Osteomyelitis is an infectious disease caused by various pathogens, most often streptococci and staphylococci. A distinctive feature of the pathology is purulent-necrotic lesions of bone tissues, including the periosteum and medulla. Late treatment of chronic osteomyelitis does not always bring a positive result - often the disease leads to disability.
When a bacterial lesion of bone tissue occurs, leukocytes join the inflamed focus. These blood cells produce specific enzymes that soften and decompose bone tissue. As osteomyelitis progresses, purulent exudate spreads throughout the body through the bloodstream - which is why this form is called hematogenous osteomyelitis. Treatment of the disease is carried out both medically and surgically at the same time.
The peculiarity of this disease is thatin parallel with the pathological process, regeneration proceeds - in necrotic foci, the affected bone tissue is covered with a new one, which is called the cover. To begin the treatment of osteomyelitis, it is necessary to accurately determine the stage and causes of the disease.
Reason in brief
In some cases, bone osteomyelitis is triggered by a bacterial infection. Among the disease-causing agents that contribute to bone damage, the most commonly found are:
- Staphylococcus aureus and epidermal staphylococci;
- variety of streptococcal infection;
- representatives of the intestinal microflora;
- Pseudomonas aeruginosa;
- tuberculosis bacillus.
Osteomyelitis is a consequence of direct entry of pathogenic bacteria into the bone and surrounding tissues, so the disease, as a rule, becomes a complication of an open fracture or significant damage to muscles, tendons, cartilage. Often, the pathology develops in the postoperative period after osteosynthesis performed without observing the necessary sanitary and antiseptic conditions.
Chronic inflammatory foci in the body can also be classified as a potential risk factor. These include:
- recurrent course of sinusitis and tonsillitis;
- dental caries;
- unhealed for a long time umbilical wound in newborns;
- furunculosis.
In this case, bacteria enter the bone cavity through the bloodstream. Osteomyelitis mainly affects the tubularbones of the limbs, skull and jaw. Sometimes the spine and ribs need treatment for osteomyelitis.
General manifestations of the disease
Symptoms and treatment of osteomyelitis depend on the area and location of the lesion, as well as the stage of the disease - acute or chronic.
The acute type of the disease is characterized by a rapidly developing onset, the rapid reproduction of pathogenic microbes in the immediate focus of the lesion, severe pain, swelling of tissues. Symptoms of the disease largely depend on the localization of the inflammatory process. If osteomyelitis is affected, for example, the jawbone, the pain will radiate to the temples, ears, eye sockets.
In addition, patients with osteomyelitis often show signs of intoxication. The chronic form of the disease proceeds, as a rule, less noticeably, alternating with periods of exacerbations and calm.
Acute osteomyelitis develops within 2-3 days. It is curious that during this time there may not be any visible and pronounced manifestations - patients, as a rule, feel only general malaise, weakness, moderate pain in the joints and muscles. However, after a couple of days the situation changes radically. First of all, the temperature rises, the affected area of \u200b\u200bthe bone begins to hurt a lot, while the intensity of pain increases during the slightest activity, which forces the patient to minimize any movement. Perhaps the appearance of nausea, vomiting, general deterioration of well-being.
The latent course of osteomyelitis carries the greatest danger to the patient, since the disease spreads rapidly froma separate inflammatory focus and passes from the acute stage to the chronic one.
It is important to understand that no doctor can identify the symptoms of osteomyelitis from a photo. Treatment of the disease, or rather, its success depends directly on the timeliness of seeking specialized medical care. Progressive osteomyelitis may present with symptoms such as:
- dramatic drop in blood pressure;
- pain in the heart;
- convulsions;
- nonsense;
- fainting;
- jaundice of the skin.
Acute stage
Acute osteomyelitis is typical for childhood, but about a third of cases the disease is diagnosed in infants. Long tubular bones are usually involved in the infectious process, flat and short ones are much less often affected by the disease. Conventionally, there are three forms of acute osteomyelitis:
- adynamic;
- septic-pyemic;
- local.
