Osteomyelitis is an infectious disease caused by various pathogens, most often streptococci and staphylococci. A distinctive feature of the pathology are purulent-necrotic lesions of bone tissue, 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, white blood cells join the inflamed lesion. 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.
A feature of this disease is that in parallel with the pathological process, a regenerative process takes place - in the necrotic foci, the affected bone tissue is covered with new, which is called a cover. To begin treatment of osteomyelitis, it is necessary to accurately determine the stage and causes of the disease.
Briefly about the reasons
In some cases, bone osteomyelitis is provoked by a bacterial infection. Among the pathogenic agents that contribute to bone damage, the most commonly found are:
- golden and epidermal staphylococci;
- varieties of streptococcal infection;
- representatives of intestinal microflora;
- Pseudomonas aeruginosa;
- tubercle bacillus.
Osteomyelitis is a consequence of the 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, and cartilage. Often, 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 potential risk factors. These include:
- recurrent course of sinusitis and tonsillitis;
- dental caries;
- non-healing umbilical wound in newborns for a long time;
- furunculosis.
In this case, bacteria enter the bone cavity through the bloodstream. Basically, osteomyelitis affects the tubular bones of the limbs, skull and jaw. Sometimes the treatment of osteomyelitis requires the spine and ribs.
Common 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 multiplication of pathogenic microbes in the immediate focus of the lesion, severe pain, swelling of the tissues. Signs of the disease largely depend on the localization of the inflammatory process. If osteomyelitis affects, for example, the jaw bone, the pain will radiate to the temples, ears, orbits.
In addition, patients with osteomyelitis often show signs of intoxication. The chronic form of the disease, as a rule, is less noticeable, alternating with periods of exacerbation and lull.
Acute osteomyelitis develops within 2-3 days. It is curious that during this time there can be no visible and pronounced manifestations - patients, as a rule, experience 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 the bone begins to hurt greatly, while the intensity of pain increases during the slightest activity, which forces the patient to minimize any movements. Perhaps the appearance of nausea, vomiting, a general deterioration in well-being.
The latent course of osteomyelitis carries the greatest danger to the patient, since the disease quickly spreads from a separate inflammatory focus and passes from the acute to the chronic stage.
It is important to understand that no doctor can determine 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 can manifest with symptoms such as:
- a sharp drop in blood pressure;
- heartache;
- bouts of seizures;
- rave;
- fainting
- yellowness of the skin.
Acute stage
Acute osteomyelitis is characteristic of childhood, but in about a third of cases, the disease is diagnosed in infants. Long tubular bones are usually involved in the infectious process, flat and short bones are affected by the disease much less often. Three forms of acute osteomyelitis are conditionally distinguished:
- adynamic;
- septic-pemic;
- local.
The most gentle course is characteristic of the local form of pathology. Infectious and inflammatory process is accompanied by symptoms of local bone damage. Moreover, the general condition of the patient practically does not suffer.
For the septic-pemic form, stable subfebrile condition is characteristic. Patients also complain of severe headache, chills, vomiting, which cannot be suppressed even by taking antiemetic drugs, and other signs of intoxication. Without timely treatment of acute osteomyelitis, consciousness is disturbed, the patient raves. The patient's condition is assessed as extremely severe. 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 is rapidly developing. Moreover, local clinical signs may be poorly expressed or absent altogether, which makes it extremely difficult to make the correct diagnosis and prescribe the correct therapy.
Chronic inflammation
In this case, the treatment and symptoms of osteomyelitis are determined by the volume of bone destruction and the duration of the exacerbation period. When the disease goes from an acute stage to a chronic one, the patient may feel short-term improvements. Along with the stabilization of general well-being, signs of intoxication disappear, and the temperature regime of the body normalizes. Moreover, in the area of inflammation, multiple or single fistulas with purulent discharge are formed. In the future, the patient develops ankylosis, the bone can be lengthened, shortened or bent.
The remission phase in chronic osteomyelitis lasts on average 1.5-2 months, but with the effectiveness of maintenance therapy, relapse may not occur even after six months. An exacerbation in many ways resembles the onset of an acute period, but with more lubricated symptoms. The fistula with recurrent osteomyelitis closes, which contributes to the accumulation of pus in the cavity and an increase in pressure inside the bone. The patient's condition worsens again, the pain syndrome intensifies. External puffiness and hyperemia of tissues, fever or low-grade fever are also returned. In blood tests, the following indicators change significantly:
- the number of leukocytes exceeds the norm;
- red blood cell granularity appears;
- erythrocyte sedimentation rate also changes.
Jaw lesion
A form of the disease in which the bone tissue of the upper, lower, or both jaws is affected is called odontogenic. The need to treat jaw osteomyelitis 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 subspecies:
- odontogenic, which occurs against the background of infectious or inflammatory diseases of the teeth;
- hematogenous - the infection spreads through the body through the bloodstream;
- traumatic - the cause of the inflammatory process is a complication after damage to the jaw.
Each of the subtypes of the disease has its own causes. So, pulpitis, periodontitis, alveolitis, tooth granuloma can provoke the development of odontogenic osteomyelitis . Pathogenic agents enter the bone through an infected root or pulp.
Through infection for the development of hematogenous osteomyelitis of the jaw, furunculosis in the jaw area, purulent otitis media, tonsillitis, sinusitis, as well as umbilical sepsis, diphtheria can be considered. With this type of disease, the jaw bone is first involved in the infectious process, and later, tooth tissue is also affected. The treatment of hematogenous jaw osteomyelitis 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 in the jaw. Sometimes a pathology can cause damage to the nasal mucosa. In this case, bacteria enter the bone tissue from the external environment.
