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Infection osseuse sur os continu: à propos de 79 cas au niveau du membre inférieur

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Réparations tissulaires à la jambe

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Résumé

L’infection osseuse est une affection grave aux étiologies et mécanismes physiopathologiques multiples. Sous le terme largement employé d’ostéite ou d’ostéomyélite (les Anglo-Saxons utilisant quasiment exclusivement le terme imprécis de osteomyelitis), les séries de la littérature rassemblent plusieurs entités pathologiques assez distinctes, allant de l’infection osseuse sur os solide (ou continu) à l’infection sur prothèse articulaire, en passant par l’ostéomyélite hématogène et la pseudarthrose suppurée, et il n’y a pas à l’heure actuelle de définition claire de l’ostéite. Nous préférons parler d’infection osseuse sur os continu. Ainsi, dans cette situation, le problème n’est pas d’obtenir la consolidation osseuse ou de savoir quand pouvoir reposer une prothèse articulaire. Lors d’une infection sur os solide, les difficultés sont de pouvoir combler une cavité osseuse, d’avoir une antibiothérapie efficace au niveau osseux, et d’obtenir une bonne couverture cutanée. Ainsi, dans notre pratique, le schéma thérapeutique de toute infection sur os continu est stéréotypé en trois temps:

  • excision de tous les tissus infectés (parties molles et os) ou à vitalité douteuse;

  • comblement de la cavité osseuse résiduelle;

  • couverture cutanée par des parties molles bien vascularisées.

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  1. Groupe hospitalier Ambroise Paré-Raymond Poincaré, Centre de référence APHP des infections ostéo-articulaires, Faculté Paris Île-de-France Ouest, France

    Th. Bauer, M. Rottman & A. Lortat-Jacob

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  1. Th. Bauer
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Bauer, T., Rottman, M., Lortat-Jacob, A. (2012). Infection osseuse sur os continu: à propos de 79 cas au niveau du membre inférieur. In: Réparations tissulaires à la jambe. Collection Approche pratique en orthopédie — traumatologie . Springer, Paris. https://doi.org/10.1007/978-2-287-99066-3_34

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