Chronic osteomyelitis of the leg. Treatment of osteomyelitis: what awaits the patient

are called inflammatory lesion all bone structures and adjacent tissues. Usually such a pathological process is accompanied by osteolysis and osteonecrosis. The bone softens and gradually collapses due to infection, followed by a violation of the blood supply to it, which is called osteolysis. Due to the same violation of blood supply, osteonecrosis develops, that is, the death of bone cells.

Among the causes of osteomyelitis, several groups can be distinguished:

• traumatic - fractures, dislocations or other lesions in history that contributed to damage to blood vessels and impaired blood supply in a particular area of ​​\u200b\u200bthe bone;
• socio-economic - low level life is accompanied by the risk of addiction to bad habits, representatives of marginal miles are more at risk of facing bone injuries, inappropriate treatment, and subsequent infection of wounds;
• corticosteroid hormone therapy - these drugs can be used to treat the most various diseases and some studies point to the relationship of their long-term use and osteonecrosis;
• the presence of concomitant diseases, in particular blood diseases.

The reasons for the transition of an acute inflammatory process of the bone into a chronic form are:

• errors in treatment (prescribing antibiotics without determining sensitivity),
• early withdrawal of antibiotics,
• late osteoperforation,
• no comprehensive treatment
• poor drainage,
• depletion of the body with concomitant diseases,
• colds.

Clinical observations show that chronic foci of infection in the tonsils, carious teeth, urinary tract, genitals are factors that provoke hematogenous osteomyelitis, especially with injuries, hypothermia, overwork, exhaustion of the body and beriberi.

Distinguish hematogenous osteomyelitis, in which microbes enter the bone marrow with the blood flow from the inflammatory focus in the body, and traumatic osteomyelitis arising from open fractures, gunshot injuries, purulent lesions bones.

The causative agent of osteomyelitis is Staphylococcus aureus, less often - streptococcus, proteus, Pseudomonas aeruginosa, etc.

According to the clinical course, there are:

• acute osteomyelitis (usually of hematogenous origin),
• chronic osteomyelitis:
• primary chronic,
• secondary chronic - a consequence of acute hematogenous osteomyelitis, bone festering wound with open gunshot fractures due to defective primary processing wounds or errors in treatment; rarely develops against the background serious condition patient with significant depression immune system.

Acute hematogenous osteomyelitis occurs mainly in childhood and adolescence, that is, it is a disease of a growing organism. Microflora from an obvious focus of infection (umbilical sepsis, pyoderma, abrasions, wound, furuncle, carbuncle, phlegmon, erysipelas) or latent latent infection ( chronic tonsillitis, chronic inflammation urinary tract, carious teeth, etc.) is carried by the blood stream in long tubular bones. In the risk zone is the area of ​​the metaphyses, where there is a wide branched network of vessels and a slow blood flow, and the sinuses of the epiphyses. Studies have shown that there are no end vessels in the epiphyses and metaphyses, but there is a wide vascular network of anastomosis with diaphyseal vessels, so the embolic theory of the pathogenesis of hematogenous osteomyelitis has lost its solidity.

Studies by other scientists have shown that microbes from the sinuses, where they settle (especially in osteoporosis), penetrate into the perivascular spaces, where inflammation begins. There is edema, purulent infiltration around the vessels, fiber, the osteon canal system (haversian canals) of a certain area of ​​the bone. The filling process takes place in a closed space with strong walls, which leads to a rapid increase in intraosseous pressure, which blocks first the venous and then the arterial network with the development of ischemic necrosis and the progression of the purulent-necrotic process in the bone. Therefore, in osteomyelitis, osteonecrosis does not occur due to embolization vasculature, but due to extravascular occlusion through vascular compression inflammatory infiltrate in extravascular tissue. Intravascular processes are secondary.

Circulatory disorders in osteomyelitis are generalized. Pain indicates an increase in intraosseous pressure. With osteomyelitis, intraosseous pressure increases by 4-5 times compared to the norm. The pain disappears immediately after the application of decompression perforations in the bone. Experimental studies have shown that prolonged administration of a foreign protein leads to venous stasis, increased exudation, edema of the fiber, which in total becomes the cause of intraosseous hypertension and creates conditions for the sedimentation of microbes in the bone with the subsequent development of the inflammatory process - osteomyelitis.
Pathological changes in hematogenous osteomyelitis occur in the bone marrow, around the vessels in the channels of the osteon, thigh, in the bone tissue, adjacent soft tissues, joints. Most often, the focus of inflammation occurs in the metaphysis and begins with bone marrow edema, vascular compression, and slowing of blood flow. Compression of the veins leads to the expansion of the arterial network of capillaries, the release of blood elements into the perivascular space. There is degeneration and disintegration of bone marrow cells, intraosseous pressure increases, intraosseous circulation is disturbed, and osteoporosis increases.

