Periostit – an acute or chronic inflammation of a periosteum. The trauma, inflammatory damage of a bone or soft fabrics, rheumatic diseases, an allergy, a number of specific infections can become the reason of development of this pathology, is more rare – tumors of bones, and also chronic diseases of veins and internals. Periostit is followed by pains and puffiness of surrounding soft fabrics. At suppuration there are symptoms of the general intoxication. The diagnosis is exposed on the basis of clinical signs and data of a X-ray analysis. Treatment can be quick or conservative.
Periostit (Latin periosteum – a periosteum) – inflammatory process in a periosteum. Can be sharp or chronic, aseptic or infectious. Depending on the nature of pathoanatomical changes allocate simple, serous, purulent, fibrous, ossifitsiruyushchy, syphilitic and tubercular periostit. The disease can affect any bones, however, is localized in the lower jaw and a diaphysis of tubular bones more often. The inflammation usually arises in one layer of a periosteum (external or internal), and then extends to other layers. The bone and a periosteum are closely tied among themselves therefore periostit often passes in osteoperiostit.
Depending on the cause of a disease orthopedists, traumatologists, oncologists, rheumatologists, phthisiatricians, venereologists and other experts can perform treatment of a periostit. Along with actions for elimination of an inflammation treatment of the majority of forms of a periostit includes therapy of the main disease.
Idle time periostit is aseptic process and arises owing to injuries (fractures, bruises) or the inflammatory centers which are localized near a periosteum (in muscles, in a bone). More often the sites of a periosteum covered with an insignificant layer of soft fabrics, for example, an elbow shoot or the perednevnutrenny surface of a tibial bone are surprised. The patient with periostity shows complaints to moderate pain. At a research of the struck area insignificant puffiness of soft fabrics, a local eminence and morbidity at a palpation comes to light. Idle time periostit usually well will respond to treatment. In most cases inflammatory process is stopped within 5-6 days. Less often the simple form of a periostit passes in chronic ossifitsiruyushchiya periostit.
Fibrous periostit arises at long irritation of a periosteum, for example, as a result of chronic arthritis, a necrosis of a bone or a chronic trophic ulcer of a shin. The gradual beginning and a chronic current is characteristic. Complaints of the patient are, as a rule, caused by the main disease. In the field of defeat insignificant or moderate hypostasis of soft fabrics comes to light, at a palpation the dense painless thickening of a bone is defined. At successful treatment of the main disease process regresses. At a long current of a periostit perhaps superficial destruction of a bone tissue, there are data on separate cases of an ozlokachestvleniye of an affected area.
Purulent periostit develops at penetration of an infection from the external environment (at wounds with injury of a periosteum), at distribution of microbes from the next purulent center (at a purulent wound, phlegmon, abscess, an erysipelatous inflammation, purulent arthritis, osteomyelitis) or at a piyemiya. Usually act as the activator staphylococcus or streptococci. More often the periosteum of long tubular bones – humeral, tibial or femoral suffers. At a piyemiya multiple defeats are possible.
At the initial stage the periosteum inflames, in it there is a serous or fibrinozny exudate which in the subsequent turns into pus. The inside layer of a periost becomes impregnated with pus and separates from a bone, sometimes – on a considerable extent. Between a periosteum and a bone subperiostalny abscess is formed. In the subsequent several options of a current are possible. In the first option pus destroys the site of a periosteum and breaks in soft fabrics, forming paraossalny phlegmon which in the subsequent can or extend to surrounding soft fabrics, or be opened outside through skin. In the second option pus otslaivat the considerable site of a periost owing to what the bone loses food, and the site of a superficial necrosis is formed. At adverse succession of events the necrosis extends in deep layers of a bone, pus gets into a marrowy cavity, there is osteomyelitis.
The sharp beginning is characteristic of a purulent periostit. The patient shows complaints to intensive pains. Body temperature is increased to febrilny figures, oznoba, weakness, weakness and a headache are noted. At a research of the struck area hypostasis, hyperaemia and sharp morbidity at a palpation comes to light. In the subsequent the fluctuation center is formed. The erased symptomatology or initially chronic current of a purulent periostit is in some cases possible. Besides, allocate the sharpest or malignant periostit, characterized by prevalence of putrefactive processes. At this form the periosteum bulks up, easily collapses and breaks up, the bone deprived of a periost is shrouded in a pus layer. Pus spreads to soft fabrics, causing phlegmon. Development of a septikopiyemiya is possible.
Serous albuminozny periostit usually develops after a trauma, strikes a metadiaphysis of long tubular bones (a hip, a shoulder, low-tibial and tibial bones) and edges more often. It is characterized by formation of a significant amount of the viscous serous and mucous liquid containing a large amount of albumine. Exudate can accumulate podnadkostnichno, form a kistovidny bag in the thickness of a periosteum or settle down on an external surface of a periost. The zone of a congestion of exudate is surrounded with red-brown granulyatsionny fabric and covered with a dense cover. In some cases the amount of liquid can reach 2 liters. At podnadkostnichny localization of the inflammatory center the otsloyka of a periosteum with formation of the site of a necrosis of a bone is possible.
