Osteomyelitis - symptoms, causes of development, methods of treatment
Osteomyelitis is an inflammatory process of the bone that is caused by pathogenic bacteria, in extremely rare cases - by fungi.As a result of the progression of inflammation in the bone, there is an increase in the volume of the bone marrow, the blood vessels in the bone marrow contract, which causes a significant reduction or complete cessation of the blood supply to the bone.In some cases, the inflammatory process goes beyond the bone, and in this case, purulent abscesses will form in the soft tissues.Table of contents: Classification of osteomyelitis Causes of osteomyelitis Symptoms of osteomyelitis
Classification of osteomyelitis
There are only two types of the disease under consideration based on etiological signs - nonspecific and specific.In the first case, the cause of osteomyelitis is pathogenic fungi and pyogenic bacteria, in the second - the disease develops against a background of infection by a certain microflora( for example, brucellosis or syphilis).
Infection can penetrate the bone in two ways:
- is hematogenous - the virus penetrates the blood stream from any inflammatory focus in the body( eg, angina, caries, infected wound of the skin, etc.);
- exogenous - the infection that has got into the body is the result of illiterate surgical intervention or after a serious injury.
Note: in the early stages of development of osteomyelitis, hematogenous and exogenous species occurs with different symptoms, but it is very difficult to distinguish these species very soon even for specialists - the clinical picture becomes the same for them.
Symptomatic of the disease under consideration is divided into the following forms:
- is a chronic;
Causes of osteomyelitis
Staphylococcus is the main causative agent of the disease in question, and most often it is the staphylococcus aureus.However, doctors say - osteomyelitis can develop and against the background of ingestion of E. coli, hemolytic streptococcus and / or Pseudomonas aeruginosa.
It is not necessary at all that if the above mentioned pathogenic pathogens get into the human body, the development of the disease in question will begin - for this several factors must "come together" simultaneously. Such factors are:
- allergic diseases;
- forced starvation or disturbed diet / diet;
- weakened immunity;
- infection of a latent nature;
- various injuries;
- long-term catarrhal diseases;
- violation of psycho-emotional state;
- frostbite and / or burn lesions of skin and soft tissues.
In addition, the risk factors include peptic ulcer, tuberculosis, diabetes, malignant neoplasms.
Please note: does not have reliable information about the reasons for the development of osteomyelitis, until now.There is a theory about the mechanism of development of the considered disease( allergic, vascular and neural-reflex), but this is only a theory that has no clear confirmation.
Symptoms of osteomyelitis
The most dangerous is osteomyelitis, which developed against the background of internal infection - the disease develops rapidly, within 2 days.It is noteworthy that in these two days there are no clearly expressed symptoms - the patient can only feel non-intensive pains in joints and muscle tissues, a general malaise.After 2 days, the body temperature suddenly rises to 40 degrees, there is a severe pain in the affected bone.Further, the disease under consideration develops rapidly - the pain in the affected bone increases with movement and forces the patient to immobilize, nausea and vomiting appear, the general condition deteriorates sharply.
The main problem of such asymptomatic osteomyelitis is a rapid transition from the localized focus of inflammation in the spilled( when affected and soft tissue), from acute to chronic.
If osteomyelitis develops against the background of intoxication, the following symptoms will appear:
- sudden drop in blood pressure;
- irregular heart pains appear;
- may develop a convulsive syndrome;
- the patient loses consciousness;
- skin becomes yellowish.
According to the clinical picture, doctors share two types of osteomyelitis - generalized and local. In the first case, the following symptoms will be fixed:
- temperature rise up to 40 degrees;
- there is a general intoxication;
- there are lesions of the neurological nature - convulsions, delirium, loss of consciousness;
- pain in the affected bone is intense, acquires a permanent character;
- the patient has a sticky sweat, there may be chills.
In the local course of the disease under consideration there will be the following symptoms:
- body temperature rises only to 38.5 degrees;
- , swelling and redness appear over the damaged area of the bone;
- pain, which has a permanent character( patients describe it as an "ache");
- appear abscesses;
- through the skin begins to stand out pus;
- traffic is extremely limited.
In general, the symptoms of osteomyelitis largely depend on which bone is affected by the inflammatory process - for example, if the pathology in the jawbones develops, the pain will be present not only in a specific place, but also "pour" into the eyebrow and into the orbit.
Please note: if the temperature suddenly increased, there were pains in the bones( localization does not matter), there is severe weakness, then immediately seek medical help.In some cases, the disease under consideration develops rapidly and if professional assistance is not provided, a fatal outcome is possible.