The most benign course is typical for the local form of pathology. The infectious-inflammatory process is accompanied by symptoms of local damage to the bone tissue. At the same time, the general condition of the patient practically does not suffer.
Sustained low-grade fever is characteristic of the septic-pyemic form. Patients also complain of severe headache, chills, vomiting that cannot be suppressed even by taking antiemetic drugs, and other signs of intoxication of the body. Without timely treatment of acuteosteomyelitis, consciousness is disturbed, the patient is delirious. The patient's condition is assessed as extremely serious. After two or three days, severe pain occurs with a clear localization of the purulent-inflammatory focus in the bone, swelling of the affected limb and increased venous pattern on it.
No less dangerous is the toxic form of acute osteomyelitis. With it, inflammation develops at lightning speed. In addition to the highest body temperature, the symptoms of the disease can also be supplemented by meningeal manifestations, a decrease in blood pressure to critical levels, convulsions and loss of consciousness. Regardless of the age of the patient, heart failure rapidly develops. At the same time, local clinical signs may be mild or absent, which makes it extremely difficult to make a correct diagnosis and prescribe the correct therapy.
Chronic form of inflammation
In this case, the treatment and symptoms of osteomyelitis are determined by the volume of bone destruction and the duration of the period of exacerbation. When the disease passes from the acute stage to the chronic stage, the patient may experience short-term improvements. Along with the stabilization of general well-being, signs of intoxication disappear, the temperature regime of the body normalizes. At the same time, multiple or single fistulas with purulent discharge are formed in the area of inflammation. In the future, the patient develops ankylosis, the bone can lengthen, shorten or bend.
The remission phase in chronic osteomyelitis lasts on average 1.5-2 months, but with the effectiveness of supportingtherapy, a relapse may not occur even after six months. The exacerbation in many ways resembles the beginning of an acute period, but with more blurred symptoms. The fistula in recurrent osteomyelitis closes, which contributes to the accumulation of pus in the cavity and increased pressure inside the bone. The patient's condition worsens again, the pain syndrome intensifies. External swelling and hyperemia of tissues, fever or subfebrile body temperature also return. In blood tests, the following indicators change significantly:
- white blood cell count above normal;
- appears granularity of erythrocytes;
- Erythrocyte sedimentation rate also changes.
Jaw damage
The form of the disease, in which the bone tissue of the upper, lower or both jaws is affected, is called odontogenic. The need for treatment of osteomyelitis of the jaw in most cases is caused by destructive changes in it. In surgical dentistry, odontogenic inflammatory processes are as common as periodontitis or periostitis of the jaw.
Osteomyelitis of the jaw is often localized on the lower jaw. The disease mainly develops in adult men. Osteomyelitis of the jaw can also be divided into three subtypes:
- odontogenic, which occurs against the background of infectious or inflammatory diseases of the teeth;
- hematogenous - the infection spreads throughout the body through the bloodstream;
- traumatic - the cause of the inflammatory process is a complication after injuryjaw.
Each of the subspecies of the disease has its own causes. Thus, pulpitis, periodontitis, alveolitis, and tooth granuloma can provoke the development of odontogenic osteomyelitis. Pathogenic agents enter the bone through an infected root or pulp.
The way of infection for the development of hematogenous osteomyelitis of the jaw can be considered furunculosis in the jaw area, purulent otitis, tonsillitis, sinusitis, as well as umbilical sepsis, diphtheria. With this type of disease, the jaw bone is first involved in the infectious process, and later the tissues of the teeth are also affected. Treatment of osteomyelitis of the jaw of hematogenous type involves the use of broad-spectrum antibacterial drugs.
The traumatic form of the disease can be the result of a fracture or a gunshot wound to the jaw. Sometimes damage to the nasal mucosa can cause pathology. In this case, bacteria penetrate into the bone tissue from the external environment.
