osteomilitis 2

Upload: assnet-hotspot

Post on 07-Apr-2018

215 views

Category:

Documents


0 download

TRANSCRIPT

  • 8/3/2019 osteomilitis 2

    1/23

    43805,8,7

    0138

    89042098 ,/,, 3108 9:,3 ,3 -,8,3, /80-,-,3 40 -,907 909,5

    ,/,3,/,3/80-,-,340,2:7

    , 9:,3 9073108 -,,3 /,,2 9:,3 ,3 :3, 8:28:2 9:,3 8073

    202-03,,703,502-03,,3,73,332030,3/3/380-0,:,79:,3,3

    ,:2,, 502-:: /,7, / /,,2 8:28:2 -8, 90790,3 2030-,-,3 -07:7,33,

    ,7,3/,7,09:,3%,35,5,84,3/,7,,3202,/,-,,3/,79:,3-8,2,9

    3108 :, -8,2030-,7 0:,7/,79:,3 /,3202-039: ,-808503:25:,3

    3,3,/,73,3:3,/809,73,28,3,/4949

    3108 ,73,3 9:,3 /80-:9 80-,, 489042098 /,3 /,5,9 92-: ,:9 ,9,:

    743039: ,:9 /.7,3 /03,3 ,/,3, ,9,3 /02,2 88902 2,:5:3 2,31089,8

    4.,,3-07,,3/03,3.05,989042098743,/,,,-,9/,7489042098,:9

    ,39/,/9,3,3/03,3-,

    89042098/,5,9/,81,8,3203,/223

    89042098!7207!030-,7,33,80.,7, 02,9403 /2,3,27447,3820 -07,8, /,7 14.:8 /9025,9 ,3

    /,3-070/,720,:87:,8/,7,

    89042098$0:3/0789042098!074393:9,9:2%07,/ ,-,9 5030-,7,3 :2,3 /,7 809,73, ,-,9 /,7 -8: :, 17,9:7 /,3

    80-,,3,

    944

    $9,54.4..:8 ,:70:8 0249::8 4,:,8 54891 80-,3, /,3 ,7,3 40

    8970594.4..:80249:8

    ,0245:8 31:03,0 5,/, ,3,,3, /-,,:2:7 9,:3 7,3820 ,3

    ,3805079,907.4$,2430,9548,/,380-,,3,

    %:,3,3-,8,3,9073/:3/03,3-,/,73108-8,203,,2310820,:

    .,7,

  • 8/3/2019 osteomilitis 2

    2/23

    7,3/,7,

    7,3/,7,-8,202-,,8:,9:3108/,7-,,39:-:,3,309:,33108

    -,8,3,907,//::39:,39:3,/,303,35,/,,3,,3,/,3/9:,3-0,,3

    5,/,/0,8,

    7,3,3203,,3/,8,3,/,3503,,:3,4-,98:390,7039,3907,/,5

    31089:,3-0,,3489042098;0790-7,3108:,-8,907,/,80549434,2

    90,/90250,35,/,9:,3805079,3907,/5,/,507-,,35,3:,9,:5,9,9:,3

    ,33,

    !030-,7,3,38:3

    7,3820 -8,202,8: 9:,380.,7,,38:3 20,:5,9, 9:,3 907-:, 80,2,

    502-0/,,39:,3,9,:/,7-03/,,3907.02,7,320302-:89:,3

    3108 ,/, 803/ -:,9,3 -,8,3, //,5,9 80,2, 502-0/,,3 /,3 -8, 2030-,7 0

    9:,3//0,93,

    3108/,7,73,3:3,//0,93,

    3108 5,/, ,73,3 :3,/809,7 9:,3 -8,2030-,7 09:,3 8090, -0-07,5,

    ,7 ,9,:23: 3108,73,3 :3, -8,92-:/ /,07,,3 203,,207:8,,3

    ,703, .0/07, 907,5 5033,7,3 ,9,: ,307 ,9,: ::8 / :9 ,3 /80-,-,3 40

    003,5,84,3/,7,,9,:/,-090803.32,38$:,9:31085,/,83:87,,3,9,:

    -8,2030-,709:,390347,

    !,941844

    #0854338,31084/02/,35033,9,3;,8:078,8

    $090,,7907,/9742-4885,/,502-::/,7,$/,3#$$

    3108 -0702-,3 ,;9,8 20/:,78 /,3 0-,, 5074890:2 2030-,7 0

    ,73,3:3,,33,/,3803/

    ,3108/439740-,,,-8089:,3,,3203,-,9,386:0897:29/,/,5,9

    203.,7907,/3;4:7:2/,32030386:0897:2489042987438

    %,3/,/,30,,

    ,2-,7,3 38 489042098 907,39:3 /,7 89,/:2 5,9403088 /,7 503,9

    /,5,9-0702-,380.,7,5747081,9,:.05,9

    !,/, ,3,,3, 3108 9:,3 ,3 //,5,9 20,: ,7,3 /,7, 2030-,-,3

    /02,2 /,3 ,/,3,/,3 / 02:/,3 ,7 2030-,-,3 307 5,/, 9:,3 ,3

  • 8/3/2019 osteomilitis 2

    3/23

    9073108,07,/,9,89:,3-8,203,,2:,/,3202-03,/,350707,,3,,3

    2032-:,3307

    3108 9:,3 -0,,3 -,8,3, 92-: 80.,7, -079,,5 2030-,-,3 307

    5:3:3/,33079:25:,/8039:07,,3202-:7:-,503/079,-0707,/,3

    9/, -07:7,3 /03,3 897,,9 502,3,8,3,9,: 23:2 4-,9 5070/,30702,2 ,3

    207:5,,39,3/,8:,9:310880739/,907,/

    3108 9:,3 ,3 /80-,-,3 40 3108 ,73,3 :3, / /0,93, ,9,: ,3

    -07,8,/,75030-,7,3 ,38:3 2030-,-,3307 /,3 502-03,,3 //,07,/,9,8

    9:,3 /,3 ,-808 -8, 907-039: / ,73,3 809,73,

    3108 3 9/, 2030-,-,3 /02,2 /,3 502078,,3 /,7, 203:3:,3 ,8 ,3

    3472,

    !03/079, ,3203,,2 3108 5,/, 803/ -:,9,3,9,: ,349,07, -,8,3,

    202307,320309,5//,07,90780-:9

    , 8:,9: 3108 9:,3 9/, -07,8 /4-,9 -8, 907,/ 489042098 203,:3

    4890420987438,/,3,/,3310839/,907/090880,2,-079,:39,:3 /,3

    9/,2032-:,30,,80,2,-0-07,5,-:,3,9,:-0-07,5,9,:3

    89042098203,:380732030-,-,33079:,33108,73,3:3,/,9,8

    9:,3 ,3 -07:,3 /,3 5030:,7,3 3,3, ,3 20309,5 ,9,: ,3 92-: /,7 :9

    !030:,7,33,3,907,/,3,3,/,79:,3,3907310820302-:85072:,,3:9

    /,38:,9:8,:7,38,:7,383:8907-039:/,79:,3203:::9

    !02078,,3503:3,3

    !02078,,3/,7,

    $0/,7,5:92033,98,25,7//8079,5033,9,3,:03/,5,3/,7,

    !02078,,39907,39-4/,3989,54.4..:8

    !02078,,3 :9:7 /,7, :39: 203039:,3 -,907 54891 /,3 /:9 /03,3 :

    80389;9,8

    !02078,,310808

    !02078,,3 10808 :39: :9:7 /,:,3 ,5,-, 907/,5,9 0.:7,,3 3108 40 -,907

    $,2430,

    !02078,,34589:,3

    !02078,,3:97,84:3/

    !02078,,33/,5,9202507,9,3,/,3,01:85,/,803/

    !02078,,37,/448

  • 8/3/2019 osteomilitis 2

    4/23

    !02078,,354945448/,,2,75079,2,9/,/902:,30,3,37,/448090,

    /:,23:,,3907,9-07:5,7017,89:,3,3-0781,9/1:8

    !7385503,9,,8,3,,3

    897,,9/,3502-07,3,3,09:39:203,3,3307

    !02-07,3.,7,3397,;03,/,3,,:507:97,31:8/,7,

    897,,94.,/03,3-/,,9,:97,8

    !02-07,3,39-49,80.05,93,808:,5030-,-

    7,3,80-0/,

    8:,30507,,9,3

    !03,,3

    ,#,,90507,,9,3

    ,,2,3507,,9203,3,,31,9471,947708480:-:3,3/03,3489042098,

    , ,3 /, 205:9 :2:7 5073, 9/,3, 97,:2, :, 907-:, 93/,,3 4507,8

    :8:83, 4507,8 9:,3 /,3907,5 7,/,8,9471,947 90780-:9,/,, 8:2-07 549038,

    907,/3,3108

    -!02078,,318

    70, 809,7 9:,3,3 9073108 203,/-03, /,3 907,8,02-0-,/5,5,88,

    :,907/,5,907902,,9,:0207,,3/,35,3,81088902203:3:,3,/,3,/02,2

    -,8,3,/,9,89,,7/779,-002,-03,3072,:5:307902,

    .#,,9584848,

    !,803 8073, 207,8, 09,:9,3 ,,97 31083, 9/, /,5,9 802-: 9,:9

    /,25:9,8,8,3,5,803/7,,9 ,2,/7:2,8,9803,507,,9507:2031,

    507:-,,3507:-,,3 0/:5,3 :8:83, :-:3,33, /03,3 0:,7, 5007,,3 ,9,:

    804,

    /!02078,,3/,3489

  • 8/3/2019 osteomilitis 2

    5/23

    ,8,-47,947:2 203:3:,3,/,3, 0:489488 /,3 ,:03/,5 /,7,2033,9

    5,803,3203,,2 310802,940380.,7,/3,/,3,4890420982,,/,:,3

    8.,3339:,3$0,39:/,5,95:,/03,3-4589:,3,9,:#

    :,348,0507,,9,3

    07-07:-:3,3/03,331,2,8/,3502-03,,3

    ,3:,3 24-8,8 18 -07:-:3,3 /03,3 307 ,,9 24-8,8 /,3 0907-,9,8,3

    203,,3-0-,3-07,9-,/,3

    5079072-07:-:3,3/03,357480831,2,8

    3809,8 -07:-:3,3 /03,3 :7,3 50309,:,3 9039,3 43/8 503,9 /,3

    5034-,9,3

    ,3:,354,9/:7-07:-:3,3/03,3307/,3,3:,37,8,3,2,3

    39407,38,9;9,8-07:-:3,3/03,3307/,309,:,93/,,2-0707,

    #084907,/,5507:,8,33108-07:-:3,3/03,3502-039:,3,-8089:,3

    !0703.,3,,30507,,9,3

    !07-07:-:3,3/03,331,2,8/,3502-03,,3

    %::,3,8!,803

    03/0243897,8,3-0-,8/,7307/,3!033,9,37,8,03,2,3,3

    7907,;,:,8

    %/, 907,/ 307,58: 2,,3 203,/ 3472,085708 ,, 708 /,3 8:: 9:-:

    3472,

    3907;038/,3#,843,8,8

    4 3907;038 #,843,8,8

    ,3/703, ,7,9078 9 307 4,8 /:7,8 390389,8 307/03,3 203 :3,,3 8,, 307

    025079,,3,3 2 24-8,8-,.8,-07,3 8443,3 8:55479 5,/,097029,8,3:,2,9507:-,,38::809,5,2

    &39: 20309,: 93,9 7,8, 307803, /,5,9 20 3039:,3 03893/,,33,

    03.0, 5070807,3 9:,3 /,35030,3,35,/,,73,3,3:,!033,9,3;03,709:73203:7:3,30/02/,3203:7,3307&39:20309,:50325,3,350325,3,3,3907,/03:7,3 7,8, 307 /,3202-07,37,8,3,2,3

