Osteomyelitis - a bone marrow inflammatory purulent character, passing on the bone area and the periosteum.
Osteomyelitis causes melting and destruction of the bone with the formation of abscesses and fistulas. The disease occurs as a complication of skeletal injuries and injuries of the musculoskeletal system. May affect any of the bone, but most often occurs in the shoulder area or thigh, in the vertebrae, the bones of the jaw.
Osteomyelitis most often occurs in children, men and the elderly due to the nature of the immune status and more frequent injuries.
Causes
Osteomyelitis can cause specific flora, such as tuberculosis, syphilis or brucellosisBut these forms are rare.
Most of osteomyelitis is caused by destruction of the bone marrow and bone tissue nonspecific flora - staphylococci, streptococci, E. coli, fungal flora.
Germs can penetrate into the bone tissue in two ways:
- exogenously - outside for injuries and damage, as a result of wounds, open surgery, the transition from soft tissue injuries;
- endogenously - within the body, typically carried by blood current and entering the bone. Thus develops one of the most common forms of osteomyelitis - hematogenous osteomyelitis, with him the germs get into the bones of boils, panaritiums, Abscesses or abscessesAnd other purulent foci, infected wounds, cavities, sinuses.
Kinds
Adrift Osteomyelitis can be acute or chronic.
Acute osteomyelitis occurs abruptly, runs hard, symptoms appear after a couple of weeks of the development process in the bone.
Chronic osteomyelitis is sluggish and for a tendency to recur appear sequestered cavity and the process becomes chronic.
Exogenous osteomyelitis is special forms:
- hematogenous osteomyelitis - the result of the penetration of pathogens of purulent infection in the bone of the bloodstream.
- post-traumatic osteomyelitis - due to injury.
- gunshot osteomyelitis - an infectious complication of gunshot fracture.
- odontogenic osteomyelitis - the result of the penetration of pathogens from the source of inflammation are localized in the tooth or periodontal tissues.
Also produce the typical and atypical forms of osteomyelitis.
Manifestations of acute osteomyelitis
Mostly acute osteomyelitis is hematogenous origin, it occurs after 2, a maximum of 3 weeks from the date of microbial focus in the bone. More likely to have young children, especially often affected femurs and tibia.
Osteomyelitis has three forms of flow:
Septikopiemichesky osteomyelitis
It manifests rapid acute onset of high fever and intoxication, chills, headaches, vomiting, loss of consciousness with delusions and convulsions, liver and jaundice.
Patients look pale, cyanotic with dry skin, rapid pulse, and extremely low pressure. Increased liver and spleen, formed secondary pneumonia.
After a few days in the area of the bone occurs hearth pains are boring, cutting, tearing character, pain aggravated by the slightest movement. soft tissue area swollen, the skin over the fire red, hot, tense tissue, joints may be affected next.
Up to 2 weeks in the affected bone is formed pus center, which feels like a liquid fingers. Pus may be in the form of an abscess, demarcated or may penetrate into the muscles and tissue phlegmon type. Usually, they are opened to the outside with the formation of a fistula, or provide secondary sepsis.
local osteomyelitis
Manifestations of purulent focus at the local form of osteomyelitis occur only locally with all the typical symptoms, the general condition remains satisfactory.
Adynamic or toxic form
It occurs infrequently and appears instantaneous start of the type of sepsis with severe toxicity and convulsions, loss of consciousness and cardiac failure. Bone symptoms appear late.
For other forms of osteomyelitis it depends on the cause and severity of the process.
Symptoms of chronic osteomyelitis
If the process is delayed, and manifestation of bone destruction prevail over its recovery, formed chronic osteomyelitis.
a cavity is formed on the site of bone fracture. Condition improves, the pain becomes blurred and aching, tracts can be complex and tortuous, opening away from the purulent focus. Among them stands out a little pus.
periods of exacerbation alternating with periods of remission, then discharge from the fistula stops and they can even be closed. With the weakening of the immunity relapse and purulent newly formed cavity with fistulas. Relapses are similar in manifestations of acute osteomyelitis.
Diagnostics
The basis of the diagnosis - a typical clinic and complaints, as well as the presence of bone lesions.
Confirmed the diagnosis of osteomyelitis bone radiographs in several projections, tomography or fistulography, and may need an ultrasound.
osteomyelitis treatment
Osteomyelitis required hospitalization, immobilization of a limb is carried through active antibiotic (for 4-6 weeks at acute osteomyelitis or chronic osteomyelitis is longer), taking into account a possible pathogen and hearth skidding infection.
Applied also detoxication therapy introduction gemodeza, polyglucin, albumin, when threat sepsis hemosorbtion can be displayed.
Required purulent drainage and removal of pus foci with oral antibiotics and washing enzymes.
In chronic processes shown sequesters excision and removal of necrosis, followed by stimulation of the regeneration of bone tissue.
The results of drug therapy are unpredictable, especially if it is accompanied by surgical debridement infectious focus. Prognosis more favorable after complete removal of the affected bone. The healing process usually takes 6 weeks.
Complications and prognosis of the treatment
Osteomyelitis in the acute phase of the dangerous development of sepsis, renal disease and exhaustion.
Chronic process leads to pathological fractures, skeletal deformities and contractures, malignancy hearth.
Osteomyelitis Treatment long, often several months required for complete cure, the prognosis of acute process beneficial in chronic - depends on the duration and form of damage.
