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Osteomyelitis is a state at which there is a defeat of all parts of a bone. The current is characteristic of this disease is purulent - necrotic process which develops in bones, and also in marrow. The inflammation can develop also in the soft tissues surrounding a bone. This process is caused by piogenic bacteria or mycobacteria (that is those that make pus).
The disease for the first time was revealed at mummies of Ancient Egypt, it was also described by the famous Ancient Greek doctor Hippocrates. Today osteomyelitis meets rather seldom, however its treatment is represented difficult process till present time.
Types of osteomyelitis
Today it is accepted to distinguish hematogenous osteomyelitis which is shown owing to hit of microbes in a bone through blood circulation, and also not hematogenous osteomyelitis (posttraumatic osteomyelitis) as the secondary disease which is shown as complication of wounds that is, not hematogenous way when microorganisms from external environment get into a bone. At an initial stage of development have both appearance of an inflammation of bones various origin. But at the same time at later stages these diseases become similar because of what they have a general name. According to features of a clinical current it is accepted to distinguish acute and chronic osteomyelitis. At the same time in most cases chronic osteomyelitis is a consequence of an acute form of a disease. However in certain cases chronic osteomyelitis is primary form of an illness.
Hematogenous osteomyelitis is most often shown at patients at children's age, and also at teenage boys. As a rule, localization of process happens in femoral and tibial bones. More seldom the disease is shown in other bones. The inflammation occurs owing to hit of microbes in marrow through blood circulation. An anthrax, furuncles, phlegmons, felons, abscesses, an ugly face, caries infected grazes and other diseases can become primary center of microbes. Development of a disease is influenced by a number of factors: anatomo-physiological, biological and immunobiological, contributing.
These are characteristics of supply with blood of bones of the child (children in the region of growth of bones have the whole looped network of small vessels therefore in them often settle various microorganisms). The disease often develops if the organism reacts peculiar, the reaction similar to allergic. The bone injury, the lowered body resistance can become the direct factors promoting a course of a disease that is promoted by diseases, overfatigue, shortage of vitamins.
Not hematogenous osteomyelitis
At this form of a disease activators microorganisms get into a bone from external environment in the course of wounds from firearms, at serious damages of soft tissues, during open changes. Owing to development of local process blood supply of a bone is broken and, as a result, there is its necrosis, that is dying off. Not hematogenous osteomyelitis differs from a hematogenous form of a disease also the fact that the inflammation can begin both in marrow, and in a periosteum.
Symptoms of acute hematogenous osteomyelitis
Initial symptoms of this disease which are shown in the very first days is the general weakness and an indisposition, feeling of an ache in extremities, muscle pain, a headache. A little later the patient feels a strong fever, at the same time body temperature rises to 39 degrees. Vomiting, feeling of weakness can join initial symptoms. The patient feels very badly, black-outs, nonsense are shown, a meninx is irritated, spasms are sometimes shown. The patient has no appetite, dryness of language is noted. Besides, symptoms of acute hematogenous osteomyelitis is pallor of the person, a xeroderma which, besides gets a yellowish shade, a tsianotichnost, mucous membranes. Arterial pressure at the patient is reduced, deaf cardiac sounds are listened, pulse becomes frequent, breath becomes frequent and superficial. During a palpation the doctor often finds the increased liver and a spleen. The area of kidneys is sometimes painful.
In one-two days after the beginning of a disease pain which has strict localization in the affected extremity begin to be shown. At the same time pain has the tearing character in view of what children often after the smallest movements by an extremity strongly to shout from the amplified pain. In certain cases because of severe pain the child is forced to hold an extremity in a condition of a full immovability. This state is called a pseudoparalysis. Also in the first days the swelling of soft tissues which is followed by clear morbidity begins to be shown. Skin in places of defeat red and tumescent, its temperature raises. The swelling of the patient of an extremity constantly increases, after a while there are visible expanded veins, regional lymph nodes increase. Often at this state sepsis develops.
Depending on that how heavy the disease is, distinguish mestnoochagovy, toxic (fulminant) and septicopyemic forms of acute type of a disease.
