Osteosclerosis – the pathological state which is followed by consolidation of a bone, increase and a thickening of compact substance and bone trabeculas. Develops at inflammatory diseases of bones, some tumors, intoxications, arthroses, a number of genetically caused diseases and in the period of recovering from a skeletal trauma. Allocate also physiological osteosclerosis arising in the field of rostkovy zones in the course of growth of bones at children and teenagers. The diagnosis is exposed on the basis of clinical signs and data of a X-ray analysis. Treatment of an osteosclerosis can be both conservative, and quick.
Osteosclerosis (Latin osteon a bone + sclerosis hardening) – the increase in density of a bone which is followed by reduction of interframe marrowy space, a thickening and increase in bone beams. At the same time the size of a bone does not increase. The imbalance between activity of osteoklast and osteoblasts is the reason of development of an osteosclerosis. The osteosclerosis leads to reduction of elasticity of bones and can become the cause of pathological changes. Is the pathological process, the second for prevalence, which is followed by violation of structure of bones after osteoporosis.
Most often this pathology comes to light at chronic inflammatory diseases and intoxications. Besides, the osteosclerosis arises at some genetically caused diseases, poisonings with lead and strontium, chronic inflammatory processes in bones (bone tuberculosis, tertiary syphilis, a Brodie's abscess, Garre's osteomyelitis), metastasis of cancer of bronchial tubes, a prostate cancer and breast cancer. The osteosclerosis of subkhondralny zones is one of radiological symptoms of arthrosis. Orthopedists and traumatologists are engaged in treatment of an osteosclerosis.
In practical orthopedics and traumatology allocate the pathological and physiological, congenital and acquired osteosclerosis. The pathological osteosclerosis arises at all listed above diseases, the physiological osteosclerosis is formed in rostkovy zones with a growth of bones at children's age. Taking into account a radiological picture distinguish a spotty and uniform osteosclerosis. The spotty osteosclerosis can be large and melkoochagovy, with multiple or rare focuses. Taking into account localization and the volume of defeat allocate a local, limited, widespread and system osteosclerosis.
The limited osteosclerosis has jet and inflammatory character and arises on border between the inflammatory center and a healthy bone tissue. Sometimes this form of an osteosclerosis comes to light in the absence of inflammatory processes and is caused by considerable static or mechanical loads of a bone. The widespread osteosclerosis is characterized by damage of one or several extremities, it is found at Leri's meloreostoza, Pedzhet's disease and metastasises of malignant tumors. The system osteosclerosis develops at a number of various diseases.
Osteosclerosis at hereditary diseases
Osteopetroz (marble disease, Albers-Schoenberg's disease) has two options of a current: with an early and late demonstration. Early family it is inherited on autosomno-prepotent type. At the time of the birth the makrotsefaliya and hydrocephaly come to light. Patients lag behind in growth, the liver and a spleen are increased. Over time because of a sdavleniye of craniocereberal nerves there are violations of sight and relative deafness. Because of violation of blood formation anemia develops. Pathological changes are possible. In x-ray pictures the generalized osteosclerosis comes to light. Bones have homogeneous structure, the marrowy channel is absent. Metafiza of long tubular bones it is club-shaped are expanded. On roentgenograms of a skull the sclerosis and reduction of a pnevmatization of sine is defined. Late it is inherited on autosomno-recessive type and shown by the same symptoms, however, the disease demonstrates at the age of 10 years or later and differs in smaller prevalence of an osteosclerosis.
Dizosteoskleroz is inherited on autosomno-recessive type. The first signs are shown in the early childhood. Lag in growth, a system osteosclerosis, the violation of development of teeth caused by an enamel hypoplasia and also an atrophy of an optic nerve and bulbarny paralysis owing to a sdavleniye of craniocereberal nerves comes to light. On roentgenograms of long tubular bones the osteosclerosis of epifiz and a diaphysis at expanded metafiza decides on not changed bone structure. The X-ray analysis of a backbone demonstrates flattening and a sklerozirovaniye of bodies of vertebras. The osteosclerosis also comes to light in basin bones, skull bones, edges and clavicles.
Piknodizostoz is inherited on autosomno-recessive type, usually demonstrates at early age. Considerable lag in growth comes to light. The face of the patient has a characteristic appearance: the corner of the lower jaw is expanded, frontal hillocks are increased, a nose of a beak-shaped form, the gipertelorizm is defined. Development of teeth is broken. The expressed shortening of brushes in combination with a hypoplasia of disteel phalanxes of fingers is noted. Pathological changes are often observed. On roentgenograms the widespread osteosclerosis, the most pronounced in disteel departments of extremities is found.
Sklerosteoz is inherited on autosomno-recessive type, demonstrates in the early childhood. Characteristic symptoms are flattening of the person, a gipertelorizm, a prognatiya and flattening of a nose bridge. The skin sindaktiliya in combination with a dysplasia of nails is often observed. On roentgenograms of the lower jaw, at a X-ray analysis of clavicles and the bases of a skull the osteosclerosis comes to light. Long tubular bones are changed slightly: the marrowy channel is kept, the zone of an osteosclerosis is well noticeable only in the field of a kortikalny layer.
Osteosclerosis at a meloreostoza
Meloreostoz ( or Leri's disease) – the congenital anomaly of development of a skeleton described in 1922 by the French neurologist Leri. The main display of a disease is the osteosclerosis which is usually affecting bones of one segment of an extremity or several segments of one extremity. In some cases signs of an osteosclerosis come to light in vertebras or the lower jaw. It is shown by pains, bystry fatigue and sometimes weakness of muscles of the affected extremity. Trophic violations are possible. Over time in circumarticular soft fabrics there is fibrosis and there are sites of calcification that becomes the reason of development of contractures.