Sometimes there are total necrosis of the bone. The periosteum thickens and exfoliates with pus that has penetrated from the medullary canal. Gradually, the periosteum is destroyed, and pus enters the adjacent soft tissues, necrosis, thrombus, arteritis with usuration occur in them. vascular wall bleeding develops. From the metaphysis inflammatory process penetrates into the epiphysis, and pus along lymphatic vessels, destroying the cartilage, penetrates into the joint cavity. There is purulent arthritis.

It is typical for hematogenous osteomyelitis that, simultaneously with inflammatory, necrotic, degenerative processes, active reparative processes occur: replacement of the focus of necrosis with a young connective tissue, newly formed vessels with the subsequent appearance of osteoblasts from the inner layers of the periosteum, bone marrow, which differentiate and form young bone tissue.

In a third of cases, an acute process turns into a subacute and chronic one with the formation of a focus of bone destruction and sequesters.

Clinical manifestations of osteomyelitis:

• seasonality is typical for the disease, namely the transition period from summer to autumn-winter and from winter to spring-summer, when weather instability, frequent colds, a decrease in the protective properties of the body, vitamin deficiency, increased sensitization are noted;
• predominantly children, young men, young people get sick;
• often the disease begins with a prodrome - the patient complains of weakness, children lose their liveliness, act up, appetite worsens, evening chills, pouring sweat occur;
• In the vast majority of cases, the onset of the disease is acute, reminiscent of an acute common infection- chills occur heat body, young children often have confusion, rapid pulse, low blood pressure;
• in the case of the toxic form, death may occur within the first days, as in septic shock;
• the patient's face is hyperemic, petechiae or a rash appear on the skin, breathing quickens and becomes superficial.

Hematogenous osteomyelitis can be isolated or multiple (involving several bones):

• the onset is acute, the body temperature reaches 39 ° C,
• there are no flushing sweats, and chills are not so intense and frequent,
• there are no manifestations of irritation of the central nervous system;
• in the affected bone there is a strong arching pain;
• the face turns pale, the lips are cyanotic, the tongue is coated, dry,
• are growing headache, general weakness, tachycardia, tachypnea, appetite disappears.

Clinically after remission acute manifestations osteomyelitis, the patient's condition almost normalizes, the symptoms of inflammation disappear. But over time, as a result of hypothermia, colds, injuries, malnutrition, inflammatory diseases genitourinary system at the site of the bone lesion, increasing pain, swelling, redness of the skin, soreness on palpation reappears, body temperature rises to 38 ° C, leukocytosis increases in the blood, ESR increases, fistulas often open with pus. Quite often small sequesters come out of purulent fistulas.

Traumatic osteomyelitis is a complication infected wound with open, gunshot fractures or postoperative complication.

Among the microflora that leads to traumatic osteomyelitis, Proteus, Staphylococcus aureus, Streptococcus and Pseudomonas aeruginosa are most often distinguished (about 54% of cases). IN clinical course allocate acute, subacute and chronic (purulent-necrotic) osteomyelitis, which may have the following phases:

• active with a fistula;
• exacerbation phase with pronounced signs local or general inflammation;
• phase of attenuation, stable remission (absence of fistulas and manifestations of purulent-inflammatory process).

In traumatic osteomyelitis, significant changes occur in the adjacent soft tissues around the focus of inflammation of the bone, namely, fistulas, ulcers with or without exposure of the bone, the presence of a soft tissue defect (purulent-necrotic wound), the bottom of which is a bone, and, finally, a trophic ulcer .

The clinical patterns of the state of wounds and open fractures indicate that after a correctly performed primary surgical treatment on the third day, the patient's condition improves - body temperature decreases, edema decreases, there are minor bleeding, leukocytosis also decreases, there is no tendency to increase in ESR. There is no throbbing pain in the area of ​​damage, gradually the pain subsides altogether. On the 10-12th day, the wound heals.

The acute stage of osteomyelitis lasts more than 2-3 months, then it becomes subacute. The general condition of the patient improves, body temperature decreases, chills and pain disappear, swelling of soft tissues decreases, and appetite appears. The wound is cleaned, filled with granulations, epithelialized along the periphery, and reduced in size. A fistula is formed with moderate purulent or serous-purulent discharge.

The radiograph shows the delimitation of the pathological focus, periosteal layers, formed sequesters. Spongy sequesters partially resolve. If within 4-6 months the process in the bone does not fade, osteomyelitis turns into chronic stage.