  • 8/3/2019 osteomilitis 2

    6/23

    425708,7,3,94,-47,8

    !02-07,34-,94-,9,3,3,08

    03:7,37,8,307

    ! ,3:,3 24-8,8 18 -07:-:3,3 /03,3 307 ,,9 24-8,8 /,3 0907-,9,8,3

    203,,3-0-,3-07,9-,/,3

    %::,3,8!,803

    ,3:,324-9,818/,5,9-07:7,38090,/,:,393/,,30507,,9,3

    7907,,8

    033,9,324-9,85,/,93,95,393,32:33

    025079,,3,354881:3843,

    033,9,31:38,38,9

    03:3:3,9032,25:20,:,3,9;9,8

    3907;038/,3#,843,8,8

    4 3907;038 #,843,8,8

    ,3/7!079,,3,3 97, -,73 /,,2

    5488,3/5747,2,3%3,3 0897029,8 ,3 8,93897:8,3 03 -,39: /,,2,9,3 7039,3 07, 5,/,0897029,8,38,9/,39,8,907 503,3, 5,/, 0897029,8,38,95,/,8,,9-0707,0,8,3 5,3/,3,3 /,30907-,9,8,3/,,2,9;9,8

    07,3 /4743,3 5,/, 03 :39:20,:,3 $ /,,2 3:50907-,9,8,3/,3-07-,39:,3808:,0-:9:,3&-,548880.,7,5074/4,-479,8

    ,7 ,3:,3 24-9,8 18 /,5,9

    -07:7,3,5,92073,3,32,8,,,3:,324-9,818,3/,,203,5,92073,3,32,8,,,3:,324-9,8,3/,,203,7 03 9/, -,3, 20,:,307,,3,3/,5,9202-,,,,3

    03:7,3 907,/3, 50325,3,350325,3,3,3/,5,9907,/03:7,3,3:,324-9,818

  • 8/3/2019 osteomilitis 2

    7/23

    84907,5,4,:,8907,5

    03:7,3,3:,324-9,818

    !5079072-07:-:3,3/03,357480831,2,8

    %::,3,8!,803

    03/0243897,8,3-0-,8/,75079072,

    7907,;,:,8

    !,803 9/, 203,,2 /0/7,8 0- ,3:98::9:-: 3472, 9/, 2:, 8:: 9:-:

    3472,

    3907;038/,3#,843,8,8

    4 3907;038 #,843,8,8

    ,3/7

    !,39,:

    :-:809,5,2:9

    %3,//,35073,5,8,3 /7,8 9:747 /,3 002-,5,3:905,8,35,,,3,3-070-,3

    ,:,3 425708 /33 ,9,:,3943 08 :39: 203:7:3,303,,38::9:-:49;,8,8:5,3.,7,34,-47,807,3 4-,9 ,395709 808:,/03,3,3:7,3

    02-07,3/,8,7:39:/0908,9!,,,3 ,3 9/, -070-,3 /,5,9203:7, 5033,9,3 8:: 9:-:/,3 /,5,9 202-07,3 7,8, 3,2,35,/,5,803

    03:7:3,3 5,3,8 20,: 57480843/:8 8079, 0;,547,8 /,32033,9,303,2,35,80302507-,0,3,3.,7,3,-,9507857,8 8079, 10-78 /,32033,9,3 93,9 03,2,3,35,803395709 202-,39: 203439745033,9,38::9:-:

    !3809,8-07:-:3,3/03,3:7,350309,:,39039,343/8503,9/,35034-,9,3

    %::,3,8!,803

    03/0243897,8,3 ,33,,3809,8/,3202-07,3 31472,89039,3574808503,9

    5747,25034-,9,3

    7907,;,:,8

  • 8/3/2019 osteomilitis 2

    8/23

    85708,,70,8

    02,8/,37,8,9,:9,3,9,:-07:7,3

    3907;038/,3#,843,8,8

    4 3907;038 #,843,8,8

    ,3/70,8,3 9::,3 5034-,9,3 5,/,5,803,5,9442,8,,3/;/:, :,3 9,3/, 0,, ,3

    20207:,3 0;,:,8 20/.05,9.4394 307 /,/, 9-,9-,/8530,/897085073,5,8,3,3:9,:,357,9080,9,3,3-,897,,94,-47,8:3,,3 4-,9 80/,91 808:,/03,3,3:7,3

    0347039,8 5747,2 5034-,9,302-,39: 203,/,7,3 03 :39:202507404397431472,8 203:7:3,3 9,:9 ,703,09/,9,:,302-07, 50309,:,3/,8,7 :39: 502,,2,3 43/8/3,207:,33, 530:24947,024947,

    20207:,3 3907;038 20/ :39:203.0, 203:7:3,3 549038,425,8025079,,3,3 080,9,3 :2:22033,9,3 50302-:,3 /,3 /,5,9203.0,0,2-:,37,50:9,3,5,803,3202-:9:,34-,950303,3:39:20343974,3809,83,

    !,3:,354,9/:7-07:-:3,3/03,3307/,3,3:,37,8,3,2,3

    %::,3,8!,803

    !4,9/:702-,3472,

    7907,;,:,8:2, ,2 9/:7 9/, 907,3: 38423, -07:7,3 ,/,3, 05:,8,3 9/:7 5,803

    203:3:,3080,907,,318/,35844

    3907;038/,3#,843,8,8

    4 3907;038 #,843,8,8

    ,3/7

  • 8/3/2019 osteomilitis 2

    9/23

    %039:,3 0-,8,,3 9/:7 ,3-,8,3,/,3507:-,,3,3907,/07,39025,99/:7,33,2,3/,3

    -0-07,5, 2 57-,/ 28,3, -,39,/,3:3:,9 7:939,8 9/:7 -,7: ,3/2,8:,3 /,,2 54, ,2, /,33:3,3-,7:4.4,3 /03,3 902,3 80,2,7,32025:3,54,9/:7807:5,/,30-:9:,32,,2,74743 -0-07,5, ,919,8 18 5,/,8,3 ,7 ,23 5,803 -07039-07,919,8 -0-07,5, ,2 80-0:29/:73897:8,393/,,370,8,8:7,30-83,3/,3,25:

    :3,,3 5,,7 9025,9 9/:7 808:,3/,8 703/,3 9025,9 9/:7 -,2:334,-47,807,3 80/,91 5349 808:,3/,8

    03, 507:3, /,3203/0391,8 3907;038 ,3905,9033,9,3 03,2,3,3 9/:7

    8079,/::3,31844858448, 7:939,8 -,7: 203,3/:3,850 80-,3, 0-,8,,3 ,2,89708/,3,3809,8/,5,9-07:7,303:7:3,3 02:33,3 -,,902,380,2,7,3-:7:3,39:/,5,9203:3/,5,803:39:9070,5,9,:2030-,-,3907-,3:39;9,88,3,7/,5,9202-,39:5,803203:3,,30307/,38,5:39:9/:72,,2,702-,39:2033/:89/:702-07,3 89:,8 43/:81 :39:9/:7!,,7 9025,9 9/:7 202-07,30,2,3,3 /,3 /,5,9 /:3,,3

    :39:202-,39:207:-,5488:33/-07,3:39:202-,39:5,803 9/:7 ,9,: 897,,9 80,2,507 4/0 97,388 /,7 7:2, 03:3,3-,7:

    !39407,38,9;9,8-07:-:3,3/03,3307/,309,:,93/,,2-0707,

    %::,3,8!,8034,-47,91

    !,803203:3:,35033,9,39407,38907,/,5,919,8

    7907,;,:,8

    03:7:33, 0:,3 907,/,5 002,,3 /,3 00,,3 /,,2 20,:,3 ,919,8

    -07:7,33,307

    3907;038/,3#,843,8,8

  • 8/3/2019 osteomilitis 2

    10/23

    4 3907;038 #,843,8,8

    ,3/70,8,3 ,9;9,8 /,3 1,947 ,3/,5,9 2033,9,3 0-:9:,3

    48033:7,35747,202,90307

    :,9 ,/, ,919,8 ,7,393,9,380.,7,-079,,5

    , 708543 ,-/4203 8090,-07,9;9,807,3425708,7,3,9

    07,9:897,,9,3.::5

    0744 8:: 08972 /,3 89702030-,-,3 ;,8443897:8

    502-:: ,7, /,3 5033,9,3-0-,3,39:303.0, 503:3,,3 0307-070-83025079,,3,35073,5,8,3,2-,9/03,3 909,5 2025079,,3,3,9,3 18 ,3 202:33,35033,9,3 02,25:,3 4949 -,39:5073,5,8,3

    #08543 ,-/4203 205:9 3,/90,3,3/,7,/,35073,5,8,3,32033,9425708 ,7 ,3,9 /,5,9203:7,37,8,307033,9,3 /,, 9,,3 5,803203.0,009,3

    !#084907,/,5507:,8,33108-07:-:3,3/03,3502-039:,3,-8089:,3

    %::,3,8!,803

    %/,907,/5084507:,8,33108,3/,,2

    7907,,8

    03.,5,,9:50302-:,3

    3907;038/,37,843,8,8

    4 3907;038 #,843,8,8

    ,3/7!079,,3,388902 ,909078907-07,3507,,9,3 ,90907 70:,7 /03,3 8,-:3

    /,3 ,7 -07,3 8,05,39-49. /809,788,90907

    03.0, 502,8:,3 -,907 /,7310880588,3:9

    2-:,8 /03,3 ,39:3 /7,3,80/0503/03

    033/,770108-,:730,3/,5,9 202,8:,3 -,907 0/,,2,3/:302

    ,8 9,3/, ;9, 507,9,3 /02,273,3 203 3,/ /,3 5073,5,8,3

    !,803 ,3 203,,2 8894845% 57489,90 -07084 :39: 84

  • 8/3/2019 osteomilitis 2

    11/23

    .05,908,50,/847039,8

    -0/, 8059. 80:-:3,3 /03,32,35:,83897:2039,8

    -807;,8 /7,3,80 /,7 :, 809,7,909078:57,5:-

    /,3,/7,33888:57,5:-2033,9,3 7084 :39: 3108,3 /3/,8,3 /03,3 07902,

    /7,3,805:7:03

    ,39-,:9,3/03,380733888:57,709745:- /,3 50730, 502-078,3/,3503073,3:9805,3,3,9:

    ,:9,3 -,8, 2030-,-,3 :979,8 /,3 202-07,3 20/, :39:5079:2-:,3 -,907 5033,9,370843108:,

