Osteomyelitis is an inflammatory disease of the bones and surrounding soft tissues, which occurs as a result of their defeat by pyogenic bacteria. Let's take a closer look at the information about the disease. Particular attention will be paid to such a form of the disease as chronic osteomyelitis. We will learn about the causes of its appearance, methods of diagnosis and treatment.
Osteomyelitis: disease classification
Based on various factors, there are several classifications of the disease. Depending on the conditions for the occurrence of the disease, it can be:
- primary (hematogenous);
- secondary (post-traumatic);
- odontogenic.
Hematogenous osteomyelitis occurs as a result of the introduction of microbes through the blood into the bone tissue from purulent wounds, pustules on the skin or inflammatory foci of internal organs. In most cases, this type of disease affects children. Hematogenous osteomyelitis begins suddenly and in the first days is accompanied by symptoms of intoxication of the body: high fever, nausea, vomiting,general weakness, headaches. After some time (up to two days), swelling of the affected limb appears, which is accompanied by severe pain.
Post-traumatic osteomyelitis can occur after bone surgery, an open fracture, or a gunshot wound. This happens in the presence of contributing factors, such as, for example, the absence or improper conduct of surgical treatment, the presence of large hematomas or foreign bodies. All of them promote the growth of bacteria, as they interfere with the normal healing process.
It is customary to refer odontogenic osteomyelitis to a separate group. It is an inflammatory process in the maxillofacial region. Odontogenic osteomyelitis affects periodontal and tooth tissues, so the disease is closely related to dentistry. This type of illness is accompanied by headaches, fever and general weakness of the body. With its progression, there may be difficulty in swallowing, the appearance of bad breath, swelling of the mucous membrane, plaque on the tongue.
The following forms of osteomyelitis, which we will consider, depend on the nature of its course:
- spicy;
- chronic.
As a rule, treatment begins already at the first stage of the disease. But in the absence of adequate therapy, acute osteomyelitis becomes chronic.
The following types of the disease are less common:
- Olie's syndrome;
- Brody's abscess;
- Garre disease.
So, we got acquainted with the general information about osteomyelitis. It's time to take a closer look at its chronic form.
Causes of disease
To find the causes of chronic osteomyelitis, you do not need to conduct a long search. It was already mentioned above that the disease occurs as a result of improper treatment of its acute form.
The causative agent of chronic osteomyelitis in most cases is Staphylococcus aureus. Although there are situations when the appearance of the disease can be provoked by Pseudomonas aeruginosa, fungus, Proteus, E. coli.
So, the main causes of chronic osteomyelitis:
- late identification of the causative agent of the disease;
- improper treatment of the acute form of the disease;
- Untimely identification of the source of an infectious disease.
Symptoms of disease
The way chronic osteomyelitis will develop depends primarily on the nature of the course, location and prevalence of the inflammatory process. In most cases, the infection also affects those tissues that are next to the affected.
Chronic osteomyelitis is characterized by:
- skin blanching;
- loss of appetite;
- sleep disorders;
- appearance of apathy and lethargy.
In addition, during the development of the disease, purulent fistulas often appear. When exposed to neighboring tissues, the formation of abscesses, phlegmon is not excluded.
Ifchronic osteomyelitis has affected the lower jaw, there may be an increase in lymph nodes.
In addition to all this, the disease is accompanied by a general deterioration in well-being, signs of intoxication and painful sensations in the area of the damaged part of the body: shoulder or femur bones, vertebrae, and so on.
Diagnosis of disease
To identify chronic osteomyelitis, you can contact a traumatologist, surgeon, orthopedist. Diagnosis will include a number of activities.
The patient can be prescribed:
- Question, inspection, palpation.
- X-ray. An x-ray can show structural changes in the bone as early as a week after the onset of the disease.
- Biochemical and complete blood count to determine the erythrocyte sedimentation rate and the presence or absence of a pathogenic agent.
- Cytological and bacteriological examination of discharge from the wound, fistula and bone marrow.
- Ultrasound of the damaged area. It is necessary to detect fluid accumulation.
- Angiography. It is carried out in order to detect areas deprived of blood supply.
- Magnetic resonance and computed tomography. It is carried out in order to obtain information about the size, localization, distribution and nature of pathological changes.
- Radionuclide studies are necessary for the timely detection of the disease, its severity and the nature of inflammatory processes.
It is recommended not only to undergo an external examination andtake an x-ray, but also find time for maximum diagnosis, since only in this case it will be possible to choose the most optimal treatment option.
