Sharp osteomyelitis – an acute purulent inflammation at which all elements of a bone are surprised: periosteum, actually bone and marrow. Usually surrounding soft fabrics are involved in process. Penetration of gnoyerodny microbes gematogenno (through blood) or kontaktno (through a wound or through the inflamed fabrics) can become the reason of development. It is shown by pain, hypostasis and hyperaemia, and also the general signs of an inflammation: weakness, weakness, fever, oznoba and headache. The diagnosis is exposed on the basis of symptoms and data of a X-ray analysis. Treatment more often surgical, is carried out against the background of antibiotic treatment.
Sharp osteomyelitis (Latin osteon a bone + myelos marrow + itis an inflammation) – sharp purulent process in bones. "Osteomyelitis" - historically developed term which is insufficiently precisely reflecting essence of a disease. It was entered by Reynaud in 1831 and in translation means "a marrow inflammation", however in clinical practice such isolated process practically does not meet. Today in traumatology understand an inflammation as osteomyelitis not only marrow, but also other elements of a bone (a periosteum and actually bone tissue).
In most cases causative agents of a disease are staphylococcus, is more rare – pneumococci and streptococci. Existence of microbic associations with a sinegnoyny stick, colibacillus or vulgar Proteus is possible. In some cases in crops klebsiyella are defined. Symptoms and the course of sharp osteomyelitis depend on a set of factors: way of infection, condition of an organism, age of the patient, existence of chronic diseases and intoxications etc. Recovery or synchronization of process (development of chronic osteomyelitis) becomes an outcome. Treatment of sharp osteomyelitis is performed by traumatologists.
Pathogenesis and classification
Depending on a way of penetration of an infection allocate endogenous and exogenous sharp osteomyelitis. At endogenous (hematogenic) osteomyelitis the infection gets into a bone through blood from primary center located in the field of a lymphoid pharyngeal ring, mucous nasopharynxes and oral cavities, the center of a latent infection (a felon, a furuncle, a piodermiya), a skin wound, an attrition or an intertrigo (at babies). This form of a disease develops at children that is caused by features of blood supply of bones at children's age.
The factors promoting development of sharp hematogenic osteomyelitis are viral infections, sharp and chronic inflammatory diseases, overcooling, unbalanced food, the hypovitaminoses and other states which are followed by decrease in resilience of an organism. Injuries with injury of a periosteum or bone tissue can play a part. Some researchers (for example, Derizhanov) consider that hematogenic osteomyelitis arises against the background of allergic reaction of the slowed-down type owing to an organism sensitization latent bacterial flora. There is also neuroreflex theory (Toronets and Elansky) according to which development of osteomyelitis is substantially caused by violation of nervous regulation of a tone of intra bone vessels and emergence of the long spasm creating favorable conditions for "subsidence" of microbes in a bone tissue.
All other forms of sharp osteomyelitis (post-traumatic, fire, postoperative and contact) are exogenous. At these forms of a disease the infection gets into a bone or directly from the external environment, or from the infected surrounding soft fabrics. Feature of exogenous sharp osteomyelitis is distribution of a purulent inflammation on all elements of a bone without the previous formation of primary inflammatory center in marrow.
Sharp hematogenic osteomyelitis
Develops mainly at children's age, at the same time in 30% of cases symptoms appear at children 1 years are younger. More often long tubular bones are surprised, is more rare – short and flat. Also simultaneous formation of several purulent centers in different bones is possible. Allocate three forms of a disease: toxic (adynamic), local and septiko-piyemichesky. Oznoba, repeated vomiting and headaches are characteristic of a septiko-piyemichesky form of sharp osteomyelitis the sharp beginning with rise in temperature to febrilny figures and the expressed intoxication. Consciousness violations, nonsense and hemolytic jaundice are possible. General serious condition. Within two days since the beginning of a disease there are intensive bone pains with accurate localization, the affected extremity holds the compelled position, the active movements become impossible. In the field of defeat the accruing hypostasis, hyperaemia, a hyperthermia and tension of skin comes to light. Emergence of the venous drawing is quite often noted. In a nearby joint arthritis can develop.