Complications of osteomyelitis of the jaw
Symptomatics in osteomyelitis of the jaw depends on the severity of the disease and its etiology. In most cases, patients experience chills, a sudden increase in temperature to 39-40 ° C, insomnia and lack of appetite. However, other manifestations of osteomyelitis may also occur.
So, for example, in the odontogenic form of the disease, patients often feel intense toothache, radiating to the temporal lobes, pressing on the ears and eyes. Over time, the symptom loses its clear localization. With osteomyelitis of the jaw, the diseased tooth, as well as the teeth adjacent to it, become mobile,gums swell. A purulent infiltrate constantly leaves the gum pocket, where the diseased tooth is located, so the patient has a sharp putrid smell from the mouth. As the disease progresses and the infection spreads to the soft tissues, the mobility of the mouth is limited, difficulty in breathing and pain during swallowing may occur.
If osteomyelitis affects the lower jaw, there is numbness and tingling in the lower lip, enlargement of adjacent lymph nodes, due to which the contours of the face become asymmetrical. Without proper treatment, the symptoms of osteomyelitis of the jaw are aggravated by the formation of abscesses, adenoid phlegmon, and thrombophlebitis of the facial veins. Often, in the chronic course of the disease, deformation or fracture of the jaw occurs, trismus develops.
Diagnosis of osteomyelitis
Treatment of this disease should always be preceded by a thorough examination. It involves the use of not only laboratory and instrumental research methods, but also the mandatory collection of a patient's history, taking into account recent infections, injuries, an objective visual examination, and palpation of the affected area. The disease is treated by surgeons or traumatologists.
Diagnosis before treatment of osteomyelitis of the bone is a whole range of procedures that the patient has to undergo:
- complete blood count;
- radiography of the inflamed area of bone tissue;
- fistulography with the introduction of a contrast agent - in the presence of fistulas;
- radiothermometry;
- ultrasound;
- thermography;
- CT, MRI, radioisotope scanning;
- Marrow puncture for bone marrow biopsy.
Surgical treatment
The fundamental method of combating osteomyelitis is surgery. Operations on bone tissue are carried out in parallel with conservative therapy. With a hematogenous form in the early stages of the disease, the patient has every chance to avoid the intervention of the surgeon, but later, when the bone lesions become very deep, only surgery can save the patient's life.
The main task in the treatment of chronic osteomyelitis is the elimination of a purulent focus that provokes an inflammatory process. Sequestrectomy involves the removal of dead bone fragments and purulent granulations, after which the diseased area must be washed and drained. For immobilization and maintenance of the limb, the Ilizarov apparatus is used, followed by extrafocal osteosynthesis. If it is impossible to use it, the limb is fixed with a plaster splint.
With odontogenic osteomyelitis of the jaw, tooth extraction is recommended. In the case of the development of the hematogenous type of the disease, the chronic infectious focus is sanitized, and after injury to the soft and bone tissues, the primary surgical treatment of the damaged areas is carried out. Treatment of chronic osteomyelitis of the jaw also requires the removal of sequestered bone fragments. Upon completion of the manipulation, the bone cavity is cleaned with antiseptic agents, after which the voids are filledosteoplastic materials containing antibiotics. In case of a threat of a jaw fracture, the patient is prescribed splinting.
Also, patients are strictly shown bed rest, physiotherapy (electrophoresis, shock wave therapy) and a strict diet.
Medicines
This disease is a direct indication for hospitalization. In addition to the surgical method of treating osteomyelitis, it is important to undergo a course of complex drug therapy. Antibiotic therapy is indispensable in this pathology. As a rule, drugs are administered intravenously or intramuscularly. In addition to antibiotics, the treatment of osteomyelitis requires a powerful detoxification therapy, which is:
- procedures for transfusion of plasma and blood substitutes;
- reception of immunomodulators and vitamin-mineral complexes;
- hemosorption.
As for the names of medicines, new generation antibiotics are used in the treatment of hematogenous osteomyelitis. Among the first-line drugs worth noting:
- "Ceftazidime", "Cefalexin" from the group of cephalosporins.
