Osteomyelitis is a chronic inflammatory process affecting the periosteum, compact and cancellous bone, bone marrow - t. E. All of the elements of the bone.The emergence of this disease due to the penetration of bone infection, which gets to the bloodstream (hematogenous), or externally as a result of all sorts of injuries.The incidence increases significantly during the war years, when there are cases of gunshot wounds, but in peacetime doctor face him repeatedly. Content
Osteomyelitis always due to hit in wound infection.80% of cases are caused by staphylococcus, at least its cause are streptococci and gonorrhea, a
More specifically, the causes of osteomyelitis can be:
By way of penetration of the pathogen into the bone are distinguished:
By the nature of osteomyelitis is also different.
Common symptoms of all forms of osteomyelitis are:
addition to the common features of the disease each clinical form of osteomyelitis has its own peculiarities of which are presented below.
most common form of the disease in peacetime.An overwhelming number of cases are children.It affects mainly the long bones - up to 85%: the femur (40% of cases), tibia (32%) and shoulder (10%).
feature of this form of the disease is that an isolated primary focus in the bone marrow is not formed, and once the inflammation extends to the entire thickness of the bone.Deep open infected wound promotes penetration pyogenic flora in bone fragments.
develop in the absence of adequate treatment of acute (as hematogenous and posttraumatic) after 3-12 weeks from the moment it began.It is diagnosed when the following symptoms:
In the case of transition from the acute inflammation in a chronic state of health of the patient is greatly improved, the pain becomes less pronounced.In the focus of infection are formed fistulas from which pus.From time to time fistulas closed, and then the process repeats.Recurrence of chronic osteomyelitis clinically resembles debut acute form of the disease, but the symptoms of intoxication and pain are expressed not so bright.
Complications of acute osteomyelitis are:
Cases of complications of chronic osteomyelitis, the main ones are:
On the basis of the patient's complaints, as well as the data history of the disease (previous injury), and Life (foci of chronic infection, severe disease, show a decrease in the immunestatus), data of objective examination (visual changes in the focus of infection, pain on palpation of the affected area) surgeon or trauma suspected osteomyelitis, and appoint additional methods of inspection, confirming the diagnosis.
Treatment of the disease is carried out exclusively in a specialist hospital.
In the case of severe intoxication patient is recommended bed rest with immobilization of the affected area.
food in the diet of the patient should be easily digestible, rich in vitamins and trace elements.To reduce the symptoms of intoxication is recommended to drink plenty of liquids.
The immediate therapeutic measures is the rehabilitation of the affected area with the follow local and systemic antibiotic therapy.In the initial stages, in order not to wait for culture results purulent masses are assigned to broad-spectrum antibiotics (cephalosporins - cefixime, ceftriaxone, Zinnat; osteotrophic antibiotics - clindamycin, lincomycin).When the results of seeding known antibiotic sensitivity vary according to the microorganism.
plays an important role detoxification therapy.The patient was administered the following solutions: Colloids (Poliglyukin, Reopoliglyukin) and crystalloid (saline);detoxification actually means (Neokompensan, Haemodesum, Neogemodez);In severe cases, apply plasmapheresis, hemosorption, UV or laser irradiation of blood.
Appointed and proof of immunity: Timalin, interleukins, gamma globulin, hyperimmune plasma, Levamisole, nucleinate sodium.
In parallel, therapy aimed at eliminating unpleasant patient symptoms:
If conservative treatment of osteomyelitis does not have the desired effect within a few days, have resorted to the treatment of Operational: make trepanation bone, its revision (removal of pus), drainage, followed by a regularwashing with antiseptic solutions.For radical surgery are sekvestrnekrektomiya and resection of bone.
direct indications for surgery are:
forecast acute osteomyelitis determined by the form of the disease, the age and general health of the patient, timely diagnosis and adequate treatment assigned.
chronic osteomyelitis prognosis also depends on the age and health of the patient, in addition, it has a value of the severity of lesions and radical surgical treatment of the disease.
Forecast chronic forms of osteomyelitis unfavorable, since destroyed, tissue degenerative changes can not be recovered.