Chronic osteomyelitis – the chronic inflammatory process striking all elements of a bone (marrow, a periosteum, compact and spongy substance). Usually becomes an outcome of sharp osteomyelitis, initially chronic current is in some cases observed. Alternation of remissions and aggravations is characteristic. In a phase of an aggravation symptoms of the general intoxication, pain, hypostasis, hyperaemia of the struck department and formation of fistulas are observed. In a remission phase symptoms smooth out or disappear. The diagnosis is exposed taking into account the anamnesis, the clinical manifestations given a X-ray analysis and other researches. Treatment is more often quick.
Chronic osteomyelitis – a chronic inflammation of a bone. Usually arises after sharp osteomyelitis. Can affect any bone, however long tubular bones suffer more often. Prevalence of patients with damage of the lower extremities is noted. Chronic osteomyelitis comes to light at people of any age and a floor. The long current with alternation of aggravations and remissions is characteristic. Duration of remissions can fluctuate from several weeks to several years.
The existing inflammation is long exerts destructive impact not only on a bone, but also on other bodies. The struck segment can be bent or be shortened, sometimes in a zone of an inflammation the false joint is formed. Mobility of the next joints is limited, there are contractures. At localization of the center in a circumarticular zone development of purulent arthritis is possible. Fistulas with constants give purulent separated to patients an essential inconvenience, are a source of an unpleasant smell, complicate communication, negatively influence career and private life. At patients, there are a lot of years having osteomyelitis, dystrophic changes of internals and kidneys often come to light.
Reasons of development of chronic osteomyelitis
Chronic osteomyelitis can become an outcome of any form of sharp osteomyelitis. At children the chronic purulent processes which arose against the background of hematogenic osteomyelitis prevail. At adults first place on prevalence is won by chronic post-traumatic osteomyelitis which usually develops against the background of open changes, but can arise also after surgeries concerning the closed injuries of a bone (such osteomyelitis call postoperative).
Chronic osteomyelitis also often develops after the fire changes which are followed by extensive damage of the fabrics destroyed as a result of direct influence of a shell and formation of a zone of a kommotion. Healing of such wounds always happens through suppuration that promotes formation of the chronic purulent center in the injured bone. Rather seldom the chronic inflammations of a bone caused by contact spread of an infection meet (from close located purulent wound, phlegmon or abscess).
Pathogenesis of chronic osteomyelitis
Initially in the inflammation center grampolozhitelny gnoyerodny bacteria, as a rule, work (staphylococcus, pneumococci or streptococci). In process of process synchronization grampolozhitelny flora is replaced with gramotritsatelny or supplements it, forming microbic associations. In crops from the centers of chronic osteomyelitis a klebsiyella, vulgar proteas, colibacillus, a sinegnoyny stick and other microorganisms can be found.
The probability of transition of sharp osteomyelitis to chronic depends on a set of factors among which the general condition of an organism, existence or lack of immune violations, features of a structure and blood supply of a bone tissue, a condition of the blood circulatory system etc. Chronic osteomyelitis develops at the patients suffering from a serious somatic illness and the combined injuries and also at the weakened and exhausted patients more often. The area of damage of a bone and surrounding soft fabrics is of great importance.
Sharp osteomyelitis passes in chronic about a month later after emergence of the first symptoms. By this moment in a bone sequesters are formed, rejection of nekrotizirovanny fabrics begins, fistulas are formed. In the absence of effect of the medical events held within 1,5 months from the moment of the beginning of a disease it is possible to speak about a chronic purulent inflammation of a bone. In the subsequent process proceeds wavy, at the same time the frequency and weight of aggravations can significantly vary.
Symptoms of chronic osteomyelitis
In a phase of remission of the patient feels well. In the struck area fistula with a small amount purulent separated usually remains, however symptoms of the general intoxication are absent. Sometimes fistula is closed. The local inflammation is poorly expressed, signs of chronic slow process prevail. Soft fabrics in a zone of the osteomiyelitichesky center are condensed, skin with crimson, is more rare – a cyanotic shade. At chronic osteomyelitis of an extremity the struck segment, as a rule, is thickened, the puffiness of disteel departments caused by violations krovo-and a limfoobrashcheniye can come to light.
