Chronic osteomyelitis - Causes, Symptoms, Diagnosis and Treatment
Chronic osteomyelitis - Chronic inflammatory process which affects all elements of the bone (bone marrow, periosteum, compact and spongy substance). Usually becomes the outcome of acute osteomyelitis, chronic primary observed in individual cases. Characterized by the alternation of remissions and exacerbations. In the acute phase there are symptoms of intoxication, pain, swelling, redness of the affected department and fistulas. In remission symptoms are smoothed or disappear. Diagnosis is exposed to the light of history, clinical symptoms, X-ray data and other studies. Treatment usually operative.
Chronic osteomyelitis
acute osteomyelitis. It may affect any bone, but often suffer from long bones. It noted the prevalence of patients with lower limb lesions. Chronic osteomyelitis is diagnosed in people of any age and gender. It is characteristic for a long period of alternating exacerbations and remissions. Duration of remission may range from several weeks to several years.
A long-term inflammation is having a devastating effect not only on the bone, but also to other organs. Struck by segment can be bent or shortened, sometimes to the area of inflammation false joint is formed. Limited mobility of the neighboring joints, contractures occur. With the localization of focus in the periarticular area may develop suppurative arthritis. Fistulas with constant purulent deliver significant inconvenience to patients, they are a source of odor, impede communication, negative impact on the career and personal life. In patients suffering from osteomyelitis many years, often revealed degenerative changes of the internal organs and renal amyloidosis.
osteomyelitis. In adults, the first place in the prevalence of chronic posttraumatic osteomyelitis takes, which usually develops in the background of open fractures, but can also occur after surgical interventions on the enclosed bone damage (this is called postoperative osteomyelitis).
Chronic Osteomyelitis often develops after gunshot fractures, accompanied by extensive tissue damage, destroyed as a result of the direct impact of the projectile and concussion education zone. The healing of wounds is always going through the abscess, which contributes to a chronic suppurative focus in the area of the damaged bone. Relatively rare chronic inflammation of the bone caused by contact spread infection (from closely situated purulent wounds, cellulitis or abscess).
streptococci). As chronic process is replaced by gram-positive gram-negative or complements it to form microbial associations. In crops of foci of chronic osteomyelitis can be detected Klebsiella, Proteus vulgaris, Escherichia coli, Pseudomonas aeruginosa and other bacteria.
The transition probability of acute osteomyelitis in chronic depends on many factors, including the overall condition of the body, the presence or absence of immune disorders, especially of the structure and blood supply to the bone, the condition of the circulatory system, and so on. D. Chronic osteomyelitis often develops in patients suffering from severe somatic disease and associated trauma, as well as in debilitated and malnourished patients. Of great importance is the area of destruction of bone and surrounding soft tissues.
Acute osteomyelitis becomes chronic after about a month after the first symptoms. By this time in the form of bone sequesters begins rejection of necrotic tissue formed fistulas. In the absence of the effect of therapeutic measures conducted for 1.5 months after onset of the disease, we can talk about chronic purulent inflammation of the bone. Subsequently, the process proceeds in waves, and the frequency and severity of exacerbations can vary significantly.
radiography. The X-ray signs of bone destruction are determined in conjunction with elements of proliferation. In the purulent focus visible cavity sequesters often identified as a dense shadow with irregular contours and preserved bone pattern. Around inflammatory defined areas of sclerosis. In the acute phase there is periostitis, the number and nature of the periosteal layers depend on the duration and severity of the process.
Sometimes, due to a significant hardening of the bones of small lesions on radiographs are not detected. In addition, X-ray does not assess changes in the soft tissue, so in case of doubt, patients were additionally directed to bone CT and MRI. An important part of the preoperative study is fistulography, the results of which determined the scope and tactics of surgical intervention. Fistulography makes it possible to see the direction of the fistulous, which is often tortuous and has a complex shape. With this research, you can determine the amount of cavities, identify fistula connection with sequestration and so on. D.
traumatology and orthopedics. Medical tactic is determined by the condition of the patient, the severity, extent and stage of pathological changes, and the presence of concomitant complications from the affected segment (false joints, shortening, rough strain) and severity of degenerative changes of the internal organs. During exacerbation Antibiotics and means for stimulating immunity, purulent drainage cavities carried by special needles or catheters.
Cavities and fistulae washed with solutions of antibiotics. Intermuscular phlegmon opened and drained. Surgery is performed after decrease in acute inflammation. Held sequestrectomy - completely remove necrotic foci, and lots of excess granulation sclerosis. Fistulous passages excised, based on data fistulography. Carry out washing with antiseptic surgical wound. After complete wound cleansing the remaining bone is perforated wall, remote areas replace bone grafts.
In some cases, carried out a more complex, multi-stage treatment of chronic osteomyelitis. When false joints, shortening and pronounced deformation may require osteotomy, bone resection site is not involved in the pathological process and other therapeutic measures. To correct angular deformities and limb lengthening of the affected segment of the trauma applied the Ilizarov apparatus.
Prognosis depends on the duration of the disease, lesion volume, the patient's health and radical surgery. When fresh processes and complete excision of small foci often observed full recovery. In old osteomyelitis prognosis worsens because of trophic changes in the soft tissues, the extensive restructuring of dystrophic bone, worsening local blood supply and the unfavorable general background due to breach of the various organs. However, operative treatment is indicated, even in advanced cases as chronic suppurative process has a negative effect on all organs and can cause a serious deterioration in the patient's health.