在低收入国家(LIC),骨感染的管理是一个巨大的挑战。大量的患者属于儿科年龄组。儿童和青少年表现出良好的骨愈合潜力,提供主要依赖于感染骨的生物学反应的治疗选择。本文的目的是强调LIC患者的治疗选择,这是基于说明治疗原则的临床案例,专注于骨骼反应和愈合潜力。首先,识别紧急情况很重要。由于骨感染引起的患者败血症是一种危及生命的疾病,需要通过脓肿切口立即进行手术治疗。应根据外科医生的经验和当地条件量身定制,以避免不必要的并发症,比如过度出血,骨折或骨丢失。在非脓毒症患者中,不复杂的病例应与复杂的病例区分开来,因为最初的病例通常只需要脓肿切口,特别是在小孩子身上,没有任何其他重大手术干预。生物力学稳定性和骨形成能力,软组织状况和关节受累是区分简单病例和复杂病例的决定性因素。中心治疗柱是用简单的方法固定感染的骨,比如巴黎的石膏,支架或外部固定。这旨在提供足够的稳定性以允许新骨形成,其随后减小感染部位的尺寸并且可以桥接先前感染的不愈合部位或骨缺陷。在大多数情况下,不进行抗生素治疗,因为抗生素不可用或负担不起.严重的软组织缺损仍然是一个主要挑战,因为微血管手术经验通常需要可靠的覆盖,建议转诊到极少数的专业中心之一。严重的骨缺损也应在具有足够专业知识的骨重建手术中心进行治疗。定期随访对于确保愈合和避免疾病恶化很重要。通过这些治疗原则可以实现令人鼓舞的成功率。然而,不应忘记,这些国家的贫困,包括有限的医疗保健,仍然是世界上最重要的问题之一。
In low-income countries (LIC), the management of bone infections is a huge challenge. A high number of patients are in the pediatric age group. Children and adolescents exhibit good bone healing potential offering treatment options that mainly rely on the biological response of the infected bone. The purpose of this article is to highlight treatment options for these patients in LIC, which is based on clinical cases that illustrate the principles of the treatment, focusing on bone reaction and healing potential. First, identification of emergency cases is of importance. Sepsis of the patient due to bone infections is a life-threatening disease that requires immediate surgical attention with abscess incision. It should be tailored to the surgeon\'s experience and local conditions to avoid unwanted complications, such as excessive bleeding, fracture or bone loss. In non-septic patients, uncomplicated cases should be distinguished from complicated cases as the first might often require only abscess incision, particularly in small children, without any other major surgical intervention. Biomechanical stability and bone formation capacity, soft tissue conditions and joint involvement are decisive factors differentiating uncomplicated from complicated cases. Central treatment column is the immobilization of the infected bone with simple methods, such as plaster of Paris, braces or external fixation. This is intended to provide sufficient stability to allow for new bone formation that subsequently downsizes the infection site and that can bridge previously infected non-union sites or bone defects. In most cases, antibiotic treatment is not performed as antibiotics are not available or affordable. Severe soft tissue defects remain a major challenge as microvascular surgical experience is often required for reliable coverage, for which referral to one of the very few specialized centers is recommended. Major bone defects should also be treated in centers with sufficient expertise for bone reconstruction procedures. Regular follow-ups are important to ensure healing and to avoid aggravation of the disease. Encouraging success rates can be achieved by these treatment principles. However, it should not be forgotten that poverty in these countries, including limited access to health care, remains one of the world\'s most important problems.