Osteomyelitis

Description:

Osteomyelitis (from the Greek words: osteo-from osteon that means "bone", myelo-that means "brain", and - itis that means "inflammation") — is purulent - the necrotic process developing in a bone and marrow, and also in the soft tissues surrounding them, caused piogenic (producing pus) bacteria or mycobacteria.

Osteomyelitis symptoms:

Acute hematogenous osteomyelitis meets mainly at children's age, and about 30% of children get sick aged till 1 year. At adults acute hematogenous ostemiyelit is a recurrence of the disease postponed at children's age. The most frequent localization of defeat — long tubular bones, is more rare flat and short. Also multiple damage of bones is observed. The clinical picture depends on a look and virulence of the activator, age of the patient, on localization and prevalence of process. An important role is played by a premorbidal condition of immunity.

Distinguish three clinical forms of acute hematogenous osteomyelitis: septicopyemic, local and toxic (adynamic). At a septicopyemic form the disease begins with rise in body temperature to 39 — 40 °. The serious general condition of patients is caused by intoxication: the fever, a headache, repeated vomiting, sometimes nonsense and a loss of consciousness are noted. Hemolitic jaundice is possible. Local changes develop quickly enough. In the first 2 days there are severe localized pains, the extremity acquires the forced provision (a painful contracture), the active movements in it are absent, passive — are sharply limited. Quickly hypostasis of soft tissues accrues. Skin over the center of defeat is hyperemic, strained, the venous drawing is quite often expressed, local temperature is increased. Often arthritis of adjacent joints, at first serous, and then purulent develops.

Already in the metabolic acidosis, a hyperpotassemia, a hypercalcemia, a hyponatremia the first few days can be observed, indicators of nonspecific factors of immunity worsen. In coagulant system of blood there are expressed phase changes: hypercoagulation, then hypocoagulation and fibrinolysis. Hormonal regulation of functions of an organism, anti-toxic function of a liver and function of kidneys are broken. At generalization of a purulent infection its hematogenous innidiation with the advent of suppurative focuses of various localization is possible (the combined damage of bones, development of acute purulent destructive pneumonia, a purulent pericardis, etc.).

At a local form of a disease the symptoms caused by inflammatory process in a bone and soft tissues prevail; the general state can be moderately severe or even satisfactory.

The toxic (adynamic) form of hematogenous osteomyelitis meets quite seldom. The disease develops immediately. The heavy picture of acute sepsis with the rough beginning prevails. Within the first days the phenomena of heavy toxicosis which are followed by the hyperthermia, meningeal symptoms, a loss of consciousness and spasms replaced by an adynamia accrue; critically the ABP decreases, acute cardiovascular insufficiency develops. Emergence of local signs considerably lags behind on time the general symptoms of a disease that complicates its diagnosis and performing timely, adequate therapy.

At localization of inflammatory process in a bone epiphysis (is more often at children up to 2 — 3 years) its distribution on a joint and para-articular fabrics is possible. In a joint serous, and then purulent exudate appears in the beginning. The child spares an extremity, its forced situation (pseudoparesis) is noted. At survey reveal hypostasis over a defeat zone, deformation of a nearby joint, local temperature increase; the dermahemia can appear later considerable time from the beginning of a disease. The palpation and the passive movements of the affected extremity cause sharp morbidity. Later there can be phlegmon of soft tissues in a joint. Radiological symptoms of such osteomyelitis come to light earlier, than at other forms. At extensive damage of a bone pathological changes and dislocations quite often meet. In the remote period note deformation of bones, an extremity growth disorder.

Acute osteomyelitis after gunshot wounds. Clinical displays of acute fire osteomyelitis depend on extensiveness of defeat, degree of dissociation of bones, peeling of a periosteum, injury of muscles, nerves, vessels. The wound is contaminated by microflora which development is promoted by numerous pockets and extensive sites of a necrosis of fabrics. An important role in development of acute fire osteomyelitis is played by localization of the center, a condition of reactivity of an organism and a mental stress. More often fire osteomyelitis arises at insufficient surgical treatment of a wound.

