Osteomyelitis is an inflammatory disease of the bones and soft tissues surrounding them, which occurs as a result of their defeat by pyogenic bacteria. Consider in more detail the information about the disease. Particular attention will be paid to such a form of the disease as chronic osteomyelitis. We learn about the causes of its appearance, methods of diagnosis and treatment.
Osteomyelitis: classification of the disease
Based on various factors, there are several classifications of the disease. Depending on the conditions of the onset of the ailment, 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), edema of the affected limb appears, which is accompanied by severe pain.
Post-traumatic osteomyelitis can occur after an operation on bones, an open fracture, or a gunshot wound. This happens in the presence of contributing factors, such as, for example, the absence or incorrect conduct of surgical treatment, the presence of large hematomas or foreign bodies. All of them contribute to the growth of bacteria, as they interfere with the normal healing process.
Odontogenic osteomyelitis is usually referred to a separate group . It is an inflammatory process in the maxillofacial region. Odontogenic osteomyelitis affects periodontal and tooth tissues, therefore, the disease is closely associated with dentistry. This type of ailment 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:
As a rule, treatment begins already at the first stage of the disease. But in the absence of adequate therapy, acute osteomyelitis becomes chronic.
Less common are the following types of disease:
- Olier syndrome;
- Brody abscess
- Garre's disease.
So, we got acquainted with general information about osteomyelitis. The time has come to consider in more detail its chronic form.
The causes of the disease
To find the causes of chronic osteomyelitis, you do not need to conduct a long search. It has already been recalled 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 provoke Pseudomonas aeruginosa, fungus, Proteus, Escherichia 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 the infectious disease.
Symptoms of the disease
How chronic osteomyelitis will develop, primarily depends on the nature of the course, location and prevalence of the inflammatory process. In most cases, the infection affects those tissues that are next to the affected.
For chronic osteomyelitis is characteristic:
- blanching of the skin;
- decreased appetite;
- sleep disturbances;
- the appearance of lethargy and lethargy.
In addition, during the development of the disease, purulent fistulas often appear. When they affect neighboring tissues, the formation of abscesses, phlegmon, is not ruled out.
If chronic osteomyelitis affects the lower jaw, an increase in lymph nodes may be observed.
In addition to all this, the disease is accompanied by a general deterioration in well-being, signs of intoxication and pain in the area of the damaged part of the body: the humerus or thigh bones, vertebra, and so on.
Diagnosis of the disease
To identify chronic osteomyelitis, you can contact a traumatologist, surgeon, orthopedist. Diagnostics will include a series of events.
The patient may be assigned:
- Interrogation, inspection, feeling.
- Roentgenography. An x-ray can show structural changes in the bone just a week after the onset of the disease.
- A biochemical and general blood test 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 imaging and computed tomography. It is carried out in order to obtain information about the size, location, distribution and nature of pathological changes.
- Radionuclide studies are necessary for the timely detection of the disease, its severity and the nature of the inflammatory processes.
At the same time, it is recommended not only to undergo an external examination and take an X-ray, but also to find time for the 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 establish the most accurate diagnosis and prescribe effective treatment.
The course of osteomyelitis may be similar to:
- the appearance of neoplasms on the bone;
- bone tuberculosis;
- osteochondropathy;
- fibrous osteodysplasia.
Drug treatment
Treatment of the acute form of the disease involves the use of local drugs: sorbents, anti-inflammatory ointments, proteolytic enzymes, as well as antibiotics.
With traumatic lesions and a generalized type of osteomyelitis, several types of therapy are necessary:
- detoxification with infusion of saline, "Reopoliglyukin" and other substances;
- antibacterial with the use of antibiotics of bone-tropic action or special drugs in case of identification of the type of pathogen;
- immune with the introduction of specific serum staphylococcal toxoid, auto vaccine.
Surgery
The need for surgery arises in cases where there is a large number of sequesters that do not resolve over time. This also includes cases of fistula formation or the presence of serious renal diseases in a patient.
With a disease of chronic osteomyelitis, surgical treatment includes several mandatory procedures:
- removal of non-viable tissue;
- treatment of wounds with antiseptic agents and antibiotics;
- soft and bone tissue repair;
- wound drainage;
- the installation of a catheter in an artery, which is located next to the lesion. This is necessary for the further administration 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 can be assigned:
- infrared laser therapy;
- UHF therapy;
- erythema doses of UVR exposure;
- Microwave therapy.
The above procedures are carried out only in combination with antibiotic therapy and if there are paths for the outflow of fistula (pus).
To accelerate tissue repair processes, it is used:
- ultrasound therapy;
- electrophoresis of drugs that improve the metabolism of vitamins and substances;
- peloid therapy;
- high-frequency magnetotherapy;
- applications of paraffin and ozokerite.
During chronic osteomyelitis in remission, electrophoresis of calcium chloride is performed. For the expansion of blood vessels in the affected area, the use of electrophoresis of vasodilators is possible.
In order to improve metabolic processes in the connective tissue, it is necessary:
- ultrasound therapy;
- percutaneous electrical stimulation;
- radon and hydrogen sulfide baths;
In the stage of remission of chronic osteomyelitis, peloid therapy 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;
- suberythemic doses of UV-radiation;
- laser irradiation of blood.
To get rid of toxins, the patient needs to drink sodium chloride hydrocarbonate mineral water three times a day (Essentuki No. 4, Borjomi, and so on).
To improve the supply of oxygen to affected tissues, oxygen therapy or ozone baths can be used.
Contraindications to physiotherapy
Despite the fact that treatment with physical factors brings many benefits, there are several situations where it is strictly prohibited. This may include cases of the patient:
- high body temperature;
- septicopyemia;
- severe intoxication;
- abscesses in the absence of a path of outflow of pus.
The 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, bone tissue becomes scarred, and pus begins to spread beyond its borders. 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, and the endocrine system. Lack of timely treatment can lead to kidney failure and death of the patient.
Prevention measures for chronic osteomyelitis
We learned about a disease like osteomyelitis. Classification, symptoms and possible treatment options were considered in the article. It remains to recall another important issue. Are there any ways to help avoid the disease?
Prevention of the appearance 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 is easier to prevent the occurrence of a problem than to fight with it all your life.