Differential Diagnosis
Chronic osteomyelitis in its symptoms may be similar to some other diseases. That is why differential diagnosis is of great importance. It will help to establish the most accurate diagnosis and prescribe effective treatment.
The course of osteomyelitis can be similar to:
- appearance of neoplasms on the bone;
- bone tuberculosis;
- osteochondropathy;
- fibrous osteodysplasia.
Medicated treatment
Treatment of the acute form of the disease involves the use of topical preparations: sorbents, anti-inflammatory ointments, proteolytic enzymes, and antibiotics.
Traumatic lesions and generalized type of osteomyelitis require several types of therapy:
- detoxification with infusion of saline, "Rheopolyglucin" and other substances;
- antibacterial with the use of bone-tropic antibiotics or special preparations in case of detection of the type of pathogen;
- immune with the introduction of specific sera of staphylococcal toxoid, autovaccine.
Surgical treatment
The need for surgical intervention occurs in cases where there is a large number ofsequesters that do not resolve over time. This can also include cases of fistula formation or the presence of serious kidney disease in the patient.
In case of chronic osteomyelitis, surgical treatment includes several mandatory procedures:
- removal of nonviable tissues;
- treating the wound with antiseptics and antibiotics;
- plasty of soft and bone tissues;
- wound drainage;
- Installation of a catheter into the artery, which is located next to the lesion. This is necessary for the further introduction of antibiotics through it.
Physiotherapy
Osteomyelitis disease requires treatment and physical factors. Their main goal is to eliminate inflammation, activate recovery processes, accelerate the formation of sequesters, reduce the body's sensitivity to bacteria, and stimulate immunity.
To reduce the activity of the inflammatory process, the patient may be prescribed:
- infrared laser therapy;
- UHF therapy;
- erythemal doses of UV radiation;
- UHF therapy.
The above procedures are performed only in combination with antibiotic therapy and if there are ways for the outflow of the fistula (pus).
To accelerate the processes of tissue repair is used:
- ultrasound therapy;
- electrophoresis means that improve the metabolism of vitamins and substances;
- peloid therapy;
- high-frequency magnetotherapy;
- paraffin and ozocerite applications.
During chronic osteomyelitis in remission, calcium chloride electrophoresis is performed. To dilate the vessels in the affected area, electrophoresis of vasodilators can be used.
In order to improve metabolic processes in the connective tissue, you need:
- ultrasound therapy;
- transcutaneous electrical stimulation;
- radon and hydrogen sulfide baths;
In the stage of remission of chronic osteomyelitis, pelotherapy and low-frequency therapy are used to reduce the activity of the blood coagulation system.
To activate the immune system, the patient is prescribed:
- heliotherapy;
- electrophoresis of drugs that affect immunomodulation;
- high-frequency magnetotherapy in the thymus area;
- suberythemal doses of UV radiation;
- laser blood irradiation.
To get rid of toxins, the patient needs to drink sodium chloride hydrocarbonate mineral waters three times a day ("Essentuki No. 4", "Borjomi" and so on).
To improve the supply of oxygen to affected tissues, oxygen barotherapy or ozone baths can be used.
Contraindications for physiotherapy
Despite the fact that treatment with physical factors brings many benefits, there are several situations when it is strictly prohibited. These include cases where the patient has:
- high body temperature;
- septicopyemia;
- pronounced intoxication;
- abscesses in the absenceoutflow of pus.
Consequences of the chronic form of the disease
Chronic osteomyelitis can cause a number of serious and life-threatening consequences. The disease can lead to fibrous dysplasia, which, in turn, can provoke the appearance of tumors. In this case, the bone tissue becomes scarred, and pus begins to spread beyond it. During this period, blood poisoning is possible, which will lead to death.
Untimely treatment of the disease can provoke the appearance of hematogenous osteomyelitis. It is characterized by the appearance of large sequesters and an extensive purulent process. All this is accompanied by metastasis to the internal organs.
In addition to everything, it is worth noting that osteomyelitis affects not only the bones, but also other organs: the liver, kidneys, endocrine system. Lack of timely treatment can lead to kidney failure and death of the patient.
Preventive measures for chronic osteomyelitis
We learned about such a disease as osteomyelitis. Classification, symptoms and possible treatments were discussed in the article. It remains to recall one more important issue. Are there ways to help avoid illness?
Prevention of chronic osteomyelitis is the timely treatment of its acute form. Already at the first signs of a possible disease, you need to seek qualified help. After all, as you know, it’s easier to prevent a problem from appearing than to spend your whole life with it.fight.