The local form of hematogenic sharp osteomyelitis proceeds rather favorably. Symptoms of a local inflammation prevail, the general state suffers slightly. Lightning development with prevalence of the general symptomatology is characteristic of a toxic form of a disease. In the first days there is a substantial increase of temperature, decrease HELL, meningealny symptoms, spasms and loss of consciousness. Quickly sharp cardiovascular insufficiency develops. At the same time local symptoms are absent or are poorly expressed that complicates timely diagnosis and purpose of adequate therapy.
Radiological signs at all forms of hematogenic sharp osteomyelitis become noticeable by the end 1-2 weeks of a disease, at babies – for 4-5 days. At early stages the periosteum thickening, a smazannost of contours of a bone, existence of sites of consolidation and discharge is defined. In the subsequent sequesters (the centers of destruction of a bone tissue) surrounded with a zone of consolidation and a thickening of a bone come to light. If necessary for specification of the diagnosis KT and MPT of the struck segment can be appointed ultrasonography.
Treatment is complex, includes antibiotic treatment, an extremity immobilization, dezintoksikatsionny therapy, immunocorrection, desensitization, antioxidant therapy, exchange correction, biostimulation, anabolic hormones, vitamin therapy and a detoxication with use of laser radiation of blood (VLOK), Ural Federal District of blood, a plasma exchange and haemo sorption. Against the background of conservative actions expeditious treatment is made. At children of younger age carry out opening of phlegmon. At teenagers opening of the purulent center is supplemented with multiple osteoperforation. In openings establish tubes for intra bone introduction of anti-septic tanks and antibiotics. According to indications carry out a sekvestrektomiya or a podnadkostnichny resection. In the postoperative period carry out an immobilization of an extremity and continue complex conservative therapy.
Traumatic and contact sharp osteomyelitis
Traumatic sharp osteomyelitis is a complication of open changes, gunshot wounds and orthopedic operations. Arises within 2-3 weeks after a trauma or surgery. In pathogenesis of post-traumatic osteomyelitis the leading role is played by observance of rules of an asepsis and antiseptics during surgical intervention and the subsequent processing of a postoperative wound. A certain value has also a condition of an organism of the patient. The probability of development of sharp osteomyelitis at open changes and gunshot wounds directly depends on such factors as extent of destruction of fabrics, intensity of microbic pollution, virulence of an infection, expressiveness of violations of local blood circulation, and also feature of reaction of an organism to traumatic influence.
Local symptoms are characteristic of post-traumatic osteomyelitis as the general, and. There is heavy intoxication, the expressed weakness and weakness, oznoba, nausea and a headache. Temperature increases to febrilny figures. Local symptoms, as a rule, appear in 5-7 days after emergence of the general symptomatology. In the field of damage sharp morbidity, hypostasis, hyperaemia and a local hyperthermia are noted. From a wound a significant amount of pus is allocated.
Treatment of sharp osteomyelitis surgical. Surgeries are carried out against the background of complex conservative therapy (the main methods of treatment – as at sharp hematogenic osteomyelitis). For improvement of outflow of purulent contents remove seams from a wound, open flow. Delete nekrotizirovanny bone otlomk and purulent granulations, carry out a sekvestrektomiya. Carry out washing and drainage. Issues of an immobilization of fragments are resolved individually. Usually use skeletal extension, at a possibility of imposing of the device of Ilizarov carry out an extra focal osteosynthesis.
Sharp contact osteomyelitis develops upon transition of an inflammation to a bone from surrounding fabrics. Arises at it is long the current purulent processes: extensive wounds (especially – a hairy part of the head), felons etc. It is shown by strengthening of local morbidity, increase in hypostasis and formation of fistulas. Treatment complex – surgical interventions against the background of antibiotic treatment and other conservative actions. Opening of the purulent centers and removal of the become lifeless fabrics with the subsequent drainage is made. At defeat of all tissues of finger amputation can be required.