How to treat osteomyelitis?

Treatment of osteomyelitis should be taken as early as possible, preferably from the first hours of the disease - this will ensure the best consequences.

Having found hematogenous osteomyelitis, broad-spectrum antibiotics (eg, gentamicin, mefoxin, kanamycin) are immediately prescribed. Depending on the severity of the disease and the patient's condition, antibiotics are administered intra-arterially, intravenously, intramuscularly and intraosseously. When carrying out antibiotic therapy, the prevention of candidomycosis is mandatory.

Except antibiotic therapy in the first days after diagnosis, it is necessary to perform osteoperforation of the bone at the site of the lesion. Osteoperforation is done with a spectrodrill or a trihedral awl with the obligatory opening of the medullary canal. Osteoperforation ensures the outflow of pus, reduces intraosseous pressure, which in turn reduces disturbances vascular network bones and localizes the lesion. IN last years osteoperforation is performed laser beam. The technique is simpler, sparing, has a significant bactericidal and hemostatic ability.

Immobilization of the limb is mandatory. In addition, compresses are applied to the site of the inflamed bone with a 30-50% solution of dimexide, which is placed on the skin, lubricated with antibiotic ointment or hydrocortisone or heparin ointment.

Antibiotic therapy and osteoperforation are carried out against the background of an increase in the body's resistance. To do this, prescribe active immunization with vaccines, staphylococcal toxoid, hyperimmune staphylococcal gamma globulin, antistaphylococcal plasma. In the case of increasing anemia, blood is transfused from donors who were previously immunized with staphylococcal toxoid.

Widely used in the treatment of vitamin therapy and proteolytic enzymes. To reduce intoxication, low molecular weight dextrans, protein preparations, infusion therapy are prescribed, taking into account the need to normalize the water-electrolyte balance, acid-base state.

Thanks to the timely comprehensive pathogenetic treatment more than 92% of patients with hematogenous osteomyelitis recover.

Treatment of chronic osteomyelitis is exclusively surgical. Before the operation, fistulography must be done to identify fistulas and streaks that need to be cut out. After that, using chisels or cutters, the sequester box is opened, sequesters, pathological granulation tissue are removed. The branches of the sequestral box are refreshed, give it a scaphoid shape and tampon with preserved bone grafts. low temperatures with antibiotics. The wound is sutured with obligatory drainage.

When the entire perimeter of the bone is affected, the affected area is resected, a bone osteotomy is made proximal or distal to the resection site, a compression-distraction apparatus is applied, and the free graft is gradually pulled to the distal or proximal fragments. Arises callus filling the defect with new healthy bone tissue.

Despite advances in antibiotic therapy, solving the problem of treating chronic bone osteomyelitis remains one of the most difficult tasks. Treatment of patients with chronic osteomyelitis should be carried out in a complex manner, based on general condition sick, concomitant diseases, age, condition of soft tissues, nature of bone damage. In chronic osteomyelitis, the bone wound and the bone cavity always fester, their walls do not collapse, the inner surface of the walls is necrotic with inflammation. The cavity is always filled with various amounts of pus, pathological granulations, sequesters. The adjacent soft tissues are infiltrated, with one or more fistulas present.

Such a bone wound does not have the conditions for self-healing, but only contributes to the deterioration of the general condition of the patient, suppression of immunity. In addition, with frequent colds, hypothermia, relapses and exacerbations of the pathological process constantly occur. Given this, the main method of treatment is surgical. It consists in the total removal of pathologically affected bone and soft tissue tissues.

What diseases can be associated

Osteomyelitis may occur due to the following diseases and violations:

• decompression sickness,
• myeloproliferative diseases,
• arterial embolism and vasculitis,

Also at the heart of osteomyelitis is a traumatism factor. But not every damage to the integrity of the bone ends with osteomyelitis. For the development of the disease, two factors are necessary - severe infection of the wound and damage to the blood supply in the damaged area, which the listed diseases only contribute to.

Hematogenous osteomyelitis becomes a trigger for the occurrence of such severe complications, like sepsis, metastatic ulcers in the lungs, liver, pleura, kidneys. Complications of hematogenous osteomyelitis are also pathological fractures, dislocations as a result of the destruction of the articular ends.

Complications of chronic post-traumatic osteomyelitis:

• bone deformities,
• stiffness and ankylosis of the joints,
• pathological fractures,
• malignancy of the fistula walls.

Treatment of osteomyelitis at home

No less important for treatment of osteomyelitis has nursing care. It must be appropriate and permanent. Considerable attention is paid to nutrition, which should be high in calories and rich in vitamins. Special attention should be given to the care of young children and patients with clouding of consciousness.

