Osteomielit - is an inflammatory process pyonecrotic nature, which affects the bone tissue surrounding periosteum and bone marrow.The agents of osteomyelitis in the majority of cases, are Staphylococcus and Streptococcus.
osteomyelitis, which appeared for the first time, called acute.If the patient has a prolonged course of the disease with exacerbations and remissions, we are talking about chronic osteomyelitis during the inflammatory process.Often, osteomyelitis in the inflammation process involves the whole bone tissue, including bone marrow area.In chronic osteomyelitis occurs during bone sclerosis and deformity.
Osteomielit cause of bacterial pathogens such as: Staphylococcus aureus, Staphylococcus epidermidis (70%), streptococci, enterobacteria and Pseudomonas aeruginosa.In rare cases, the cause of osteomyelitis can be Mycobacterium tuberculosis.
Osteomielit occurs by direct contact of pathogenic microorganisms in the bone and surrounding tissue
chronic inflammatory processes in the body can also be attributed to the causes of osteomyelitis.These include: chronic sinusitis and tonsillitis, tooth decay, long unhealed umbilical wound at newborns, abrasions, etc.In such cases, the microorganisms fall into bone tissue hematogenous route.Chronic inflammatory processes in the body are the second highest rate after traumatic bone.
osteomyelitis affected, in most cases, the long bones of the upper and lower extremities, bones of the skull and jaw, spine and ribs.
When there is loss of bone tissue micro-organisms to the affected inflammation of the hearth join white blood cells that produce certain lytic enzymes which have the property of decomposing bone tissue.As the blood vessels occurs spread purulent exudate from the affected chamber, which leads to bone sequestration.The result is a hotbed of chronic infection.At the same time begins to form new bone in the area of necrosis, a so-called cover.During histological examination established the exact stage of osteomyelitis: acute or chronic.
Osteomielit caused by various pathogens, and for various reasons, therefore, proceeds differently.
osteomielit There are acute, chronic, gunshot, traumatic, hematogenous, odontogenic, osteomyelitis of the jaw, osteomyelitis of the spine and joints, etc.
Signs of osteomyelitis depends on the area of the lesion.
Acute osteomyelitis is characterized by an acute onset with rapid multiplication of pathogens in the affected area, severe pain, signs of intoxication, great purulent discharge from the affected area, and significant tissue edema.
Chronic osteomyelitis occurs often subacute and is accompanied by periods of exacerbation and remission periods.
odontogenic osteomyelitis accompanied by intense pain in the affected tooth area radiating to the ear or the eye, fever, chills, insomnia, lack of appetite.
gunshot osteomielit characterized in the early days of rapid festering wounds.This is due to the fact that the wound in gunshot wounds extensively populated by pathogenic microorganisms, which develops as a result of numerous pockets and large areas of tissue necrosis.The characteristic role here and is localized outbreak, the state of the immune system and stress situations.But the main cause of fire osteomyelitis is insufficient sanitary and debridement.
After festering wound inflammation process moves to the bone, which is accompanied by hectic fever, hypochromic anemia, weakness, leukocytosis and intoxication.Local reaction in the affected chamber remain virtually unchanged: the lack of infiltration in the wound, swelling of the limbs are not growing, profuse discharge of pus.But, at the same time, the wound itself changes its appearance, which is characterized by gray patina on it and the appearance of necrotic granulation.Thereafter, the process proceeds to the wound inflammatory bone area, extending beneath the periosteum and marrow channel.When not providing adequate treatment for acute Firearms osteomielite inflammation process becomes long, that is chronic.
bone fractures as a result of gunshot wounds tend to occur early or late inflammatory complications.Early necrotic complications that arise immediately after the destruction caused by the rapid defeat of microorganisms bone marrow and symptoms of sepsis.Late complications can be caused by acute inflammation.It should be noted that the destructive process is not formed in the medullary canal, and in the area of bone debris or foreign body.
Posttraumatic osteomyelitis similar to osteomyelitis gunshot in almost all respects.Inflammatory processes also extends to the entire area of the bone.Sometimes this process is called post-traumatic panostita.Soft tissue during open bone fracture is the most common complication, which leads to the ingress of pyogenic flora in the area of the damaged bone.The development of the inflammatory process in posttraumatic osteomyelitis is due to contamination of a wound during the injury and is accompanied by a febrile temperature (39-40 ° C), pronounced leukocytosis, increased erythrocyte sedimentation rate, intoxication and anemia.Local manifestations characterized by swelling of the tissue around the lesion, copious pus from the wound, redness of the skin and severe pain at the site of the lesion.
