Chronic osteomyelitis

Description:

Chronic osteomyelitis - the purulent or proliferative inflammation of a bone tissue which is characterized by formation of sequesters or lack of a tendency to recovery and increase of resorptive and productive changes in a bone and a periosteum 2-3 months later from the beginning of acute process.

Symptoms of Chronic osteomyelitis:

The clinical course of chronic osteomyelitis consists of two phases: recurrence and remirsiya. At active pathogenic flora against the background of a bslableniye of an organism, cooling, an injury and other factors there is an exacerbation of chronic osteomyelitis — a disease recurrence phase. As a result of antimicrobic treatment or spontaneously sharpness of inflammatory changes passes and there comes the phase of remission of a disease. Such change of phases can repeatedly repeat.
Chronic osteomyelitis is characterized by a triad of the main signs: recurrent current, existence of the sequester (or osteomiyelitichesky cavity), purulent fistula.
The recurrence of chronic osteomyelitis is shown by deterioration in the general state. At the patient the indisposition, weakness, a headache, fervescence, perspiration are noted, there can be a fever. It has extremity pain, purulent fistula opens. In a row спучаев over the chronic osteomiyelitichesky center skin becomes hyperemic and infiltration soft fabrics, in the subsequent — a fluctuation symptom, earlier closed purulent fistula opens or there is a spontaneous opening of phlegmon in the new place. After emptying of an abscess intoxication decreases, temperature becomes subfebrile, the local inflammation is gradually liquidated, purulent fistula continues to function or too is gradually closed. There comes the phase of remission of osteomyelitis which can be replaced by a recurrence phase again.

The clinical current of different types of chronic osteomyelitis in principle is identical — there is a change of phases of a disease. But at posttraumatic (including fire osteomyelitis) the inflammation of a bone is usually limited to area of a change from where purulent fistulas proceed. Existence of osteomiyelitichesky damage of a bone on a considerable extent of a metaepiphysis and a diaphysis with various localization of purulent fistulas, quite often several is characteristic of chronic hematogenous osteomyelitis. According to big distribution of an inflammation at chronic hematogenous osteomyelitis displays of chronic purulent intoxication, change in blood (a leukocytosis, SOE, a disproteinemia), a renal failure, etc. are more expressed.

When collecting the anamnesis it is easy to establish that the patient in the past had the acute hematogenous osteomyelitis or a fracture of bones which was complicated by suppurative process. It is necessary to specify number of a recurrence of a disease, remission duration, an otkhozhdeniye from fistulas of small bone sequesters. Find out number of operations in the past, their character, a type of plastics of a bone cavity, the immediate postoperative result.

At clarification of complaints it is necessary to specify irradiation of pains in joints, existence of pains on the course of neurovascular bunches that can indicate formation of new purulent zatek.

The general symptoms at a recurrence of osteomyelitis are identical to any purulent surgical disease therefore they determine body temperature, do necessary blood tests and urine.

When determining local changes it is necessary to pay attention to prevalence of a hyperemia of integuments, infiltration of soft tissues, existence of a symptom of fluctuation. It is important to specify extent of functioning of fistula, to investigate it the bellied probe that allows to establish localization of the osteomiyelitichesky center at some patients.

In the presence of ulcers in places of long existence of purulent fistula it is necessary to examine carefully their surface and edges and at the slightest suspicion on a malignancy to make a biopsy. For specification of prevalence of inflammatory process on the next joints determine the volume of movements, existence of morbidity and an exudate in them.

Reasons of Chronic osteomyelitis:

Transition of osteomyelitis to a chronic form is caused by a variety of reasons from which are main late begun treatment, insufficiently correct carrying out operation, an antibioticotherapia error. Transition of acute process to a chronic stage is promoted by insufficient drainage of a suppurative focus in a bone. Most often it occurs when the periosteum over all struck part of a bone is not cut and the put frezevy openings do not correspond to prevalence of osteomiyelitichesky process. The main errors of an antibioticotherapia is use of antibiotics without the changing sensitivity of pathogenic flora and unreasonably early interruption of a course of an antibioticotherapia.

Treatment of Chronic osteomyelitis:

Surgical treatment at chronic osteomyelitis is shown in the presence of sequesters, purulent fistulas, osteomiyelitichesky cavities in bones, osteomiyelitichesky ulcers, a malignancy, at a nearthrosis, at a frequent recurrence of a disease with the expressed pain syndrome, intoxication and dysfunction of a musculoskeletal system, and also at detection of the expressed functional and morphological changes of the parenchymatous bodies caused by a persistent purulent infection.

Contraindications for radical chronic osteomyelitis operation — necretomies — are the expressed renal failure because of an amyloidosis, a decompensation of cardiovascular, respiratory systems. The main link of complex treatment of chronic osteomyelitis is radical operation — a necretomy which often still is called a sequestectomy. The operation purpose — elimination of a chronic suppurative focus in a bone and surrounding soft tissues. At a radical necretomy make removal of sequesters, opening and elimination of all osteomiyelitichesky cavities with their internal walls of granulations and  excision of all purulent fistulas.

The following important stage of radical operation is sanitation and plastics of a bone cavity. Now apply plastics to plastics of bone cavities a muscular rag, on a krovosdabzhayemy leg, bone plastics (with use of an autogenic and tinned bone tissue), a chondroplasty (with use of a tinned cartilage), carry out skin plastics less often.

Various biopolymer materials are used: a collagenic sponge, impregnirovanny antibiotics, glue compositions with various ingredients and the biopolymer seals containing antiseptic agents. All these materials incorporate also the drugs activating an osteanagenesis.

Sanitation of bone cavities after a necretomy is carried out by methods of active long washing drainage and method of pumping out. Quite often these methods use at the same time: through the bringing drainage wash out a bone cavity, attach the taking-away drainage to a suction. For washing sanitation which is carried out during 7 — 15 days various antiseptic solutions are used: antibiotics, dioxidin, Furacilin, фурагин potassium, Rivanolum, etc. Efficiency of sanitation of a bone cavity is controlled by microbiological researches.

After performance of a necretomy treatment is directed mainly to suppression of residual microflora in the field of surgical intervention that provides good immediate postoperative result.

This goal is achieved by the following medical events: 1) antibioticotherapia, 2) immunotherapy, 3) local holding physiotherapeutic procedures: ultrasonic therapy, electrophoresis of medicinal substances.

In the postoperative period infusional therapy is carried out: hemotransfusions, proteinaceous blood substitutes, electrolytic solutions; correction of exchange processes; an extremity immobilization, and then physiotherapy exercises for improvement of function of a musculoskeletal system.