tailieunhanh - Sinh lý bệnh của nhiễm trùng

Nhiễm trùng phức tạp cố định nội bộ của gãy xương là một biến chứng nghiêm trọng đó là khó khăn để điều trị. Bất cứ khi nào các thiết bị kim loại cấy trong cơ thể, biointegration thành công đòi hỏi rằng các tế bào chủ xâm chiếm bề mặt cấy ghép phản ứng cao. | Pathophysiology of Infections After Internal Fixation of Fractures Andrew H. Schmidt MD and Marc F. Swiontkowski MD Abstract Infection complicating internal fixation of fractures is a serious complication that is difficult to treat. Whenever metallic devices are implanted in vivo successful biointegration requires that host cells colonize the highly reactive implant surface. Bacteria such as staphylococci can also become adherent to metallic or polymeric implants and will compete with host cells for colonization of the implant surface. Once adherent these bacteria form a biofilm and undergo phenotypic changes that make them resistant to the normal host immune response as well as to antibiotics. Furthermore metallic implants themselves cause specific deficits in the function of the local immune system that may render the host response to infection inadequate. Any associated soft-tissue injury causes even greater impairment of local immune function. Despite the potentially detrimental impact of internal fixation fracture stability is of paramount importance in achieving fracture union and in preventing infection. It has been demonstrated in animal models that contaminated fractures without internal fixation develop clinical infection more commonly than similar fractures treated with internal fixation at the time of colonization. Because of the potential for infection whenever internal fixation is utilized appropriate prophylactic antibiotic coverage for staphylococci and Gram-negative organisms should be provided. Open wounds and severely damaged soft tissues require aggressive management so that a viable soft-tissue envelope is maintained around the implant. Host factors such as smoking and malnourishment should be corrected. Early diagnosis and aggressive treatment of implant-related infection with antibiotics debridement and maintenance of stable internal fixation are essential to successful treatment. J Am Acad Orthop Surg 2000 8 285-291 appear to modulate local