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Currently, this name combines the defeat of all parts of the bone: inflammation of the bone (osteitis), bone marrow (myelitis) and periosteum (periostitis). It occurs as a result of endogenous (hematogenous) or exogenous infection of the bone.
There are hematogenous osteomyelitis, which develops as a result of the introduction of microbes into the bone through the blood, and wound or traumatic osteomyelitis, which is secondary and develops as a complication of the wound process, surgical treatment of closed fractures. In the initial stage, these two types of bone inflammation are completely different both in origin and manifestation. However, in the later phases, the differences are gradually smoothed out, so they are collectively called.
Hematogenous osteomyelitis is more common in male children and adolescents. The process is usually localized in the femur and tibia and less often in all others. From the primary focus (boils, carbuncles, panaritiums, phlegmon, abscesses, erysipelas, infected abrasions and wounds, carious teeth, tonsillitis, chronic inflammatory processes in the adnexal cavities of the nose and ear, etc.), microbes enter the bone marrow through the blood stream and cause inflammation . The following factors are distinguished that influence the development of osteomyelitis: 1) anatomical and physiological, 2) biological and immunobiological, 3) predisposing. According to the clinical course, acute and chronic osteomyelitis are distinguished, which in the overwhelming majority of cases is the outcome of acute, but can also proceed as primary chronic.
Acute hematogenous osteomyelitis. Symptoms and course. In the first 1-2 days, the patient notes general malaise, aching limbs, muscle pain, headache. Then a stunning ozno appears with a persistent increase in temperature to 39 ± C, and above, weakness, weakness, headache, and sometimes vomiting. The general condition becomes severe, consciousness becomes darker, delirium appears, symptoms of irritation of the meninges, and sometimes convulsions. The appetite disappears, the tongue is covered, dry. The face becomes pale, the eyes sink, the lips and mucous membranes are cyanotic, the skin is dry, with a jaundice, its turgor is reduced.
Blood pressure is lowered, heart sounds are deaf, the pulse is frequent, weak filling and, as a rule, corresponds to temperature. Respiration is rapid, shallow. Symptoms of bronchopneumonia are sometimes found in the lungs. The liver and spleen are enlarged, painful on palpation. Sometimes the area of ​​the kidneys is painful, there is little urine, in the urine there is protein and cylinders.
From day 1-2 of the disease, severely localized severe pain appears in the affected limb, tearing, boring, bursting. Patients, especially children, at the slightest movements of the affected limb, jerks of the bed, shifting often scream from increased pain. To reduce pain, they lie completely still. In connection with the deep location of the focus, methodical palpation is important in such cases, which must be done carefully. It allows you to identify the area of ​​greatest pain, corresponding to the center of the process. An early diagnosis method is heel or elbow striking, which causes severe pain at the lesion site.
In the next 1-2 days, local phenomena appear more distinctly. Corresponding to the site of the lesion, a painful swelling of soft tissues appears, which quickly grows, moderate redness and swelling of the skin, and an increase in its temperature. Despite the fact that the X-ray examination during this period still does not provide any data, the diagnosis becomes quite clear. Swelling of the extremity increases rapidly, dilated veins begin to shine through, and regional lymph nodes increase. At the end of 1 week in children and in two weeks in adolescents, fluctuation begins to be detected in the center of a painful and dense swelling.
With the development of intermuscular phlegmon, the general condition of the patient improves somewhat, but if it remains severe, it is necessary to look for some complications (the transition of the process to a nearby joint, multiple bone damage, the formation of pemic foci, etc.). Without surgical treatment, intermuscular phlegmon can open itself with the subsequent formation of a fistula. In more unfavorable cases, it progresses and leads to secondary purulent arthritis, paraarticular phlegmon and sepsis.
The course of acute hematogenous osteomyelitis depends on the timeliness of the started treatment, in particular the use of antibiotics. This is indicated by medical practice, noting the recent increase in “subacute” forms and a significant reduction in the number of acute and septic cases.
The cause of the transition of acute osteomyelitis to chronic is the ongoing necrosis of the infected area of ​​the spongy or compact layer of the bone. The resulting sequestration is one of the main pathoanatomical substrates supporting reactive inflammation of the surrounding bone tissue. Weak development of regenerative processes, caused by a sharp violation of the nutrition of the bone and periosteum, contributes to the chronic course.
Clinical symptoms in patients suffering from chronic osteomyelitis with or without fistula are mostly insignificant and intensify only with an exacerbation of the inflammatory process. They occur when the body's resistance to infection of the nesting bone in the bone is weakened (trauma, cooling, general severe illness, etc.).
X-ray examination is valuable for determining the location and extent of the lesion, helps to establish the nature of the existing pathological changes. The first radiological symptoms begin to be detected from 10-14 days of illness.
In a number of unclear cases, the use of tomography is advisable. In chronic osteomyelitis, proceeding with the formation of fistulas, fistulography occupies an important place. It allows you to clarify the localization of the sequestration and identify when ordinary images are not clear enough. When fistulography, contrast agents are used (iodolipol, sergosine, diode, etc.). It is possible to determine the area of ​​bone lesion most accurately by the method of radioactive scanning using radioactive technetium, which is extremely important for solving the question of the volume of surgery.
High antibiotic efficacy significantly improved outcomes with conservative treatment and reduced the need for surgery. Treatment of hematogenous osteomyelitis consists of measures of general effect on the patient's body and local - on the focus of infection.
Immobilization, carried out from the very first days of the disease, helps to limit the process, reduces pain and improves the general well-being of the patient. The operation (it is rarely necessary to resort to it) is indicated in case of running processes with the development of phlegmon in cases where conservative treatment is unsuccessful, and to remove sequestration.