Multivitamins, tonics and spa treatment are widely used.

What drugs to treat osteomyelitis?

For treatment of osteomyelitis Among other things, apply:

• broad spectrum antibiotics
• low molecular weight dextrans
• neocompensated;
• protein preparations
• native plasma,
• protein,
• aminopectides,
• hydrolysine;
• 30-50% dimexide solution;

Treatment of osteomyelitis with folk methods

The use of folk remedies in the treatment of such a serious disease as osteomyelitis is unacceptable, since it only takes precious time. Seek specialized and professional help in medical institutions necessary at the first manifestations of pathology. Most often, the patient is hospitalized.

Treatment of osteomyelitis during pregnancy

The development of osteomyelitis during pregnancy is not accompanied by a favorable prognosis. Bacteremia in the body of the expectant mother poses a threat both to her health and to the course of pregnancy. Treatment should be immediate, taking into account the period of pregnancy and medications allowed at this stage.

In any case, the doctor evaluates the potential risks and appropriateness of a particular medication, but saving the woman's life is a priority.

Which doctors to contact if you have osteomyelitis

After the start of treatment, acute general symptoms and the symptoms of intoxication are significantly reduced and come to the fore local symptoms, that is, pain in the limb, swelling at the site of the lesion of the bone. The patient spares the limb, protects it from movement and fixes it in a bent position, in which the antagonist muscles relax and the severity of pain decreases. In the area of ​​edema fever skin and even superficial palpation exacerbates pain.

Constant pain leads to sleep disturbance.

The intensity of joint pain increases with the accumulation of inflammatory fluid (synovitis) in the joint cavity. During the puncture of the joint, purulent synovial fluid is obtained.

X-ray control allows confirming the clinical diagnosis and revealing the nature of the osteomyelitic focus. But it should be remembered that in the case of an acute onset, radiological manifestations in the affected bone can be detected no earlier than 2-3 weeks from the onset of the disease, and their severity depends on the severity of the inflammatory process and the area of ​​bone damage.

At the onset of the disease, radiographs show a loss of spongy and cortical bone structures, followed by the formation of an osteoporosis focus with destruction, over which there is a thickening of the periosteum.

In addition to paraclinical diagnostic methods, a significant place is given to bone puncture, which has not only diagnostic, but also medicinal value, because perforation of the bone leads to a decrease in intraosseous pressure and a decrease in pain.
In traumatic osteomyelitis, X-ray examination should be carried out in the dynamics of the disease, since at first destructive changes V bone structure do not appear, but in the future they arise.

Treatment of osteomyelitis with folk remedies can complement traditional drug therapy. Healing herbs possess useful properties leading to the cleansing of the focus of inflammation from pus. Alternative treatment includes the use of other agents that have a pronounced antiseptic effect.

Why treatment should be approached with caution

Due to the ingress of pyogenic bacteria into the bloodstream, and from there into the bone, surrounding tissues (periosteum) and bone marrow, a purulent-necrotic process often develops. The course of the disease can be severe, with an increase in temperature to critical values ​​(toxic, septic-pyemic form). The patient's condition can be characterized as moderate or satisfactory ( local form And ).

In any case, bone tissues are involved in the process, which undergo necrotic changes. Thanks to the activity of leukocytes that fight infection, hard tissues decompose to form a large number of pus. Part of it comes out through the fistulas characteristic of chronic form osteomyelitis. The disease is accompanied by painful sensations in the affected limb, over time, its deformation may also appear.

A serious illness requires an equally serious treatment. Only a doctor can make a correct diagnosis. Any self-treatment may be meaningless and harmful to the health of the patient, so it is necessary to consult with specialists before taking any of the non-traditional medicines.

Traditional medicine has long used a number medicinal plants to reduce inflammation and necrosis. Also used are natural substances, like propolis or mummy, which have wound healing and antiseptic properties. Competently combining antibiotics and strength natural medicines, it is possible to achieve significant relief of the patient's condition and defeat a complex disease.

Plant Application

Medicinal herbs used for the treatment of osteomyelitis have an antiseptic effect. They serve to disinfect the focus of inflammation and can be used both locally (in the form of baths, compresses, poultices, etc.), and for oral administration. In the latter case, they act as medicinal substances from a number of salicylates or antibiotics, helping the body in the fight against microbes.

Plantain juice has just such properties. In winter, it is better to treat chronic osteomyelitis with a pharmacy preparation, and in the summer you can squeeze fresh juice from the leaves of the plant.

