨及股骨为最多，其次为肱骨。外伤性骨髓炎则因外伤<span style="color: black;">状况</span>可<span style="color: black;">出现</span>于任何年龄及部位，战伤中多见。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">（二）症状</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.全身症状 在急性血源性骨髓炎，全身症状严重。前躯症状有全身倦怠，继以全身酸痛，食欲不振，畏寒，严重者可有寒战，多有驰张性高热达39～41℃，烦燥不安，脉搏快弱，<span style="color: black;">乃至</span>有谵妄，<span style="color: black;">晕倒</span>等败血症现象，<span style="color: black;">也</span>可<span style="color: black;">显现</span>脑膜刺激症状。此病人<span style="color: black;">常常</span>有贫血脱水和酸中毒。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">外伤后<span style="color: black;">导致</span>的急性骨髓炎，除非有严重并发症或<span style="color: black;">海量</span>软组织<span style="color: black;">损害</span>及感染等，<span style="color: black;">通常</span>全身症状较轻，感染多较局限而少<span style="color: black;">出现</span>败血症，但应<span style="color: black;">重视</span>并发厌气菌感染的危险。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.局部症状 血源性骨髓炎<span style="color: black;">初期</span>有局部剧烈<span style="color: black;">病痛</span>和跳痛，肌肉有<span style="color: black;">守护</span>性痉挛，肢体不敢活动。患部肿胀及压痛<span style="color: black;">显著</span>。如病灶接近关节，则关节<span style="color: black;">也</span>可肿胀，但压痛不<span style="color: black;">明显</span>。当脓肿穿破骨质、骨膜至皮下时，即有波动，穿破皮肤后，形成窦道，经久不愈。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在外伤性骨髓炎，有开放骨折及软组织<span style="color: black;">损害</span>等，<span style="color: black;">按照</span>局部<span style="color: black;">损害</span>程度，感染范围而有不同表现。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">（三）X线<span style="color: black;">检测</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急性血源性骨髓炎早期<span style="color: black;">没</span><span style="color: black;">显著</span>变化，发病后3周<span style="color: black;">上下</span>可有骨质脱钙、破坏，少量骨膜增生，以及软组织肿胀<span style="color: black;">暗影</span>等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">（四）化验<span style="color: black;">检测</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在急性血源性骨髓炎，<span style="color: black;">初期</span>血培养阳性率较高，局部脓液培养有化脓性细菌，应作细菌培养及<span style="color: black;">药品</span><span style="color: black;">敏锐</span><span style="color: black;">实验</span>，以便<span style="color: black;">即时</span><span style="color: black;">选择</span>有效<span style="color: black;">药品</span>。血化验中白血球及中性多核白血球均<span style="color: black;">升高</span>，<span style="color: black;">通常</span>有贫血。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">应尽早诊断血源性骨髓炎，以便<span style="color: black;">即时</span>治疗。<span style="color: black;">初期</span>诊断<span style="color: black;">重点</span><span style="color: black;">按照</span>临床表现和血培养；如有局部蜂窝组织炎表现，应<span style="color: black;">思虑</span>有骨髓炎并给适当抗菌<span style="color: black;">药品</span>等治疗，必要时，局部穿刺抽取脓液作细菌培养。外伤所<span style="color: black;">导致</span>骨髓炎，<span style="color: black;">按照</span>外伤病史及局部症状<span style="color: black;">就可</span>诊断。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急性血源性骨髓炎应与下列疾患鉴别：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.