    :3,,3503/:3:995048942

    02-07,35073/:3,3:39::9809,7 203.0, 0847,8 /,3203:7:3,370843108

    4,-47,807,3,39-49.808:,3/,8

    :33 /-07,380.,7,5741,980:-:3,3 /03,3 5033,9,3708431085,/,57489,90942

    ,19,7!:89,,

    !:73,,3:3,/,59,$009,0/4907,3/800/,08:,5:8&

    $405,72,32:!03,9,,2/,,!0307-9&

    40308,733#03.,3,8:,30507,,9,3,,79,

    ,2,3/4342:!03,9,,2,,!0307-9&,,79,

    ,3840771,59,$009,0/4907,30/,08.:,,5:8&,,79,

    !73.0$;,3/07843!,9418444380538!74808!74808!03,9/

    ,,79,

    3907309

    440.42

    8905-48549.42

    8.7-/.42

    20/,,8:,30507,,9,3-48549

    ,-0,8050507,,9,30!07,,%,320/,-0/,

    4220398

  • 8/3/2019 osteomilitis 2

    12/23

    !489,422039

    !48930-,7:!4893,2,07,3/,$:-8.7-094!48,342039,7942

    $,-9:0-7:,7

    80589042098

    548,340**+85,0$,9$,-9:0-7:,7,-0,8050507,,9,30!07,,%,320/,-0/,

    43805,8,7

    0138 89042098 ,/,, 3108 9:,3 ,3 -,8,3, /80-,-,3 40 -,907 909,5

    ,/,3,/,3/80-,-,340,2:7

    , 9:,3 9073108 -,,3 /,,2 9:,3 ,3 :3, 8:28:2 9:,3 8073

    202-03,,703,502-03,,3,73,332030,3/3/380-0,:,79:,3,3

    ,:2,, 502-:: /,7, / /,,2 8:28:2 -8, 90790,3 2030-,-,3 -07:7,33,

    ,7,3/,7,09:,3%,35,5,84,3/,7,,3202,/,-,,3/,79:,3-8,2,9

    3108 :, -8,2030-,7 0:,7/,79:,3 /,3202-039: ,-808503:25:,3

    3,3,/,73,3:3,/809,73,28,3,/49493108 ,73,3 9:,3 /80-:9 80-,, 489042098 /,3 /,5,9 92-: ,:9 ,9,:

    743039: ,:9 /.7,3 /03,3 ,/,3, ,9,3 /02,2 88902 2,:5:3 2,31089,8

    4.,,3-07,,3/03,3.05,989042098743,/,,,-,9/,7489042098,:9

    ,39/,/9,3,3/03,3-,

    89042098/,5,9/,81,8,3203,/223

    89042098!7207!030-,7,33,80.,7, 02,9403 /2,3,27447,3820 -07,8, /,7 14.:8 /9025,9 ,3

    /,3-070/,720,:87:,8/,7,

    89042098$0:3/0789042098!074393:9,9:2

  • 8/3/2019 osteomilitis 2

    13/23

    %07,/ ,-,9 5030-,7,3 :2,3 /,7 809,73, ,-,9 /,7 -8: :, 17,9:7 /,3

    80-,,3,

    9:44

    $9,54.4..:8 ,:70:8 0249::8 4,:,8 54891 80-,3, /,3 ,7,3 40

    8970594.4..:80249:8

    ,0245:8 31:03,0 5,/, ,3,,3, /-,,:2:7 9,:3 7,3820 ,3

    ,3805079,907.4$,2430,9548,/,380-,,3,

    %:,3,3-,8,3,9073/:3/03,3-,/,73108-8,203,,2310820,:

    .,7,

    7,3/,7,

    7,3/,7,-8,202-,,8:,9:3108/,7-,,39:-:,3,309:,33108

    -,8,3,907,//::39:,39:3,/,303,35,/,,3,,3,/,3/9:,3-0,,3

    5,/,/0,8,

    7,3,3203,,3/,8,3,/,3503,,:3,4-,98:390,7039,3907,/,5

    31089:,3-0,,3489042098;0790-7,3108:,-8,907,/,80549434,2

    90,/90250,35,/,9:,3805079,3907,/5,/,507-,,35,3:,9,:5,9,9:,3

    ,33,

    !030-,7,3,38:3

    7,3820 -8,202,8:9:,3 80.,7, ,38:320,: 5,9, 9:,3 907-:, 80,2,

    502-0/,,39:,3,9,:/,7-03/,,3907.02,7,320302-:89:,3

    3108 ,/, 803/ -:,9,3 -,8,3, //,5,9 80,2, 502-0/,,3 /,3 -8, 2030-,7 0

    9:,3//0,93,

    3108/,7,73,3:3,//0,93,

    3108 5,/, ,73,3 :3,/809,7 9:,3 -8,2030-,7 09:,3 8090, -0-07,5,

    ,7 ,9,:23: 3108,73,3 :3, -8,92-:/ /,07,,3 203,,207:8,,3

    ,703, .0/07, 907,5 5033,7,3 ,9,: ,307 ,9,: ::8 / :9 ,3 /80-,-,3 40

    003,5,84,3/,7,,9,:/,-090803.32,38$:,9:31085,/,83:87,,3,9,:

    -8,2030-,709:,390347,

    !,941844

    #0854338,31084/02/,35033,9,3;,8:078,8

    $090,,7907,/9742-4885,/,502-::/,7,$/,3#$$

  • 8/3/2019 osteomilitis 2

    14/23

    3108 -0702-,3 ,;9,8 20/:,78 /,3 0-,, 5074890:2 2030-,7 0

    ,73,3:3,,33,/,3803/

    ,3108/439740-,,,-8089:,3,,3203,-,9,386:0897:29/,/,5,9

    203.,7907,/3;4:7:2/,32030386:0897:2489042987438

    %,3/,/,30,,

    ,2-,7,3 38 489042098 907,39:3 /,7 89,/:2 5,9403088 /,7 503,9

    /,5,9-0702-,380.,7,5747081,9,:.05,9

    !,/, ,3,,3, 3108 9:,3 ,3 //,5,9 20,: ,7,3 /,7, 2030-,-,3

    /02,2 /,3 ,/,3,/,3 / 02:/,3 ,7 2030-,-,3 307 5,/, 9:,3 ,3

    9073108,07,/,9,89:,3-8,203,,2:,/,3202-03,/,350707,,3,,3

    2032-:,3307

    3108 9:,3 -0,,3 -,8,3, 92-: 80.,7, -079,,5 2030-,-,3 307

    5:3:3/,33079:25:,/8039:07,,3202-:7:-,503/079,-0707,/,3

    9/, -07:7,3 /03,3 897,,9 502,3,8,3,9,: 23:24-,9 5070/,30702,2 ,3

    207:5,,39,3/,8:,9:310880739/,907,/

    3108 9:,3 ,3 /80-,-,3 40 3108 ,73,3 :3, / /0,93, ,9,: ,3

    -07,8,/,75030-,7,3 ,38:3 2030-,-,3307 /,3 502-03,,3 //,07,/,9,8

    9:,3/,3,-808-8,907-039:/,73,3809,73,

    3108 3 9/,2030-,-,3 /02,2 /,3 502078,,3 /,7,203:3:,3 ,8

    ,33472,

    !03/079, ,3203,,2 3108 5,/, 803/ -:,9,3,9,: ,349,07, -,8,3,

    202307,320309,5//,07,90780-:9

    , 8:,9: 3108 9:,3 9/, -07,8 /4-,9 -8, 907,/ 489042098 203,:3

    4890420987438,/,3,/,3310839/,907/090880,2,-079,:39,:3 /,3

    9/,2032-:,30,,80,2,-0-07,5,-:,3,9,:-0-07,5,9,:3

    89042098203,:380732030-,-,33079:,33108,73,3:3,/,9,8

    9:,3 ,3 -07:,3 /,3 5030:,7,3 3,3, ,3 20309,5 ,9,: ,3 92-: /,7 :9

    !030:,7,33,3,907,/,3,3,/,79:,3,3907310820302-:85072:,,3:9

    /,38:,9:8,:7,38,:7,383:8907-039:/,79:,3203:::9

    !02078,,3503:3,3

    !02078,,3/,7,

    $0/,7,5:92033,98,25,7//8079,5033,9,3,:03/,5,3/,7,

  • 8/3/2019 osteomilitis 2

    15/23

    !02078,,39907,39-4/,3989,54.4..:8

    !02078,,3 :9:7 /,7, :39: 203039:,3 -,907 54891 /,3 /:9 /03,3 :

    80389;9,8

    !02078,,310808

    !02078,,3 10808 :39: :9:7 /,:,3 ,5,-, 907/,5,9 0.:7,,3 3108 40 -,907

    $,2430,

    !02078,,34589:,3

    !02078,,3:97,84:3/

    !02078,,33/,5,9202507,9,3,/,3,01:85,/,803/

    !02078,,37,/448

    !02078,,354945448/,,2,75079,2,9/,/902:,30,3,37,/448090,

    /:,23:,,3907,9-07:5,7017,89:,3,3-0781,9/1:8

    !7385503,9,,8,3,,3

    897,,9/,3502-07,3,3,09:39:203,3,3307

    !02-07,3.,7,3397,;03,/,3,,:507:97,31:8/,7,

    897,,94.,/03,3-/,,9,:97,8

    !02-07,3,39-49,80.05,93,808:,5030-,-

    7,3,80-0/,

    8:,30507,,9,3

    !03,,3

    ,#,,90507,,9,3

    ,,2,3507,,9203,3,,31,9471,947708480:-:3,3/03,3489042098,

    , ,3 /, 205:9 :2:7 5073, 9/,3, 97,:2, :, 907-:, 93/,,3 4507,8

    :8:83, 4507,8 9:,3 /,3907,5 7,/,8,9471,947 90780-:9,/,, 8:2-07 549038,

    907,/3,3108

    -!02078,,318

  • 8/3/2019 osteomilitis 2

    16/23

    70, 809,7 9:,3,3 9073108203,/-03,/,3907,8, 02-0-,/5,5,88,

    :,907/,5,907902,,9,:0207,,3/,35,3,81088902203:3:,3,/,3,/02,2

    -,8,3,/,9,89,,7/779,-002,-03,3072,:5:307902,

    .#,,9584848,

    !,803 8073, 207,8, 09,:9,3 ,,97 31083, 9/, /,5,9 802-: 9,:9

    /,25:9,8,8,3,5,803/7,,9 ,2,/7:2,8,9803,507,,9507:2031,

    507:-,,3507:-,,3 0/:5,3 :8:83, :-:3,33, /03,3 0:,7, 5007,,3 ,9,:

    804,

    /!02078,,3/,3489

    ,8,-47,947:2 203:3:,3,/,3, 0:489488 /,3 ,:03/,5 /,7,2033,9

    5,803,3203,,2 310802,940380.,7,/3,/,3,4890420982,,/,:,3

    8.,3339:,3$0,39:/,5,95:,/03,3-4589:,3,9,:#

    :,348,0507,,9,3

    07-07:-:3,3/03,331,2,8/,3502-03,,3

    ,3:,3 24-8,8 18 -07:-:3,3 /03,3 307 ,,9 24-8,8 /,3 0907-,9,8,3

    203,,3-0-,3-07,9-,/,3

    5079072-07:-:3,3/03,357480831,2,8

    3809,8 -07:-:3,3 /03,3 :7,3 50309,:,3 9039,3 43/8 503,9 /,3

    5034-,9,3

    ,3:,354,9/:7-07:-:3,3/03,3307/,3,3:,37,8,3,2,3

    39407,38,9;9,8-07:-:3,3/03,3307/,309,:,93/,,2-0707,

    #084907,/,5507:,8,33108-07:-:3,3/03,3502-039:,3,-8089:,3

    !0703.,3,,30507,,9,3

    !07-07:-:3,3/03,331,2,8/,3502-03,,3

    %::,3,8!,803

    03/0243897,8,3-0-,8/,7307/,3!033,9,37,8,03,2,3,3

    7907,;,:,8

    %/, 907,/ 307,58: 2,,3 203,/ 3472,085708 ,, 708 /,3 8:: 9:-:

    3472,

    3907;038/,3#,843,8,8

    4 3907;038 #,843,8,8

  • 8/3/2019 osteomilitis 2

    17/23

    ,3/703, ,7,9078 9 307 4,8 /:7,8 390389,8 307/03,3 203 :3,,3 8,, 307

    025079,,3,3 2 24-8,8-,.8,-07,3 8443,3 8:55479 5,/,097029,8,3:,2,9507:-,,38::809,5,2425708,7,3,94,-47,8!02-07,34-,94-,9,3,3,08