Plantain should not be collected on city streets or in small squares, it is better to find grass in the countryside or in the forest.

Fresh leaves must be crushed into gruel in such an amount as to squeeze 1 tbsp out of them. l. juice.

Plantain juice should only be prepared for immediate use. Take fresh juice 1 tbsp. l. 20-30 minutes before meals. Reception is repeated 3 times a day. The course of treatment with this remedy is limited only by its availability, since the herb does not have toxic properties.

Another good remedy that can be prepared for the winter is comfrey root. The plant can be independently collected outside the city, in wet places (near streams or ponds, in ravines and bushes). Comfrey officinalis is easy to grow and suburban area as a large and rather beautiful design element.

Comfrey root should be prepared in the fall, cutting it into pieces and drying the medicinal raw material in the shade. The following medicines are made from the root:

1. A decoction in milk is taken orally 1 tsp 3 times a day before meals. To prepare a decoction, pour dried root powder (1 tsp) with boiling milk (1 l) and simmer the potion in the oven for 4 hours at a temperature of +100ºС.
2. Alcohol tincture is prepared from 100 g of dry root powder and 500 ml of vodka. The remedy must be insisted in the dark for 2 weeks, and then consumed 50 drops each (20 drops for children), diluted in 1 tbsp. l. water. Reception to produce 3 times a day before meals.
3. For external use, an ointment with comfrey root is also prepared. To do this, take 1 weight part of dry root powder, 0.5 parts pine resin(resin), 3.5 parts melted internal fat pigs or birds (goose, ducks), badger fat. The components must be combined and kept for 2.5 hours in a water bath, constantly stirring. The ointment is applied to the sore spot 2 times a day, applying the mass to the bandage and fixing it on the body.

For getting quick effect in the treatment of advanced disease, oral administration is recommended in combination with external use of the ointment. The tumor is quickly opened, pus begins to flow from the wound, after which it is cleared. In combination with medications it is often possible to achieve a stable remission of the disease.

Great celandine is constantly used by healers to treat purulent wounds. The herb has antiseptic properties and successfully fights many microorganisms (Staphylococcus aureus, mycobacteria, etc.), which can cause purulent inflammation of tissues. Prepared from celandine healing infusion, pouring 2 tbsp. l. dry herbs 1 cup boiling water and steeping the mixture for 30 minutes. Compresses are made from the infusion by applying a moistened cloth to the affected area.

Fistulas formed in chronic osteomyelitis are treated fresh juice celandine, digging it into the hole. 10 minutes after treatment, a bandage soaked in juice is applied to the fistula. The course of treatment is 1.5–2 months, depending on the result.

Home Therapies

There are other ways to treat osteomyelitis at home with natural or artificial substances.

1. Among them is Vishnevsky's ointment, known to many, which draws out pus, accelerating the ripening of abscesses, and such an unusual remedy as tar soap.
2. Natural substances that are used to heal patients have antiseptic and tissue regeneration properties. These can be attributed badger fat and mummy.
3. For external use and can be included in the ointment with comfrey root, enhancing the effectiveness of the product.
4. Shilajit with osteomyelitis is used in small doses. For oral administration, a solution is prepared from the mummy powder (2–7 g per 1 tbsp. clean water), which take 1 tbsp. l. in the morning before meals. The course of treatment is usually about 15 days, after which there is a noticeable relief. Mumiyo solution can also be used for antiseptic dressings.

Healing properties of salt

Dressings with hypertonic (saturated) solution table salt for the treatment of purulent wounds, the famous Russian surgeon N.I. Pirogov. For treatment, he used napkins soaked in saline, covered the wound and the skin around it with a cloth. Thanks to the antimicrobial action of salt, the wound healed quickly.

Healing properties of cooking and sea ​​salt can also be used in the treatment of osteomyelitis. Salt dressings and baths will clean fistula cavities well from pus, but they are ineffective when the focus of inflammation is closed. For a bath or dressing, you need to dissolve about 150 g of table or sea salt in 1 liter of water.

For dressings, the old Pirogov method is used, soaking gauze or fabric with this solution and applying it to the inflamed areas. The fabric should be fixed with a bandage and changed as needed.

The bath salt solution is prepared in the amount necessary to immerse the diseased limb in it. While taking a salt bath, the fistula area is massaged, helping the solution to penetrate into its cavity. The procedure can be carried out daily for 30 days.

To enhance the effect salt dressings and baths, healers use decoctions for solution medicinal herbs with antiseptic properties (comfrey, yarrow, celandine, succession, etc.).

How to apply Vishnevsky ointment and soap?

Ointment Vishnevsky includes:

• Birch tar;
• xeroform;
• Castor oil.