Osteomielit joints manifests itself as severe pain in the affected joint.Movement of the patient severely constrained.Often, the patient can not sit not stand in this kind of localization osteomyelitis.During the chronic osteomyelitis patients, the risk of the joint purchase serious consequences in the form of destruction of the joints (hip, knee, etc.).The only way out in the course of such a joint replacement.
condensing osteitis developing Garre subacute and manifests itself mainly during the night.Characterized night pain in the affected limb osteomyelitis, dysfunction of limbs and fever to subfebrile digits (37,5 ° C).Also sclerosing Garre's disease is accompanied by a swelling of the soft tissues with the expansion of the subcutaneous venous network.Because crucial considered differential diagnosis sarcoma.
Albuminozny osteomielit Ollier is characterized by scarce local manifestations in the skin in the form of low congestion and low infiltration of soft tissues of the limb.
also scant clinical picture may be accompanied by an abscess Brodie, in which the disease is sluggish and torpid character.
osteomyelitis of the jaw - a purulent inflammation process in the area of the jaw.It is characterized by the penetration of pathogens into the jawbone, and destructive changes in it.Osteomyelitis of the jaw is considered one of the most common diseases in the dental surgery on the number of odontogenic inflammatory processes along with periodontitis and periostitis of jaw jaw.It is localized mainly in the lower jaw, and affects mainly the male sex.Among the different localization of osteomyelitis, accounting for over a third of cases.
osteomyelitis of the jaw is divided into: odontogenic (dental disease), hematogenous (chronic foci of infection) and traumatic (jaw injury).
Reasons odontogenic osteomyelitis of the jaw may include: caries, pulpitis, periodontitis, perikoronarit, alveolitis, dental granuloma.Contact infection occurs through the affected bone infection or root of the tooth pulp.
for osteomyelitis of the jaw main source of infection can be: abrasions in the jaw, purulent otitis media, acute tonsillitis, umbilical sepsis omphalitis infants, diphtheria, etc.
When hematogenous spread of infection initially affects the bones of the jaw, and later involved tooth tissue.
traumatic osteomyelitis of the jaw is the result of a fracture or a gunshot wound to the jaw.Also, the reason can act damage the nasal mucosa.In such cases, the infection in the bone tissue penetrates from the outside environment.
pathogens that causes osteomyelitis of the jaw, is revealed in the form of microbial associations or monocultures, among which mainly seems to Staphylococcus aureus, group B streptococcus and other pathogens anaerobic microorganisms.
Talking about symptoms of osteomyelitis of the jaw, it should take into account the stage.For the current acute osteomyelitis of the jaw is typical manifestation of a sudden manifestation of the common symptoms.Celebrated in most cases: a fever, a sharp increase in body temperature to 39-40 ° C, signs of intoxication, insomnia and lack of appetite.
With the development of inflammation in the jaw odontogenic osteomyelitis patient complained of intense dental pain radiating to the temporal lobes, or in orbit.Over time, the pain changes the nature of the location and becomes diffuse.Causal tooth intact and with it the neighboring teeth are mobile, slimy gums - edematous.From the pockets of the gums in the area of the infected tooth is often observed purulent expectoration.Patient mouth has been a sharp putrid odor.With the spread of infection in the soft tissues of the mouth appears limited mobility, marked shortness of breath and pain when swallowing.Osteomyelitis of the mandible there is numbness of the lower lip, and a tingling feeling in her.
During acute osteomyelitis of the mandible observed pronounced inflammatory infiltration in the affected area, swelling and redness of the soft tissue, a local increase in groups of lymph nodes (submandibular, cervical, parotid), due to this facial contours become asymmetric.
Also, there is the formation of subperiosteal abscesses and phlegmonous adenitis admaxillary abscesses.Osteomyelitis of the jaw with diffuse over complicated cellulitis eye sockets, facial vein thrombophlebitis, sinusitis.
