Osteomyelitis

December 30, 2011

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Osteomyelitis - A condition in which there is loss of bone parts. For this disease is characteristic for purulent necrotic process That develops bones As well as bone marrow . Inflammation can develop in the soft tissue surrounding the bone. This process causes pyogenic bacteria and   or mycobacteria   (that is, those that produce pus).

The disease was first detected even at the mummies of ancient Egypt, it is also described by the ancient Greek physician Hippocrates. Today osteomyelitis is relatively rare, but it is treated to the present time, it is a difficult process.

Forms of osteomyelitis

To date, to distinguish between hematogenous osteomyelitis Which manifests itself due to ingress of microbes in the bone through the blood circulation, as well as negematogenny osteomyelitis (post-traumatic osteomyelitis) as a secondary disease manifested as a complication of wounds, i.e., negematogennym manner when the bone fall microorganisms from the external environment. At the initial stage of development of both types of inflammation of the bone have different origins. But while in the later stages of these diseases are similar, because of which they have a common name. According to clinical features to distinguish between sharp   and chronic osteomyelitis . In most cases, chronic osteomyelitis is a consequence of an acute form of the disease. However, in some cases, it is chronic osteomyelitis is a primary form of the disease.

Hematogenous osteomyelitis

Hematogenous osteomyelitis is most often seen in patients during childhood and teenage boys. Generally, localization process occurs Femoral   and tibial bones . More rarely, the disease manifests itself in the rest of the bones. Inflammation occurs due to contact with microbes in the bone marrow via the blood circulation. The primary focus of microbes may be carbuncles . boils . cellulitis . panaritiums . abscesses . mug . caries . infected abrasions   and other diseases. The development of the disease affects a number of factors: anatomic and physiologic . biological   and immunobiologicheskie . predisposing .

This is a characteristic blood supply to the bones of the child (children in the area of ​​bone growth there is a whole network of small vascular loop wale, so they often settle a variety of micro-organisms). The disease often develops when the body reacts uniquely, a reaction similar to allergy. The immediate factors contributing to the development of disease, may become a bone injury, decreased body resistance, aided by the disease, overwork , Shortage of vitamins.

Negematogenny osteomyelitis

In this form of the disease pathogens, microorganisms in the bone enter from the environment in the process of wounds from firearms, with severe soft tissue injuries during open fractures. Due to the development of the local blood supply to the bone is broken and as a result, it takes place necrosis That is dying. Negematogenny hematogenous osteomyelitis of different forms of the disease by the fact that inflammation can start in the bone marrow and periosteum.

Symptoms of acute osteomyelitis

The initial symptoms of the disease, which manifest themselves in the early days, a general weakness and malaise, aching sensation in the extremities, muscle pain, headache . A little later, the patient feels a strong fever, the body temperature rises to 39 degrees. By the initial symptoms may be attached vomiting, a feeling of weakness. The patient feels very bad, manifest dimming of consciousness, delirium, irritated meninges, sometimes manifested convulsions. The patient has no appetite, there is dryness of the tongue. In addition, the symptoms of acute osteomyelitis is a pale face, dry skin, which, moreover, becomes yellow, cyanotic mucous membranes. Arterial pressure   the patient is reduced, muffled heart sounds are heard, it quickens the pulse, breathing becomes frequent and superficial. During palpation the doctor often finds an enlarged liver and spleen. The kidneys sometimes painful.

After one or two days after the onset of the disease begin to show the pain that have strict localization in the affected limb. This pain is tearing character, which is why children are often the least movement of the limbs after much screaming from the pain intensified. In some cases, due to the intense pain the child is forced to hold the limb in a state of immobility. This condition is called psevdoparalichem . Also, in the first days it begins to show swelling of soft tissue, which is accompanied by a distinct soreness. Skin lesions in places red and swelling, its temperature rises. Swelling of the affected limb is constantly increasing, after a while become visible veins, regional lymph nodes increases. Often, when this condition develops sepsis.