These components have an antimicrobial effect, and castor oil also promotes tissue regeneration. The ointment is a pharmaceutical preparation, it is produced in tubes and glass jars.

You can try to cure osteomyelitis of the bone with Vishnevsky's ointment. To do this, the mass is applied to the bandage and cover the area of ​​​​inflammation with it. When treating fistulas, tampons with ointment are placed in the cavity and bandaged. Dressings and tampons should be changed 2-3 times a day. The total duration of the course of treatment is 1-3 weeks.

Tar soap contains the same birch tar, which is one of active ingredients Vishnevsky ointment. folk recipe with its use, it also includes onions, which have strong bactericidal properties. To prepare an ointment with tar soap, you need a small piece of it (about 50 g). Grate soap and mix with fresh onion gruel (100 g). Spread the composition on the fabric and apply to the focus of inflammation or fistula, changing the dressings 2-3 times a day.

Believers can pray to God or read a conspiracy from a carnivore (this is what healers call osteomyelitis). Among the folk ways to get rid of this painful disease, methods such as homeopathy are quite appropriate.

Modern medicine has accumulated extensive experience in the treatment of purulent inflammation with antibiotics. Most often, people are afraid of the possibility of surgical intervention. In difficult cases, it is difficult to do without it, but folk methods are not able to replace adequate treatment and can only be used as adjuvants.

What is osteomyelitis?

Osteomyelitis is an infectious disease accompanied by inflammation of the bone and the bone marrow contained in it, manifested by fever, intoxication syndrome and pain.

Causes of osteomyelitis

Currently, the causes of osteomyelitis are well understood. The disease can be caused by various bacterial pathogens, but more often it occurs through the fault of Staphylococcus aureus and epidermal (these microbes are the cause of osteomyelitis in 70-80% of cases), streptococci, gram-negative enterobacteria and Pseudomonas aeruginosa, less often - Haemophilus influenzae and Mycobacterium tuberculosis.

Osteomyelitis can develop when the infection directly enters the bone as a result of its open fracture or as a result of extensive infected damage to the soft tissues above the bone. The disease can also be caused by ongoing operations on bone tissue (osteosynthesis). Also, osteomyelitis can occur when pathogens enter the bone from chronic foci of infection of the body (chronic tonsillitis, caries, umbilical wound in newborns, etc.). In these cases, microbes enter the bone through the blood. Osteomyelitis, developed in this way, is the most common. The most commonly affected bones in osteomyelitis are the tubular bones of the lower and upper limbs, upper jaw, ribs and vertebrae and skull bones.

As soon as the bacteria enter the bone, leukocytes and other blood cells migrating to the site of the lesion secrete a number of enzymes, leading to its gradual destruction. Infection in osteomyelitis often spreads further and can spread to the surrounding soft tissues, causing their purulent inflammation and, in some cases, ending in the formation of external fistulas. Gradually, osteomyelitis leads to necrosis and rejection (sequestration) of bone areas. In some cases, the process may become chronic.

Signs and symptoms of osteomyelitis

The first sign of developing osteomyelitis may be fever up to 39-40 ° C and symptoms of general intoxication (general weakness and fatigue, chills, headaches and muscle pain, sweating, etc.). Within a few days there is pain in the bone. With osteomyelitis, this pain may be aching at first, then it intensifies, becomes bursting, boring. Also characteristic is an increase in the intensity of pain during movements, as well as palpation of the affected area. Quite quickly, with osteomyelitis, local changes in the proper soft tissues develop, manifested in edema, redness and tension of the skin and an increase in local temperature. Osteocutaneous fistulas are often formed, from which purulent contents are released. In case of untimely treatment of osteomyelitis, as well as when the process becomes chronic, pathological fractures of the affected bone and its deformation occur, and non-healing fistulas persist for a long time.

Complications of osteomyelitis include sepsis, ankylosis and joint contractures, bone deformity and fractures, secondary purulent arthritis and soft tissue phlegmon, fistula formation and malignancy, pleurisy, amyloidosis, etc. Often osteomyelitis, despite ongoing adequate therapy, is synchronized.

Diagnosis of osteomyelitis

The clinical diagnosis of osteomyelitis in most cases does not present significant difficulties. The auxiliary diagnostic methods used are necessary, first of all, to assess the severity of the lesion, as well as the involvement of associated tissues.

main method instrumental examination patients with osteomyelitis is x-ray. However, clearly visible signs lesions on the bone radiograph appear rather late - only at the end of the first - beginning of the second week of the disease. More sensitive method diagnosis of osteomyelitis is computed tomography. In the presence of fistulas, fistulography is performed (introduction of contrast into the fistula, followed by x-ray examination). This method helps to assess the involvement of soft tissues in osteomyelitis. In order to obtain material for microbiological research a puncture of the affected bone can be performed.

