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Entzündliche (infektiöse und nichtinfektiöse) Skeletterkrankungen

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Skeletterkrankungen

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Abstract

Aus pathologisch-anatomischer sowie auch aus klinischer Sicht wird entsprechend der Eintrittspforte der Erreger in den Knochen zwischen akuter und chronischer hämatogener Osteomyelitis einerseits sowie zwischen akuter und chronischer exogener (posttraumatischer und postoperativer) Osteomyelitis unterschieden. Als sog. sekundäre Osteomyelitis wird noch eine Form bezeichnet, bei der die Infektion im Wesentlichen von dem umgebenden Weichteilmantel (Hautabszesse, Dekubitus, gangränöses Ulkus bei Diabetikern und Patienten mit Gefäßprozessen) ausgeht. Aus röntgenologischer Sicht sind diese Unterscheidungen jedoch von geringerer Bedeutung im Vergleich zu der Feststellung, dass die Bildgebung vielmehr von der Virulenz der jeweiligen Erreger (z. B. Staphylococcus aureus, Streptokokken, Proteus, Pseudomonas aeruginosa) und der Abwehrlage des Wirtsorganismus geprägt wird: So verläuft der Prozess z. B. bei schlechter Abwehrlage (Diabetes mellitus, Patienten unter Immunsuppression, Kinder mit chronischer granulomatöser Erkrankung etc.) mehr destruktiv (hochakute Osteomyelitis) und kann in eine chronische Form übergehen (chronische Osteomyelitis), bei guter Abwehrlage und weniger virulenten Keimen hingegen primär sklerosierend (chronischer Knochenabszess nach Brodie, Plasmazellenosteomyelitis).

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(2008). Entzündliche (infektiöse und nichtinfektiöse) Skeletterkrankungen. In: Skeletterkrankungen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-45531-8_14

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