On roentgenograms the osteosclerosis and is defined. Consolidations of a bone tissue have an appearance of longitudinal faltering or continuous strips that creates a characteristic picture of "flows of wax on a candle". In the next departments of an extremity unsharply expressed osteoporosis sometimes comes to light. Treatment is symptomatic. Prevention of contractures is carried out, at considerable deformations surgical correction is carried out. The forecast is favorable.
Osteosclerosis at Pedzhet's disease
Pedzhet's disease or the deforming osteodystrophy – the disease which is followed by violation of structure and pathological growth of separate bones of a skeleton. Develops at men more often 40 years are more senior. Quite often proceeds asymptomatically. Perhaps slow, gradual formation of rigidity of joints, at a part of patients pains and deformation of bones are observed. Other symptoms depend on localization of pathological changes. At damage of a skull the forehead and nadbrovny arches increases, there are headaches, injuries of an inner ear are sometimes observed. At damage of vertebras their height decreases that leads to growth reduction. The compression of nervous backs which is shown weakness, prickings and a sleep of extremities is possible. Occasionally paralyzes develop. At damage of bones of the lower extremities instability of gait, deformation of the struck segment and pathological changes is observed.
When studying roentgenograms a certain staging of process comes to light. In an osteolytic phase processes of a resorption of a bone prevail, in the mixed phase the resorption is combined with osteoblastichesky bone formation. The osteosclerosis develops in an osteoblastichesky phase. Deformations, incomplete and complete pathological fractures can be found. On roentgenograms of a skull the thickening of the arch and the non-uniform centers of an osteosclerosis is defined. For specification of the diagnosis and assessment of extent of dystrophic processes determine the level of alkaline phosphatase, phosphorus, magnesium and calcium in blood. Also appoint a stsintigrafiya. Treatment usually conservative – reception of bifosfat and NPVP. If necessary carry out endoprosthesis replacement of joints. At decrease in hearing use hearing aids.
Osteosclerosis at Garre's osteomyelitis
Chronic skleroziruyushchy osteomyelitis of Garre is caused by staphylococcus and more often comes to light at men of 20-30 years. Usually the hip, a shoulder or a beam bone are surprised. The pathological center arises in an average third of a diaphysis or in a diafizarny zone is closer to a metafiz. Perhaps sharp, subsharp and initially chronic beginning. In surrounding fabrics there is expressed dense hypostasis, expansion of hypodermic venous network is often noted. Hyperaemia and other signs of an inflammation can be absent. In the subsequent, unlike other forms of osteomyelitis, a softening does not come, fistula is not formed. On the contrary, infiltrate is even stronger condensed and palpated in the form of the dense, connected with a bone opukholevidny education. Pains become more and more sharp, amplify at night, often irradiate, feigning radiculitis, neuritis and an ishialgiya.
The clinical picture at chronic osteomyelitis of Garre quite often reminds sarcoma. However at a X-ray analysis of a hip, shin or X-ray analysis of a forearm it is found out that "the bone tumor" actually consists of soft fabrics. At the same time on the roentgenogram characteristic pathological changes come to light: the correct spindle-shaped thickening of a diaphysis, is more rare – a thickening in the form of a semi-spindle, narrowing or a zarashcheniye of the marrowy channel, the expressed osteosclerosis, strengthening of a bone shadow to eburneation degree. Cavities, sequesters and the centers of destruction usually are absent. Finally crops in which the culture of staphylococcus is found allow to confirm the diagnosis often. Treatment includes antibiotic treatment in combination with X-ray therapy. If necessary surgeries are made. The forecast is favorable for life, however in the outcome at patients working capacity violations are often observed.
Osteosclerosis at other diseases of bones
Brodie's abscess – the inflammatory disease caused by golden staphylococcus. Arises at young men more often. It is localized in circumarticular area of a long tubular bone (more often – tibial). Proceeds chronically, with rare aggravations. Almost asymptomatic current is possible. The Brodie's abscess represents the bone cavity executed by granulations and filled with serous or purulent liquid. Around a cavity the osteosclerosis center settles down.
It is shown by not clear pains, sometimes – insignificant hypostasis and hyperaemia. Because of proximity to a joint development of a sinovit is possible. Fistulas are absent. When carrying out a X-ray analysis of a shin the roundish center of depression with smooth contours, surrounded with a zone of a moderate osteosclerosis comes to light. The Brodie's abscess is differentiated with primary and chronic osteomyelitis, the extra articulate tubercular center and the isolated syphilitic gummy. At osteomyelitis center contours uneven and indistinct, come to light more expressed periostalny imposings. At syphilis in the field of a gumma more extensive center of an osteosclerosis is found. Treatment conservative – antibiotic treatment in combination with X-ray therapy.
The limited osteosclerosis can be also observed at early congenital syphilis, late congenital and tertiary syphilis. At an ossifitsiruyushchy osteitis and a periostita the center of an osteosclerosis arises upon termination of inflammatory infiltration. In the subsequent develops , the bone is thickened, the marrowy channel is closed. Especially brightly the phenomena of an osteosclerosis are expressed at syphilitic gumma. Gumma are localized intrakortikalno, podnadkostnichno or in marrow and represent the inflammation center with disintegration in the center. Around gummozny knot there is a wide zone of a jet osteosclerosis well noticeable in x-ray pictures. In some cases gumma suppurate with formation of the sequesters which are also surrounded with the osteosclerosis centers.