In subacute osteomyelitis of the jaw during the general condition is markedly improved, inflammatory infiltration reduced but may be increased tooth mobility.
process Chronic osteomyelitis of the jaw appears as a complication of acute osteomyelitis of the treated badly and has a prolonged duration.
destructive process occurs with symptoms of intoxication and increase in regional lymph nodes, because of which can form fistulas with purulent discharge and pronounced granulation, also may appear larger sequesters.
Often, chronic course, leading to osteomyelitis of the jaw broken jaw.Also, there may be a deformation of the jaw and lockjaw.
diagnosis of osteomyelitis of the jaw is not complicated and is based on data from medical history, examination dental surgeon, traumatologist and laboratory data.It is important differential diagnosis of periodontitis, perikoronaritom, alveolitis, etc.
first objective in the treatment of osteomyelitis of the jaw is considered to be the elimination of suppurative focus, which is the cause of inflammation.With the development of odontogenic osteomyelitis of the mandible shows tooth extraction, with the development of hematogenous - rehabilitation of chronic foci of infection, traumatic - primary surgical treatment of infected wounds and gunshot.
Common remedial measures consist of detoxification, immunomodulatory, symptomatic, desensitizing therapy.Treatment also includes the appointment of a massive antibiotic semisynthetic penicillins, cephalosporins, macrolides.
chronic osteomyelitis of the jaw after the X-ray examination of the jaw addressed the issue of sequestrectomy - removal of sequestered bone sites.After the manipulation of the cavity of the bone is subjected to washing with antiseptic and filling osteoplastic materials with antibiotics.With the threat of a broken jaw made splinting.
symptoms and course of acute osteomyelitis depends on many factors: the state of the immune system, the method of infection, the patient's age, presence of chronic foci of infection.
Acute osteomyelitis is divided into exogenous and endogenous acute osteomyelitis.With the development of endogenous osteomyelitis (hematogenous osteomyelitis), infectious bacteria gets into the bone tissue with the passage of blood from the primary tumor, which is located in the area of the pharyngeal lymphoid ring, nose, throat and mucous membranes of the mouth, etc.This form is also developing osteomyelitis in children because of the peculiarities of blood supply to the bone of the child.
factors that contribute to the development of acute osteomyelitis course, are: viruses, acute and chronic purulent-inflammatory diseases, unbalanced diet, hypothermia, vitamin deficiencies, diabetes, liver disease and kidney failure.Also play an important role trauma with damage to the periosteum and bone.
Other forms of acute osteomyelitis (gunshot, post-operative, post-traumatic and contact) are considered exogenous.In such forms of acute osteomyelitis, infectious agents penetrate into the bone tissue from the environment or from the surrounding soft tissue.The main feature of an exogenous acute osteomyelitis is the penetration of infection in all elements of the bone tissue without primary inflammatory focus in the medullary canal.
Acute hematogenous osteomyelitis is characterized mainly for the children's age, while a third of cases the symptoms appear in infants.In this type of osteomyelitis infectious process involved in long bones, much less - flat and short.
There are three forms of acute osteomyelitis: adynamic (toxic), septic piemicheskuyu and local.For acute osteomyelitis in septic piemicheskoy form characterized by acute onset of febrile temperature, severe intoxication, persistent vomiting, headaches, chills.Maybe impaired consciousness, delirium, and hemolytic jaundice.The patient's condition - very heavy.During the first two days of the onset of the disease appear severe pain with a clear localization of the affected bone, the affected limb is in a forced position, active movements are not possible.The affected area is defined by a strong swelling and redness of the skin.There is also increase in venous pattern.
With local form of acute osteomyelitis process is more gentle way.Symptoms of local inflammation.Overall condition is practically not affected.
of toxic forms of acute hematogenous osteomyelitis develops natural lightning during the process of inflammation with predominance of symptoms of violation of general condition of the body.In the first 24 hours, the body temperature rises rapidly to 40-41 ° C, a sharp drop in blood pressure, meningeal symptoms, loss of consciousness and seizures.A rapidly developing congestive heart failure.Along with this, the local symptoms are mild or absent, which greatly complicates the correct diagnosis and prompt appointment of medical therapy.
for diagnosis may be used: ultrasound, MRI, CT and X-ray of the affected area, laboratory blood tests.