Depending on how severe the disease is, distinguish mestnoochagovuyu . toxic   ( lightning ) And septikopiemicheskuyu   type forms of acute disease.
For mestnoochalovoy form of osteomyelitis is typical for most stable. The disease begins at completely healthy child who complains of pain in a particular place. Temperature rises to 39-40 degrees C, over time, there is restriction of movement, gradually emerging: limitation of movement in the joints, skin redness, severe persistent pain.

When septikopiemicheskoy form a patient in the short term, there are many pockets of pus and this process takes place in parallel in the internal organs or bones.

When toxic form people can dramatically lose consciousness, delirium. These signs are called signs of "septic intoxication." They are extremely fast progress and lead to death within the first hours or days of the disease. In this case, by the clinical signs of bone and soft tissue do not have time to form.

In adult patients due to osteomyelitis is affected, usually the hip or spine. Accordingly, in this area and pain occur. However, because of the many reasons for the occurrence of pain in these areas diagnosis of osteomyelitis in adults is sometimes more difficult than in children.

The course of acute osteomyelitis depends on how promptly started treatment of the disease, which primarily includes antibiotics.

Typically, acute osteomyelitis becomes chronic due to the ongoing necrosis of the infected area or a compact layer of spongy bone. Patients who suffer from chronic osteomyelitis, clinical symptoms, usually expressed slightly. Their gain is observed only in the case of aggravation of inflammation. Clinical symptoms are compounded if the overall resistance of the body decreases due to the presence of infection in the bone. This phenomenon can cause cooling, trauma, severe illness and other phenomena.

Diagnosis of osteomyelitis

In the process of diagnosis of acute osteomyelitis is primarily made methodical palpation carried out with caution, with which you can determine the most painful area, which will correspond to the center of the development of the inflammatory process.

With the help of X-ray examination can determine the location and extent of the lesion, as well as to determine how serious were changes mortem perspective. However, with the help of X-ray examination symptoms can be detected only with the 10-14 days of developing the disease. When examined by X-ray can determine the isolated portions destruction. When considering their x-ray shows how the hole in the bone.
In some cases, the establishment of an accurate diagnosis is advisable to use the method of computed tomography. If the specialist suspects a patient of chronic osteomyelitis, sometimes to diagnose the method fistulography. This method of diagnosis allows to identify the location of a curtailment if the usual pictures do not show the necessary data clearly enough. In the application of the method used contrast agents (sergozin, yodolipol, Diodon). The most accurate results can be obtained from the use of radioactive scanning method, which is used for the radioactive technetium.

It is also in the process of diagnosis of osteomyelitis, a complex of laboratory tests. Thus, the most informative method is to determine the erythrocyte sedimentation rate ( ESR ), Indicating the presence of inflammation in the body.

In order to definitively confirm the diagnosis, it is often the method of biopsy sampling of tissue. Bone puncture is performed under anesthesia . This technique is used for bacteriological examination.

Osteomyelitis Treatment

To date, the treatment of osteomyelitis widely used antibiotics . This method of therapy significantly improved the effectiveness of conservative treatment and, accordingly, reduced the need for surgery. Current therapy of osteomyelitis includes a number of measures the total effect on the patient's body, as well as the use of the local effects on the site of infection.

In the first days after the onset of the disease is carried immobilization, which limits the process, reduces pain.

In more rare cases, surgery is required, which is used if the disease is too advanced and developed cellulitis. The operation was also carried out to remove the curtailments.

To date, the most effective method is considered to be gentle method osteoperforation . If the patient has a subperiosteal abscess, her autopsy performed without detachment of the periosteum. After that, burr holes are applied directly to the bone. Through holes in the bone produced drainage of the medullary canal and into the bone administered antibiotics and antiseptics.

As general methods of conservative treatment is applied antibiotic therapy, detoxification activities, physiotherapy, produce correction immunity disorders.