Complications of jaw osteomyelitis
Symptoms in osteomyelitis of the jaw depend on the severity of the disease and its etiology. In most cases, patients have chills, a sudden increase in temperature to 39-40 ° C, insomnia and lack of appetite. However, other manifestations of osteomyelitis may occur.
So, for example, with the odontogenic form of the disease, patients often experience intense toothache, extending to the temporal lobes, pressing on the ears and eyes. Over time, the symptom loses its clear localization. With osteomyelitis of the jaw, a diseased tooth, as well as teeth adjacent to it, become mobile, gums swell. Purulent infiltrate constantly leaves the gingival pocket, where the diseased tooth is located, therefore, the patient has a sharp putrid odor from the mouth. As the disease progresses and infection passes to the soft tissues, the mobility of the mouth is limited, breathing difficulties and soreness during swallowing are possible.
If osteomyelitis affects the lower jaw, numbness and tingling in the lower lip are felt, neighboring lymph nodes increase, due to which the contours of the face become asymmetric. Without proper treatment, the symptoms of jaw osteomyelitis are aggravated by the formation of abscesses, phlegmon adenoids, 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
The treatment of this disease should always be preceded by a thorough examination. It implies the use of not only laboratory and instrumental research methods, but also the compulsory collection of the patient’s history taking into account recent infections, injuries, objective visual examination, and palpation of the affected area. The treatment of the disease is carried out by surgeons or traumatologists.
Diagnosis before treatment of bone osteomyelitis is a whole complex of procedures that the patient has to go through:
- general blood analysis;
- radiography of the inflamed area of bone tissue;
- fistulography with the introduction of a contrast agent - in the presence of fistulas;
- radiothermometry;
- ultrasonography;
- thermography;
- CT, MRI, radioisotope scanning;
- bone marrow canal puncture for bone marrow biopsy.
Surgery
The fundamental method of controlling osteomyelitis is surgical. Bone surgery is performed in parallel with conservative therapy. With a hematogenous form in the early stages of the disease, the patient has every chance of avoiding the intervention of the surgeon, but later, when 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 the purulent focus, which provokes the inflammatory process. Sequestrectomy involves the removal of dead bone fragments and purulent granulations, after which the affected area must be washed and drained. To immobilize and maintain the limb, the Ilizarov apparatus with subsequent extrafocal osteosynthesis is used. If it is impossible to use, the limb is fixed with a gypsum plank.
With odontogenic osteomyelitis of the jaw, tooth extraction is recommended. In the case of the development of the hematogenous type of the disease, a chronic infectious lesion is readjusted, and after injury to the soft and bone tissues, primary surgical treatment of the damaged areas is performed. Treatment of chronic jaw osteomyelitis also requires the removal of sequestered bone fragments. At the end of the manipulation, the bone cavity is cleaned with antiseptic agents, after which the voids are filled with osteoplastic materials containing antibiotics. In case of a threat of a fracture of the jaw, the patient is prescribed splinting.
Also, patients are strictly shown bed rest, physiotherapeutic procedures (electrophoresis, shock wave therapy) and a strict diet.
Medicines
This disease is a direct indication for hospitalization in a hospital. In addition to the surgical method of treating osteomyelitis, it is important to undergo a course of complex drug therapy. Antibiotic therapy is indispensable for 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 naming of drugs, a new generation of antibiotics is used in the treatment of hematogenous osteomyelitis. Among the first-line drugs, it is worth noting:
- "Ceftazidime", "Cephalexin" 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, other antibacterial agents can be used:
- Gentamicin.
- "Cephalozolin."
- "Linkomycin."
- Clindamycin.
- "Fluoroquinolone."
- "Rifampicin."
After surgery or injuries, antibiotics can be prescribed for prophylactic purposes. Most often these are drugs such as Ofloxacin, Linkomycin, Vancomycin.
Osteomyelitis in children
In children under ten years of age, osteomyelitis of the epiphyseal form is more common, in which cartilage tissue is affected mainly, which is explained by the physiological characteristics of blood circulation. In adolescence, in contrast, hematogenous osteomyelitis is diagnosed, which is characterized by inflammation of the bones.
Since the focus of inflammation does not immediately make itself felt, 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 a 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. Moreover, the severity of symptoms and treatment of osteomyelitis in a child will largely depend on his age, the characteristics of the immune system and the size of the affected area.
In infants, the course of the disease affects general well-being. They become restless, sleep poorly, and act up. Children with this disease refuse food, 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, possibly the appearance of diarrhea, vomiting. The kid will try to protect the limb from movement, and at the slightest touch to the inflamed area - scream piercingly.
It is quite difficult to diagnose osteomyelitis in a child at an early age, 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 late 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 at an 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 to consider is the physiological development of the child and the greater likelihood of complications after surgical treatment of osteomyelitis on the affected bone. The patient is carefully monitored in intensive care conditions. He is prescribed massive antibiotic therapy, anti-inflammatory and desensitizing agents. Antibacterial drugs are prescribed in the same way as adults, combining penicillins and cephalosporins, macrolides and cephalospirins.
In infants, surgery involves opening the phlegmon, and in adolescence, in addition to opening the purulent-inflammatory focus, they carefully osteoperforate it. 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 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 peeled, then pour raw materials into 500 ml of vodka. For insisting, it will take about two weeks, after which the finished product must be filtered. 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 eliminate pain in bones and joints. It is necessary to take 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 several tablespoons of dry plant material and one bottle of vodka. The mixture is sent for a couple of weeks to a dark, cool place for insisting. The finished product is used as a compress - a gauze dressing soaked in a solution is applied to the place of pain dislocation and is kept for up to 10 minutes.