With osteomyelitis, the presence of inflammatory changes is noted in the general blood test. To clarify the cause of the disease, bacteriological cultures of the contents of the bone canal of the affected bone and purulent discharge from the drains or fistula are widely used. Differential Diagnosis osteomyelitis is performed with bone tumors, eosinophilic granuloma and fibrous dysplasia, soft tissue sarcomas and bone lesions in syphilis.

Treatment and prevention of osteomyelitis

Treatment of osteomyelitis is long-term and is carried out by surgical doctors (purulent surgeons, traumatologists). As a rule, at first, a patient with diagnosed osteomyelitis is hospitalized, after discharge from the hospital, treatment continues on an outpatient basis. As soon as possible, all patients are prescribed antibiotic therapy. For this purpose, in osteomyelitis, III-IV generation cephalosporins (ceftriaxone, cefotaxime and cefepime), inhibitor-protected beta-lactams, clindamycin, fluoroquinolones (levofloxacin and moxifloxacin), aminoglycosides (gentamicin and amikacin) and some other drugs are usually used. All antibiotics at the onset of the disease are administered intravenously or intramuscularly, later it is possible to switch to their oral administration. The duration of antibiotic therapy for osteomyelitis averages 4-6 weeks. Performed according to indications surgical interventions, consisting in the treatment of wounds, the removal of necrotic tissues and the drainage of the affected bone.

In the treatment of patients with osteomyelitis in case of fever and symptoms of general intoxication, detoxification therapy (glucose-salt solution infusions) is widely used, and anti-inflammatory drugs (ibuprofen, nimesulide) are also prescribed. During the recovery period, patients are prescribed physiotherapeutic treatment, as well as therapeutic physical culture. It should be noted that the determination of treatment tactics and the use of drugs for osteomyelitis is carried out only upon prior consultation with a doctor.

Prevention of osteomyelitis consists in the timely rehabilitation of foci chronic infection, as well as in the proper treatment of skin injuries, soft tissues and fractures by specialists.

Osteomyelitis- a purulent inflammatory process that affects the bone, periosteum and bone marrow.
The cause of the disease can be an infection, bacteria or fungi.

Osteomyelitis:

In the past few years, there have been more people affected by osteomyelitis, this is associated with technogenic factors, especially the increased number of traffic accidents.

About the treatment of osteomyelitis is described in the video below.

Summary of the video:
Osteomyelitis is a nonspecific purulent-inflammatory or purulent-necrotic lesion of bone tissue, bone marrow, periosteum and surrounding soft tissues.
There are several types of osteomyelitis: acute hematogenous osteomyelitis, which occur mainly in children and adolescents, osteomyelitis on the background obliterating diseases vessels lower extremities and diabetes.

In the main group of patients, osteomyelitis is an inflammatory process that developed after open fractures, in surgery on bones, arthroplasty of large joints.
The most severe for the patient is osteomyelitis caused by injuries, the so-called post-traumatic osteomyelitis, it accounts for more than 50% of cases.

With this form of the disease, the inflammatory process usually occurs in the long bones of the lower extremities: the tibia and femur. With osteomyelitis, a person is worried about intense pain, pus oozes from the fracture site, trophic ulcers and swelling appear around the wound.

Osteomyelitis is acute and chronic acute.
Osteomyelitis usually occurs in open fractures when there are unfavorable conditions for the normal healing process. For example, if the wound has foreign bodies or broken bones.

If no measures are taken in 30-40 days, then the disease passes into a chronic stage, in more severe cases inflammation of the bone marrow occurs, therefore it is so important to consult a doctor immediately after a fracture or injury, who will select proper treatment. Most often it is antibiotic therapy and surgical treatment.

See the video for more details:

Symptoms:

• general malaise,
• discomfort in muscles and joints,
• then the temperature rises to 40 degrees,
• arises strong pain in the area of ​​bone loss.

osteomyelitis- the disease is quite serious, so you should not try to treat it yourself at home. First of all, you should consult a doctor so that he can make a correct diagnosis and prescribe drug treatment. See the video below for doctor's advice. Folk remedies can serve as an addition to the main course.