    &39: 20309,: 93,9 7,8, 307803, /,5,9 20 3039:,3 03893/,,33,03.0, 5070807,3 9:,3 /,3

    5030,3,35,/,,73,3,3:,!033,9,3;03,709:73203:7:3,30/02/,3203:7,3307&39:20309,:50325,3,350325,3,3,3907,/03:7,3 7,8, 307 /,3202-07,37,8,3,2,303:7,37,8,307

    ! ,3:,3 24-8,8 18 -07:-:3,3 /03,3 307 ,,9 24-8,8 /,3 0907-,9,8,3

    203,,3-0-,3-07,9-,/,3

    %::,3,8!,803

    ,3:,324-9,818/,5,9-07:7,38090,/,:,393/,,30507,,9,3

    7907,,8

    033,9,324-9,85,/,93,95,393,32:33

    025079,,3,354881:3843,

    033,9,31:38,38,9

    03:3:3,9032,25:20,:,3,9;9,8

    3907;038/,3#,843,8,8

    4 3907;038 #,843,8,8

    ,3/7

    !079,,3,3 97, -,73 /,,25488,3/5747,2,3%3,3 0897029,8 ,3 8,93897:8,3 03 -,39: /,,2,9,3 7039,3 07, 5,/,0897029,8,38,9/,39,8,9

    ,7 ,3:,3 24-9,8 18 /,5,9-07:7,3,5,92073,3,32,8,,,3:,324-9,818,3/,,203

  • 8/3/2019 osteomilitis 2

    18/23

    07 503,3, 5,/, 0897029,8,38,95,/,8,,9-0707,0,8,3 5,3/,3,3 /,30907-,9,8,3/,,2,9;9,807,3 /4743,3 5,/, 03 :39:

    20,:,3 $ /,,2 3:50907-,9,8,3/,3-07-,39:,3808:,0-:9:,3&-,548880.,7,5074/4,-479,884907,5,4,:,8907,5

    ,5,92073,3,32,8,,,3:,324-9,8,3/,,203,7 03 9/, -,3, 20,:,307,,3,3/,5,9202-,,,,303:7,3 907,/3, 50325,3,3

    50325,3,3,3/,5,9907,/03:7,3,3:,324-9,81803:7,3,3:,324-9,818

    !5079072-07:-:3,3/03,357480831,2,8

    %::,3,8!,803

    03/0243897,8,3-0-,8/,75079072,

    7907,;,:,8

    !,803 9/, 203,,2 /0/7,8 0- ,3:98::9:-: 3472, 9/, 2:, 8:: 9:-:

    3472,

    3907;038/,3#,843,8,8

    4 3907;038 #,843,8,8

    ,3/7!,39,:

    :-:809,5,2:9

    %3,//,35073,5,8,3 /7,8 9:747 /,3 002-,5,3:905,8,35,,,3,3-070-,3,:,3 425708 /33 ,9,:,3943 08 :39: 203:7:3,303,,38::9:-:49;,8,8:5,3.,7,3

    02-07,3/,8,7:39:/0908,9!,,,3 ,3 9/, -070-,3 /,5,9203:7, 5033,9,3 8:: 9:-:/,3 /,5,9 202-07,3 7,8, 3,2,35,/,5,80303:7:3,3 5,3,8 20,: 57480843/:8 8079, 0;,547,8 /,32033,9,303,2,35,80302507-,0,3,3.,7,3,-,9507857,8 8079, 10-78 /,32033,9,3 93,9 03,2,3,3

  • 8/3/2019 osteomilitis 2

    19/23

    4,-47,807,3 4-,9 ,395709 808:,/03,3,3:7,3

    5,803395709 202-,39: 203439745033,9,38::9:-:

    !3809,8-07:-:3,3/03,3:7,350309,:,39039,343/8503,9/,35034-,9,3

    %::,3,8!,803

    03/0243897,8,3 ,33,,3809,8/,3202-07,3 31472,89039,3574808503,9

    5747,25034-,9,3

    7907,;,:,8

    85708,,70,8

    02,8/,37,8,9,:9,3,9,:-07:7,3

    3907;038/,3#,843,8,84 3907;038 #,843,8,8

    ,3/70,8,3 9::,3 5034-,9,3 5,/,5,803,5,9442,8,,3/;/:

    , :,3 9,3/, 0,, ,320207:,3 0;,:,8 20/.05,9.4394 307 /,/, 9-,9-,/8530,/897085073,5,8,3,3:9,:,357,9080,9,3,3-,897,,94,-47,8

    :3,,3 4-,9 80/,91 808:,/03,3,3:7,3

    0347039,8 5747,2 5034-,9,302-,39: 203,/,7,3 03 :39:202507404397431472,8 203:7:3,3 9,:9 ,703,09/,9,:,302-07, 50309,:,3/,8,7 :39: 502,,2,3 43/8

    /3,207:,33, 530:24947,024947,20207:,3 3907;038 20/ :39:203.0, 203:7:3,3 549038,425,8025079,,3,3 080,9,3 :2:22033,9,3 50302-:,3 /,3 /,5,9203.0,0,2-:,37,50:9

    ,3,5,803,3202-:9:,34-,950303,3:39:20343974,3809,83,

  • 8/3/2019 osteomilitis 2

    20/23

    !,3:,354,9/:7-07:-:3,3/03,3307/,3,3:,37,8,3,2,3

    %::,3,8!,803

    !4,9/:702-,3472,

    7907,;,:,8

    :2, ,2 9/:7 9/, 907,3: 38423, -07:7,3 ,/,3, 05:,8,3 9/:7 5,803

    203:3:,3080,907,,318/,35844

    3907;038/,3#,843,8,8

    4 3907;038 #,843,8,8

    ,3/7%039:,3 0-,8,,3 9/:7 ,3-,8,3,/,3507:-,,3,3907,/

    07,39025,99/:7,33,2,3/,3-0-07,5, 2 57-,/ 28,3, -,39,/,3:3:,9 7:939,8 9/:7 -,7: ,3/2,8:,3 /,,2 54, ,2, /,33:3,3-,7:4.4,3 /03,3 902,3 80,2,7,32025:3,54,9/:7807:5,/,3