Symptoms of the chronic form of the disease in question will differ from the signs of acute course. Patients will complain of:
- permanent pain in the affected bone of a non-intensive nature;
- body temperature - it is always subfebrile( 37, 5 degrees maximum);
- fistulas are formed in the locations of the focus of inflammation;
- secretion through the orifices of fistula cords and fragments of dead tissue particles;
- lack of proper sleep.
Diagnosis of osteomyelitis
As a rule, an expert can suspect the considered disease only on the basis of patient complaints - they are too typical. But for confirmation it will be necessary to conduct a full body examination:
- X-ray examination;
- computed tomography;
- laboratory study of biomaterial.
A similar examination will help the doctor not only make sure that the preliminary diagnosis of osteomyelitis is correct, but will also determine the type of pathogen.
Methods of treatment of osteomyelitis
Treatment of osteomyelitis is a complex of measures that consist of medical treatment, surgical intervention and physiotherapy.
The main drug used to treat the disease in question is antibacterial.The choice of a specific antibiotic depends only on the results of the examination, from the detection of a particular pathogen of the disease - only the doctor can solve the problem.An antibacterial drug is injected directly into the focus of the inflammatory process, directly into the bone cavity.The course of treatment with an antibacterial drug is long - from 1 to 2 months, and in especially severe cases, treatment can be 3 and 4 months.
Features of medical treatment of osteomyelitis:
- it is necessary to ensure the immobility of the part of the body in which the bone is struck - for example, plaster the leg, arm or put on a corset, put the tires on the jaw;
- as the course of antibacterial drugs is too long, the patient needs to make infusions of special solutions - they will help the body cope with the aggressive effect of large doses of antibiotics;
- if the lesion is too heavy, then it is necessary to carry out ultraviolet irradiation of the blood;
- if sepsis is diagnosed, purification of blood from toxins is carried out;
- throughout the course of treatment the physician must monitor the electrolyte balance of the patient's body.
Operative treatment of osteomyelitis
Indications for the surgical treatment of osteomyelitis are:
- purulent inflammation of the periosteum;
- too frequent recurrences of the disease;
- formed fistula;
- the course of the disease in an atypical form;
- inflammatory process becomes purulent.
The essence of the surgery is to remove the purulent focus, but in general the operation process for osteomyelitis is as follows:
- Antiseptics treat the field of future surgical intervention.An
- Anesthesiologist assesses a patient's condition.
- The surgeon travels through the incision to the purulent focus.
- With the help of special tools, a bone patch opens right above the hearth.
Note: if diffuse purulent formations are observed, then they are first removed, and only then the surgeon works directly above the purulent focus on the bone tissue.
- Then small holes in bone in the form of a rectangle are drilled with a special tool - you will be able to remove the plate if you drill / saw the sides of the drilling points with a medical jig saw.Before the surgeon appears the bottom of the medullary canal - this is where the focus of osteomyelitis is concentrated.
- The channel is washed with antiseptics, then a drainage tube is inserted into it.
- The edges of the wound are sutured layer by layer.
In the postoperative period, the wound is rinsed through the drainage using antiseptic solutions and the contents of the wound are monitored.With positive dynamics, the wound is gradually sutured.
It's about exercise therapy - the exercises will be prescribed by a doctor, and the specialist will make a schedule of classes / trainings.You can begin physical therapy exercises only 20 days after the surgical intervention or when the patient's condition is stabilized with medical treatment.
Regularly conducted exercises under the supervision of a specialist will help restore muscle performance, ensure the supply of vitamins and minerals to bone tissue.
It is also necessary to correct the diet of a patient with a diagnosis of osteomyelitis - the menu should contain foods rich in iron, calcium, phosphorus, vitamins, magnesium.Do not get carried away during the treatment of the disease under consideration with fried and smoked foods, spices, coffee and chocolate - the body needs support, it is not worth overloading it.
Note: very often you can find prescriptions for the treatment of osteomyelitis folk remedies - healers promise to literally in a few days rid the disease.In fact, such an aggressive inflammatory process can not be stopped only by medicinal tinctures, decoctions and ointments based on plants, honey and other products.Only professional medical care will prevent the transition of the acute form of osteomyelitis into chronic, prevent the development of sepsis.
Osteomyelitis is a dangerous disease that can lead to disability of the patient, and in some cases, to death.Therefore, when the first signs of the pathology in question appear, you should immediately seek help from specialists - perhaps, osteomyelitis and will not be confirmed, but it is absolutely necessary to be reinsured.
Tsygankova Yana Aleksandrovna, medical reviewer, therapeutist of the highest qualification category.