小结
定义
病史和体格检查
关键诊断因素
- 危险因素
- 跛行或不愿负重
- 感染部位的非特异性疼痛
- 不适感和疲劳
- 局部背痛，伴有全身症状
- 椎旁肌压痛和痉挛
- 局部炎症、压痛、红斑或肿胀
- 发热
- 脊髓或神经根受压
其他诊断因素
- 伤口有分泌物流出，存在急性或已愈合的陈旧性窦道
- 瘢痕、既往皮瓣移植、骨折固定
- 活动范围缩小
- 糖尿病足感染时感觉能力减弱
- 尿路症状
- 斜颈
- 皮肤或其他感染、近期发生金黄色葡萄球菌血流感染、留置尿管
- 肢体畸形
- 叩诊压痛
- 脑膜炎
危险因素
- 既往骨髓炎
- 穿通伤
- 静脉注射药物滥用
- 糖尿病
- 艾滋病病毒 (HIV) 感染
- 近期手术史
- 远端或局部感染
- 镰状细胞性贫血
- 类风湿关节炎
- 慢性肾病
- 导致免疫功能低下的疾病
- 上呼吸道感染或水痘感染（儿童）
诊断性检查
首要检查
- 全血细胞计数 (FBC）
- 红细胞沉降率 (ESR)
- C 反应蛋白 (CRP)
- 血培养
- 受累部位的 X 线平片
需考虑的检查
- 骨样本和骨活检
- 聚合酶链反应 (PCR)
- MALDI-TOF 质谱分析
- 拭子
- 尿显微镜检查、培养及药敏试验
- 组织学
- 骨探针检查
- 骨 MRI
- 超声
- CT 扫描
- 放射性核素扫描
- 骨闪烁显像
- 超声心动图
- 胸部 X 线检查
- 结核菌素试验
治疗流程
疑似脓毒症
疑似急性外周骨髓炎
疑似急性自发性脊椎骨髓炎
有疑似急性骨髓炎的糖尿病足患者
慢性骨髓炎
撰稿人
专家顾问
Michael Barrett, MB ChB, FRCS (Tr&Orth), PGCert Med Ed
ST8 in Trauma and Orthopaedic Surgery
Royal London Hospital
Barts Health NHS Trust
London
UK
利益声明
MB discloses that he owns, runs, and produces educational content for the www.frcsortho.com membership website. He is also a director of www.orthohub.xyz, a free interactive orthopaedic educational resource. This website receives funding from industry partners.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:
Jamie Ferguson, MB ChB (hons), MEd., FRCS (Orth)
Consultant in Trauma and Reconstruction Surgery
The Bone Infection Unit
Nuffield Orthopaedic Centre
Oxford University Hospitals Foundation NHS Trust
Oxford
Tse Hua Nicholas Wong, BSc, MB BS, DPhil, MRCP, FRCPath
Consultant in Infectious Diseases and Microbiology
Buckinghamshire Healthcare NHS Trust
Aylesbury
Bridget L. Atkins, MA, MBBS, MSc, FRCPath, FRCP
Consultant Infectious Diseases, Microbiology and Bone Infection
Oxford University Hospitals NHS Foundation Trust
Oxford
Martin McNally, MB, BCh, MD, FRCSEd, FRCS(Orth)
King James IV Professor and Consultant in Limb Reconstruction
The Bone Infection Unit
Nuffield Orthopaedic Centre
Oxford University Hospitals Foundation NHS Trust
Oxford
UK
利益声明
JF and MM received a research grant in 2013 from Bonesupport AB, Lund, Sweden to collect data for a study on antibiotic carriers in osteomyelitis treatment. THNW and BLA declare that they have no competing interests.
同行评议者
Martin McNally, MB, BCh, MD, FRCSEd, FRCS(Orth)
King James IV Professor and Consultant in Limb Reconstruction
The Bone Infection Unit
Nuffield Orthopaedic Centre
Oxford University Hospitals Foundation NHS Trust
Oxford
UK
利益声明
MM received a research grant in 2013 from Bonesupport AB, Lund, Sweden to collect data for a study on antibiotic carriers in osteomyelitis treatment.
Emma Nickerson, MRCP
Infectious Diseases Consultant
Addenbrooke’s Hospital
Cambridge University Hospitals NHS Foundation Trust
Cambridge
UK
利益声明
EN declares that she has no competing interests.
编辑
Celia Pincus
Section Editor, BMJ Best Practice
利益声明
CP declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Anna Ellis
Head of Editorial, BMJ Best Practice
利益声明
AE declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
鉴别诊断
- 化脓性关节炎
- 幼年特发性关节炎
- 一过性滑膜炎
更多 鉴别诊断指南
- 针对诊断成人外周骨感染的共识文件：由 EANM、EBJIS 和 ESR 联合发表的论文（获得 ESCMID 认可）
- 骨和关节感染
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