The aggravation reminds the erased picture of sharp osteomyelitis. At the patient temperature increases, weakness, weakness, muscle pains and other symptoms of intoxication appears. Hypostasis of the struck segment increases. Skin reddens, the pain syndrome becomes more intensive. The formation of intermuscular phlegmons which is followed by deterioration in the general state and emergence intensive of the holding apart or pulling pains interrupting the patient's sleep is possible.
Soft fabrics in the field of phlegmon become intense, local temperature increases. In some cases at a palpation it is possible to define the site of fluctuation. The quantity separated on fistula increases. If during remission fistula was closed, the condition of the patient improves after formation of new fistula or several fistulas which can be formed both in close proximity to the purulent centers, and on considerable removal.
Diagnosis of chronic osteomyelitis
The main tool method of a research at chronic osteomyelitis is the X-ray analysis. On roentgenograms signs of destruction of a bone in combination with proliferation elements are defined. In the field of the purulent center the cavity is visible, sequesters in the form of dense shadows with uneven contours and the kept bone drawing often come to light. Around a zone of an inflammation sites of a sclerosis are defined. In a phase of an aggravation arises periostit, the quantity and the nature of periostalny stratifications depend on prescription and expressiveness of process.
Sometimes because of a considerable sklerozirovaniye of a bone the small centers on roentgenograms do not come to light. Besides, the X-ray analysis does not allow to estimate changes of soft fabrics therefore in doubtful cases of patients in addition direct to KT of a bone and MRT. An important part of a preoperative research is the fistulografiya by results of which the volume and tactics of surgery is defined. Fistulografiya gives the chance to see the direction of the svishchevy course which quite often happens twisting and has irregular shape. By means of this research it is possible to determine the volume of cavities, to reveal communication of fistula with the sequester etc.
Treatment of chronic osteomyelitis
Treatment of chronic osteomyelitis is carried out by experts in the field of traumatology and orthopedics. Medical tactics is defined depending on a condition of the patient, expressiveness, prevalence and a stage of pathological changes, and also existence of the accompanying complications from the struck segment (false joints, shortening or rough deformation of an extremity) and expressiveness of dystrophic changes of internals. In the period of an aggravation appoint antibiotics and means for immunity stimulation, carry out drainage of purulent cavities by means of special needles or catheters.
Cavities and fistulas wash out solutions of antibiotics. Intermuscular phlegmons open and drain. Surgical interventions carry out after subsiding of the sharp inflammatory phenomena. The sekvestrektomiya is carried out - the centers of a necrosis, granulation and sites of an excess sklerozirovaniye completely are removed. The Svishchevy courses excise, based on data of a fistulografiya. Carry out washing of an operational wound solutions of anti-septic tanks. After full clarification of a wound the remained bone walls punch, remote sites replace with bone transplants.
In some cases more difficult, multi-stage treatment of chronic osteomyelitis is carried out. At false joints, shortening and the expressed deformation the osteotomiya, a resection of the site of a bone which is not involved in pathological process and other medical actions can be required. For correction of angular deformations and lengthening of the struck extremity segment traumatologists impose Ilizarov's devices.
The forecast depends on prescription of a disease, volume of defeat, the state of health of the patient and radicalism of surgical intervention. At fresh processes and full excision of the small centers the absolute recovery is often observed. At chronic osteomyelitis the forecast worsens because of trophic changes of soft fabrics, extensive dystrophic reorganization of a bone, deterioration in the local blood supply and an adverse general background caused by violation of activity of various bodies. Nevertheless, expeditious treatment is shown even in the started cases as chronic purulent process exerts negative impact on all bodies and can become the reason of serious deterioration in health of the patient.