The clinical picture of a disease in the first weeks is caused by wound suppuration. Transition of inflammatory process to a bone is shown by increase of gektichesky fever, weakness, hypochromia anemia, a leukocytosis, intoxication. Local symptoms at the same time are left practically without changes: puffiness of an extremity does not increase, there are no infiltrates in the field of a wound and a plentiful purulent discharge. However the type of a wound changes — its walls and granulations become dim, necrotic, the gray plaque appears. Further inflammatory process passes to the wound surface of a bone, extends on the marrowy channel and under a periosteum. In the subsequent acute purulent process passes into chronic.

At fire fractures of bones early and late pyoinflammatory complications are possible. The early pyoinflammatory complications arising right after wound are connected with the progressing ichorization of marrow and the general septic phenomena, up to development of sepsis. Later complications are caused by an exacerbation of a disease. At the same time destructive process is localized out of the marrowy channel, generally around bone fragments and foreign bodys.

Acute posttraumatic osteomyelitis is similar with fire on an etiology, a pathogeny and a clinical picture. The purulent inflammation extends to all departments of a bone that this process gives the grounds sometimes to call a posttraumatic panosteitis. Suppuration of soft tissues at open changes — the most frequent and serious complication leading to penetration of pyogenic flora into a zone of the injured bone. Development of posttraumatic osteomyelitis is promoted by pollution of a wound during an injury, especially at splintered changes. Development of a disease is followed by high temperature of a body, the expressed leukocytosis with neutrophylic shift to the left, increase by SOE, anemia, intoxication. Local changes are characterized plentiful purulent separated from a wound, hypostasis of fabrics, a dermahemia, severe local pain.

Kind of posttraumatic osteomyelitis is the postoperative osteomyelitis arising after a bone tissue operations, is more often than an osteosynthesis. Usually postoperative osteomyelitis is connected with traumatic technology of operation and violation of the rules of an asepsis.

Acute contact osteomyelitis results from transition to a bone of a purulent inflammation from surrounding fabrics. The disease is characterized by rather long existence of purulent process in soft tissues about bones. The most often contact osteomyelitis meets at purulent processes on brush fingers, at extensive purulent wounds of a pilar part of the head. Formation of fistulas, strengthening of local morbidity and hypostasis of soft tissues in a zone of damage of a bone are clinical signs of acute contact osteomyelitis.

Sclerosing osteomyelitis of Garre begins subacutely and is characterized by night extremity pains, the disturbance of its function moderated by fervescence. Damage of a bone can be followed by hypostasis of soft tissues, expansion of hypodermic venous network in this connection it is necessary to carry out the differential diagnosis with sarcoma.

Albuminous osteomyelitis of Ollye proceeds with insignificant local manifestations in the form of a small dermahemia and infiltration of soft tissues of an extremity. Very scanty clinical symptomatology accompanies a Brodie's abscess. Course of a disease sluggish, torpid.

Osteomyelitis reasons:

  
Ways of penetration of disease-producing bacteria:
    * through a blood stream (hematogenous osteomyelitis)
    * result of penetration of activators from the inflammation center
    * the getting injury, including the iatrogenic reasons, such as replacements or internal fixing of changes or sealing of channels of teeth or installation an endoprosthesis (posttraumatic and dontogenous osteomyelitis).

Treatment of Osteomyelitis:

    * Obligatory hospitalization
    * Massive antibacterial therapy
    * Symptomatic therapy

General treatment:

    * an antibioticotherapia (intramusculary cephalosporin, lincomycin, etc.) — begin as soon as possible (in the first 8 hours of a disease — absolute recovery);
    * powerful desintoxication — from the first days of a disease (plasma transfusion and disintoxication blood substitutes);
    * increase in immune forces of an organism;
    * hemosorption.
    * GBO - hyperbaric oxygenation.

Topical treatment:

    * rest, extremity immobilization plaster longetka;
    * surgical treatment — at early stages when process did not go beyond a bone, make their trepanation (formation of openings in bones through which carry out a flowing drainage), in the started cases when also phlegmon of soft tissues around a bone was formed, make, besides, and opening of an abscess, open washing, up to removal of the center and fistulas;
    * physical therapy (UVCh, Ural federal district, electrophoresis).