- "Augmentin", "Amoxiclav" (drugs based on amoxicillin and clavulanic acid from the penicillin series).
In case of an allergic reaction to antibiotics of these groups, combinations of Ampicillin and Sulbactamax or Ceftriaxone and Oxacillin are used as an alternative. Depending on the causative agent of the hematogenous form of the disease, can be used andother antibacterials:
- Gentamicin.
- Cephalosolin.
- Lincomycin.
- Clindamycin.
- Fluoroquinolone.
- Rifampicin.
After surgery or injury, antibiotics may be prescribed as a preventive measure. Most often, these are drugs such as Ofloxacin, Lincomycin, Vancomycin.
Osteomyelitis in children
In children under ten years of age, osteomyelitis of the epiphyseal form is more common, in which cartilage tissue is predominantly affected, which is explained by the physiological characteristics of blood circulation. In adolescence, on the contrary, hematogenous osteomyelitis is diagnosed, which is characterized by inflammation of the tubular bones.
Since the focus of inflammation does not make itself felt immediately, but after some time, very often there are certain difficulties in diagnosing the disease and prescribing adequate therapy. The inability to recognize osteomyelitis immediately or the detection of the disease with a delay is fraught with both serious complications and death.
In childhood, the causes of bone damage are the same bacterial infections as in adults, infection of open wounds. In this case, the severity of symptoms and treatment of osteomyelitis in a child will largely depend on his age, characteristics of the immune system and the size of the affected area.
In infants, the course of the disease affects the general well-being. They become restless, sleep poorly, act up. Children with this diseaserefuse to eat, become lethargic and passive due to high temperature (up to 41 ° C). In addition, changes in the body are manifested by pallor of the skin, diarrhea and vomiting may occur. The kid will try to protect the limb from movement, and at the slightest touch to the inflamed area, he will scream piercingly.
At an early age, it is quite difficult to diagnose osteomyelitis in a child, since local signs of the disease in the form of redness and swelling do not appear immediately. After a few days, hyperemia and edema spread further. With a belated visit to the doctor, purulent foci can spread throughout the body.
In adolescents, the symptoms are more pronounced, but the disease does not develop as rapidly. Local signs of osteomyelitis in older age occur a week after the main symptoms or even later.
How to cure osteomyelitis in a child?
The treatment regimen in childhood is similar to the treatment of the disease in adults. The only thing that needs to be taken into account is the peculiarities of the physiological development of the child and the high probability of complications after surgical treatment of osteomyelitis on the affected bone. The patient is closely monitored in intensive care. He is prescribed massive antibiotic therapy, anti-inflammatory and desensitizing agents. Antibacterial drugs are prescribed in the same way as for adults, combining penicillins and cephalosporins, macrolides and cephalospirins.
In infants, surgery involves an autopsyphlegmon, and in adolescence, in addition to opening the purulent-inflammatory focus, they perform its thorough osteoperforation. Rehabilitation after this disease requires several months, in severe cases - a whole year. The child is shown spa treatment, vitamin therapy and immunotherapy.
Treatment of osteomyelitis with folk remedies
To get rid of this disease, in addition to drug therapy, you can use a whole arsenal of alternative medicine:
- Walnut tincture. About 100 g of fruit must be shelled, then pour 500 ml of vodka into the raw material. It will take about two weeks to infuse, after which the finished product must be filtered. You need to take tincture for 1 tsp. three times a day before meals. The duration of treatment depends on how soon relief comes.
- Fish oil and chicken egg. This mixture, like the previous remedy, helps to eliminate pain in the bones and joints. It is necessary to use the medicine on an empty stomach in the morning and in the evening. One raw egg mixed with a tablespoon of fish oil can be divided into two doses.
- Alcohol tincture of lilac. To prepare the medicinal composition, you will need a few tablespoons of dry plant materials and one bottle of vodka. The mixture is sent for a couple of weeks to a dark, cool place for infusion. The finished product is used as a compress - a gauze bandage soaked in the solution is applied to the pain location and held for up to 10 minutes.