    0-:9:,32,,2,74743 -0-07,5, ,919,8 18 5,/,8,3 ,7 ,23 5,803 -07039-07,919,8 -0-07,5, ,2 80-0:29/:73897:8,393/,,370,8,8:7,30-83,3/,3,25::3,,3 5,,7 9025,9 9/:7 808:,3/,8 703/,3 9025,9 9/:7 -,2:334,-47,807,3 80/,91 5349 808:,

    03, 507:3, /,3203/0391,8 3907;038 ,3

    905,9033,9,3 03,2,3,3 9/:78079,/::3,31844858448, 7:939,8 -,7: 203,3/:3,850 80-,3, 0-,8,,3 ,2,89708/,3,3809,8/,5,9-07:7,303:7:3,3 02:33,3 -,,902,380,2,7,3-:7:3,39:

    /,5,9203:3/,5,803:39:9070,5,9,:2030-,-,3907-,3:39;9,88,3,7/,5,9202-,39:5,803203:3,,30307/,38,5:39:9/:72,,2,702-,39:2033/:89/:702-07,3 89:,8 43/:81 :39:9/:7!,,7 9025,9 9/:7 202-07,30,2,3,3 /,3 /,5,9 /:3,,3:39:202-,39:207:-,5488:33/-07,3:39:202-,39:5,803 9/:7 ,9,: 897,,9 80,2,507 4/0 97,388 /,7 7:2, 0

  • 8/3/2019 osteomilitis 2

    21/23

    3/,8

    3:3,3-,7:

    !39407,38,9;9,8-07:-:3,3/03,3307/,309,:,93/,,2-0707,

    %::,3,8!,8034,-47,91!,803203:3:,35033,9,39407,38907,/,5,919,8

    7907,;,:,8

    03:7:33, 0:,3 907,/,5 002,,3 /,3 00,,3 /,,2 20,:,3 ,919,8

    -07:7,33,307

    3907;038/,3#,843,8,8

    4 3907;038 #,843,8,8

    ,3/7

    0,8,3 ,9;9,8 /,3 1,947 ,3/,5,9 2033,9,3 0-:9:,348033:7,35747,202,90307

    :,9 ,/, ,919,8 ,7,393,9,380.,7,-079,,5

    , 708543 ,-/4203 8090,-07,9;9,807,3425708,7,3,9

    07,9:897,,9,3.::5

    0744 8:: 08972 /,3 89702030-,-,3 ;,8443897:8502-:: ,7, /,3 5033,9,3-0-,3,39:303.0, 503:3,,3 0307-070-83025079,,3,35073,5,8,3,2-,9/03,3 909,5 2025079,,3,3,9,3 18 ,3 202:33,3

    5033,9,3 02,25:,3 4949 -,39:5073,5,8,3#08543 ,-/4203 205:9 3,/90,3,3/,7,/,35073,5,8,3,32033,9425708 ,7 ,3,9 /,5,9203:7,37,8,307033,9,3 /,, 9,,3 5,803203.0,009,3

    !#084907,/,5507:,8,33108-07:-:3,3/03,3502-039:,3,-8089:,3

    %::,3,8!,803

    %/,907,/5084507:,8,33108,3/,,2

    7907,,8

    03.,5,,9:50302-:,3

    3907;038/,37,843,8,8

  • 8/3/2019 osteomilitis 2

    22/23

    4 3907;038 #,843,8,8

    ,3/7!079,,3,388902 ,909078907-07,3507,,9,3 ,90907 70:,7 /03,3 8,-:3/,3 ,7 -07,3 8,05,39-49. /809,7

    88,90907

    03.0, 502,8:,3 -,907 /,7310880588,3:9

    2-:,8 /03,3 ,39:3 /7,3,80/0503/03

    033/,770108-,:730,3/,5,9 202,8:,3 -,907 0/,,2,3/:302

    ,8 9,3/, ;9, 507,9,3 /02,273,3 203 3,/ /,3 5073,5,8,3.05,908,50,/847039,8

    !,803 ,3 203,,2 8894845% 57489,90 -07084 :39: 84-0/, 8059. 80:-:3,3 /03,32,35:,83897:2039,8

    -807;,8 /7,3,80 /,7 :, 809,7,909078:57,5:-

    /,3,/7,33888:57,5:-2033,9,3 7084 :39: 3108,3 /3/,8,3 /03,3 07902,/7,3,805:7:03

    ,39-,:9,3/03,380733888:57,709745:- /,3 50730, 502-078,3/,3503073,3:9805,3,3,9:

    ,:9,3 -,8, 2030-,-,3 :979,8 /,3 202-07,3 20/, :39:5079:2-:,3 -,907 5033,9,370843108:,

    :3,,3503/:3:995048942

    02-07,35073/:3,3:39::9809,7 203.0, 0847,8 /,3

    203:7:3,370843108

    4,-47,807,3,39-49.808:,3/,8

    :33 /-07,380.,7,5741,980:-:3,3 /03,3 5033,9,3708431085,/,57489,90942

    ,19,7!:89,,

    !:73,,3:3,/,59,$009,0/4907,3/800/,08:,5:8&

    $405,72,32:!03,9,,2/,,!0307-9&

    40308,733#03.,3,8:,30507,,9,3,,79,

    ,2,3/4342:!03,9,,2,,!0307-9&,,79,

    ,3840771,59,$009,0/4907,30/,08.:,,5:8&,,79,

    !73.0$;,3/07843!,9418444380538!74808!74808!03,9/

    ,,79,

  • 8/3/2019 osteomilitis 2

    23/23

    #0,/247099580-7:-48549.42,80548904209892-;.7