蜂窝组织炎，全身中毒症状较轻，局部炎症较广泛，压痛范围<span style="color: black;">亦</span><span style="color: black;">很强</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.急性化脓性关节炎，肿胀、压痛在关节间隙而不在骨端，关节动度几乎完全消失，有疑问时，关节腔穿刺抽液<span style="color: black;">检测</span>可<span style="color: black;">知道</span>诊断。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.风湿性关节炎，<span style="color: black;">通常</span>病情较轻，发热较低，局部症状<span style="color: black;">也</span>较轻，病变部位在关节，且常有多个关节受累。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/UGAb2H64KzcGvBpPwR2wtUsWzPmzweCibFO8biczGfoBk2ay6aO5E83fQj1ibxLSwTPtFicYg9580oM9clOOtdhPYA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性骨髓炎是<span style="color: black;">出现</span>于骨组织的慢性感染，病变可<span style="color: black;">触及</span>骨髓、骨质、骨膜及<span style="color: black;">周边</span>软组织，<span style="color: black;">导致</span>骨髓破坏、骨质坏死、骨膜穿破、皮肤破溃，形成一个或多个瘘 管、窦道、反复排出脓汁或死骨，瘘口<span style="color: black;">周边</span>，皮肤色素沉着及瘢痕形成。<span style="color: black;">倘若</span>皮肤表面愈合，而内有脓液排除不畅或遇外伤寒冷及抵抗力下降，局部肿胀、<span style="color: black;">病痛</span>加剧，<span style="color: black;">显现</span>发热和全身不适的症状。之后，再次破溃、流脓，经久不愈，致使局部肌肉萎缩、全身消瘦、神疲<span style="color: black;">没</span>力、食欲<span style="color: black;">衰退</span>、腰膝<span style="color: black;">疲软</span>等症状，慢性骨髓炎骨质破坏严重，可并发病理性骨折、肢体畸形、关节强直、癌变等并发症。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/UGAb2H64KzcGvBpPwR2wtUsWzPmzweCibH6elMsyzUftywtIicmkog6ibnfHuVzxaalcWqmgLlbwxaekNTT1PrYMQ/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性骨髓炎多由急性骨髓炎治疗不<span style="color: black;">即时</span>或不彻底转变而来。中医认为骨髓炎是附着于骨的深部脓疡。急性骨髓炎叫附骨痈，慢性骨髓炎叫附骨疽。发病<span style="color: black;">原由</span>有内因和外因两种<span style="color: black;">原因</span>。内因是身体虚弱、抵抗力下降；外因或为热病后热毒未尽，深蕴入内流注于骨繁衍聚毒为病；或为金刃所伤、邪毒侵延注骨为病；或为筋伤后淤血化热、深蕴入里、留于筋骨、经络阻隔、气凝血滞、腐筋蚀骨、蕴郁成脓、破溃而出。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/UGAb2H64KzcGvBpPwR2wtUsWzPmzweCibGib6cT07CsEWKBDedfVDwdS6ArWD8uic2j5JiaPm5DYpov8fPicboMibaEg/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">慢性骨髓炎的治疗要充分<span style="color: black;">表现</span>内外兼治的原则。内应扶养正气、<span style="color: black;">加强</span>机体抵抗力，<span style="color: black;">加强</span>机体对外来邪毒的抗病能力。<span style="color: black;">重点</span>采用养阴益气、温肾健脾、托里排毒等<span style="color: black;">办法</span>，这是治疗的<span style="color: black;">重要</span>。它不仅<span style="color: black;">能够</span>促进脓液、死骨的排出，窦道的<span style="color: black;">早点</span>愈合，还<span style="color: black;">能够</span>防止窦道的反复<span style="color: black;">爆发</span>。外治要从三步进行：一要排毒，用<span style="color: black;">拥有</span>排脓、腐蚀<span style="color: black;">功效</span>的中药，自内而外破坏窦道和死骨，促进脓液、死骨和<span style="color: black;">没</span>活力组织排出，使肉芽鲜红形成<span style="color: black;">鲜嫩</span>创面。二要生肌，采用<span style="color: black;">拥有</span>祛腐生肌、长肉敛疮<span style="color: black;">功效</span>的中药，自内向外促进骨髓、骨质、肌肉及皮肤组织再生和修复，最后使窦口愈合。三对大块死骨及病灶<span style="color: black;">没</span>法排出时，可采用手术<span style="color: black;">办法</span>进行病灶清理、死骨清除、连续灌洗术。对皮肤、软组织<span style="color: black;">缺失</span>严重，创面深陷呈漏斗状者应行带蒂肌瓣填充术，方能消灭死腔。</p>
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