The stablest current is characteristic of a mestnoochalovy form of osteomyelitis. The illness begins at completely healthy child who complains of pain in the specific place. Temperature to 39-40 degrees increases With, over time there is a movement restriction, Gradually appear: restriction of movements in joints, erubescence, severe constant pains.
At a septicopyemic form the patient in a short space of time has many suppurative focuses and, this process happens in parallel in internals or bones.
At a toxic form of people can sharply faint, rave. These signs are called symptoms of "septic intoxication". They extraordinary quickly progress and lead to death during the first hours or days of a disease. In this case clinical signs from bones and soft tissues do not manage to form.
At adult patients owing to hematogenous osteomyelitis the hip or a backbone is surprised, as a rule. Respectively, in this area there are also pains. However owing to existence of many reasons for emergence of pain in the specified areas diagnosis of osteomyelitis at adults sometimes is more difficult, than at children.
The course of acute hematogenous osteomyelitis directly depends on that, treatment of a disease which first of all includes reception of antibiotics was how timely begun.
As a rule, acute osteomyelitis passes into a chronic form in view of the proceeding necrosis of the infected site of a spongy or compact layer of a bone. At patients who have chronic osteomyelitis clinical symptoms are, as a rule, expressed slightly. Their strengthening is observed only in a case an inflammation aggravation. Clinical manifestations of symptoms are aggravated if the general body resistance decreases in view of existence in an infection bone. Cooling, an injury, serious illnesses and other phenomena can provoke the similar phenomenon.
Diagnosis of osteomyelitis
In the course of diagnosis of acute hematogenous osteomyelitis first of all the methodical palpation which is carried out with care by which it is possible to define the most painful site which will correspond to the center of development of inflammatory process is made.
It is possible to define localization and extent of the center of defeat by X-ray inspection, and also to establish how heavy were changes from the patologoanatomicheskiy point of view. However by means of X-ray inspection symptoms of a disease it is possible to reveal only from 10-14 in the afternoon courses of a disease. At research it is possible to define the isolated destruction sites by a X-ray. By consideration of their roentgenogram it is visible as openings in a bone.
In certain cases for establishment of the exact diagnosis use of a method of a computer tomography is reasonable. If the specialist suspects existence at sick chronic osteomyelitis, then sometimes the fistulografiya method is applied to diagnosis. This diagnostic method allows to reveal localization of the sequester if usual pictures do not show necessary data rather accurately. In the course of use of this method use contrast agents (Sergosinum, Iodolipolum, Diodonum). The most exact results can be received owing to use of a method of radioactive scanning to which radioactive technetium is applied.
Also in the course of diagnosis of osteomyelitis the complex of laboratory researches is applied. So, the most informative method is definition of the blood sedimentation rate (BSR) that demonstrates existence in an organism of inflammatory process.
Finally to specify the diagnosis, the biopsy method with capture of a sample of fabrics is very often applied. The puncture of a bone is made under anesthetic. This technique is used also for carrying out bacteriological research.
Treatment of osteomyelitis
Today at treatment of osteomyelitis antibiotics are widely applied. This method of therapy considerably improved productivity of conservative treatment and, respectively, reduced need of carrying out operations. Modern therapy of hematogenous osteomyelitis includes a number of actions of a systemic effect on the patient's organism, and also uses of means of local impact on the infection center.
In the very first days after a course of a disease the immobilization which limits process is carried out, reduces pain.
In more exceptional cases operation which is applied if the disease is too started is required, and phlegmon developed. Operation is also performed for the purpose of removal of sequesters.
Today the method of the sparing osteoperforation is considered the most effective method. If the patient has a subperiostal phlegmon, its opening is made without amotio of a periosteum. After that frezevy openings directly are applied on a bone. Through openings in a bone the drainage of the marrowy channel is made, and also in a bone antibiotics and antiseptic agents are entered.
As the general methods of conservative treatment apply therapy by antibiotics, disintoxication actions, physiotherapeutic procedures, make a correcting of disturbances of immunity.