Current of a periostit usually subsharp or chronic. The patient complains of pains in the struck area. At the initial stage perhaps slight increase of temperature. If the center is located near a joint, there can be a restriction of movements. At survey puffiness of soft fabrics and morbidity at a palpation comes to light. The area of defeat at initial stages is condensed, in the subsequent the site of a softening is formed, fluctuation is defined.
Ossifitsiruyushchy periostit – the common form of a periostit arising at long irritation of a periosteum. Develops independently or is a consequence it is long the current inflammatory process in surrounding fabrics. It is observed at chronic osteomyelitis, chronic varicose ulcers of a shin, arthritis, bone and articulate tuberculosis, congenital and tertiary syphilis, rickets, bone tumors and Bambergera-Mari's periostoza (simptomokompleks which arises at some diseases of internals, is followed by a thickening of nail phalanxes in the form of drum sticks and deformation of nails in the form of hour glasses). Ossifitsiruyushchy periostit is shown by growth of a bone tissue in an inflammation zone. Ceases to progress at successful treatment of the main disease. At long existence in some cases can become the reason of sinostoz (an union of bones) between bones of a tarsus and a wrist, tibial bones or bodies of vertebras.
Tubercular periostit, as a rule, is primary, arises at children more often and is localized in edges or a skull. Current of such periostit chronic. Formation of fistulas with putreform separated is possible.
Syphilitic periostit can be observed at congenital and tertiary syphilis. At the same time initial signs of damage of a periosteum in some cases come to light already in the secondary period. At this stage in the field of a periost there are small swellings, there are sharp flying pains. In the tertiary period bones of a skull or long tubular bones, as a rule, are surprised (tibial is more often). The combination of gummozny defeats and an ossifitsiruyushchy periostit is observed, process can be both limited, and diffusion. Ossifitsiruyushchy defeat of a diaphysis of tubular bones is characteristic of a congenital syphilitic periostit.
Patients with a syphilitic periostit complain of the intensive pains amplifying at night. At a palpation the round or spindle-shaped limited swelling of a plotnoelastichesky consistence comes to light. Skin over it is not changed, the palpation is painful. The spontaneous rassasyvaniye of infiltrate, growth of a bone tissue or suppuration with distribution on nearby soft fabrics and formation of fistulas can become an outcome.
Except the listed cases, periostit it can be observed also at some other diseases. So, at gonorrhea in a periosteum inflammatory infiltrates which sometimes suppurate are formed. Chronic periostit can arise at a sapa, a typhus (damage of edges is characteristic) and a blastomikoza of long tubular bones. Local chronic damages of a periosteum meet at rheumatism (the main phalanxes of fingers, plusnevy and pyastny bones usually are surprised), a varicosity of deep veins, a disease to Gosha (a disteel part of a femur is surprised) and diseases of bodies of blood formation. At excessive load of the lower extremities it is sometimes observed periostit a tibial bone, followed by the expressed pain syndrome, insignificant or moderate hypostasis and sharp morbidity of the struck area at a palpation.
The diagnosis of a sharp periostit is exposed on the basis of the anamnesis and clinical signs as radiological changes of a periosteum become visible not earlier than in 2 weeks from the beginning of a disease. The main tool method of diagnostics of a chronic periostit is the X-ray analysis allowing to estimate a form, structure, outlines, the sizes and prevalence of periostalny stratifications, and also a condition of the subject bone and, to some extent, surrounding fabrics. Depending on a look, the reasons and stages of a periostit can come to light needle, layered, lacy, pectineal, fringed, linear and other periostalny stratifications.
For it is long the current processes the considerable thickening of a periosteum and its merge to a bone is characteristic owing to what the kortikalny layer is thickened, and the volume of a bone increases. At purulent and serous periostita peeling of a periosteum with formation of a cavity comes to light. At ruptures of a periosteum owing to purulent fusion on roentgenograms "the fragmentary fringe" is defined. At malignant new growths periostalny stratifications have an appearance of peaks.
The radiological research allows to make idea of character, but not about the reason of a periostit. The preliminary diagnosis of the main disease is exposed on the basis of clinical signs, for final diagnostics, depending on these or those manifestations the most different researches can be used. So, at suspicion of a varicosity of deep veins ultrasonic duplex scanning is appointed, at suspicion of rheumatoid diseases – definition of a rheumatoid factor, S-jet protein and level of immunoglobulins, at suspicion of gonorrhea and syphilis – PTsR-researches etc.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Tactics of treatment depends on the main disease and a form of a periostit. At a simple periostit recommend rest, anesthetics and resolvents. At purulent processes appoint analgetics and antibiotics, carry out opening and drainage of an abscess. At a chronic periostit carry out therapy of the main disease, sometimes appoint laser therapy, a dimethyl sulfoxide and chloride of calcium. In some cases (for example, at a syphilitic or tubercular periostit with formation of fistulas) expeditious treatment is shown.