How to treat osteomyelitis of the bone with Vishnevsky ointment. Review.
The girl fell and badly hurt her ankle. Soon the leg was swollen, there was pain. Went to the doctor and was admitted to the hospital. Doctors tried to treat osteomyelitis of the leg, periodically placed the child in the hospital, but nothing worked - the bone rotted. We decided to do an operation: clean the bone and introduce some kind of filler. The mother of the child did not agree and took the girl home. Began to treat bone osteomyelitis at home - at night they made a foot bath from warm urine, then wiped the foot and put a compress with Vishnevsky ointment. Wash your feet in the morning. And so 10 days. The swelling subsided. The doctors continued to insist on the operation, again put the child in the hospital, took an x-ray and the operation was canceled, because cartilage had grown in place of the rotten bone. To avoid relapses, it was advised to use birch bark: the most thin layer bark from young birch trees: the birch bark was bandaged to the leg for 7 days, then changed, this went on for a year, the leg never got sick again. (Source: newspaper "Bulletin of Healthy Lifestyle" 2006, No. 22, p. 9)

In this article, we have collected the most effective and popular folk remedies for the treatment of osteomyelitis.

• Treatment of osteomyelitis of the leg with birch leaves.
  The teenager had a severe cold in his leg, inflammation began, then the leg began to abscess, and he had to go to the doctors. In the hospital, the abscess was opened, but a new abscess began to brew. An operation was proposed to which the patient did not agree. He was discharged home in poor condition. In the spring, when everything began to turn green, one woman offered him folk remedy from osteomyelitis of the leg: collect birch leaves in a bag, put the bag on the leg and tie it with a rope. In the morning, the bag was removed from the leg - all the pus remained on the leaves, the leg was as if steamed and mobility was restored in it. Four such procedures were performed, and soon the patient began to step on his foot and slowly walk. After some time, the disease completely disappeared. (Source: newspaper "Bulletin of Healthy Lifestyle" 2011, No. 14, p. 30)

  

• Mumiye will help if the bone rots.
  The man had an accident and received an open fracture of the lower leg. Osteomyelitis started. They cleaned his bone and injected him, but there were no results - the process of decay was ahead of the healing process. The temperature constantly kept around 37.2 - 37.7.
  All his friends tried to help him and looked for folk remedies for the treatment of osteomyelitis. Applied recipe Tibetan medicine. Per glass boiled water take 2 g of pure mummy, dilute until completely dissolved, you get brown cloudy liquid. Drink on an empty stomach 1 tbsp. l. The man had enough 1 glass, i.e. 12 days of treatment. Two days later, the temperature dropped to 36.6. The healing process went at a fast pace.
  If osteomyelitis is hip bone, then it is necessary to dissolve in a glass of water not 2 g, but 7 g of mummy (Source: newspaper "Bulletin of healthy lifestyle" 2010, No. 3, pp. 32-33)

  

• Feedback on the treatment of osteomyelitis at home
  At the age of 9, a child developed a tumor on the forearm, the temperature rose above 40 degrees. The child was admitted to the hospital, where he was diagnosed with osteomyelitis of the bone. The bone was cleaned, the wound did not heal for a long time, the doctors could not do anything, they discharged him home. Parents were advised such a folk remedy for osteomyelitis: take 60 grams of propolis, divide into pieces the size of a bean, Before breakfast and dinner, heat 1 piece in 1 tbsp. l. butter, stirring, so that the propolis becomes soft. Eat this portion warm 40 minutes before meals.
  At the same time, the following mixture was prepared: 500 ml of aloe juice, 500 ml of vodka, 1 liter of honey, 200 g of fresh interior pork fat- put all this in a pot, cover the cracks with dough. Put in the oven for 4 hours to languish. Apply this remedy to the wound, soaking a gauze swab. The same remedy is taken orally - 1 tbsp. l. 3 times a day. Within a week of such treatment, the wound healed.
  The same folk remedy helped to cure a man with a wound in the lung, who returned from the Second World War. The wound constantly opened, festered, often blood flowed from the throat. He was bedridden for 12 years until he learned this recipe. Often drank this composition, as a result, he lived up to 80 years. (Source: newspaper "Bulletin of Healthy Lifestyle" 2010, No. 12, p. 33)
• How to treat osteomyelitis at home with plantain juice. Review.
  The man had osteomyelitis of the ribs. He was operated on 6 times, scraped, cleaned. As a result, half a rib was removed and cartilage tissue. The wound in the side did not heal, it constantly oozed from it. The man's wife decided that since psyllium was the treatment for external wounds, psyllium could also be used to treat osteomyelitis of the bone. We bought 5 bottles of 200 g of plantain juice at the pharmacy, the man took them 1 tbsp. l. three times a day before meals. At the same time, he took mummy for treatment - 5 g per half liter warm water, take 1 tbsp. l. only in the morning on an empty stomach. A bandage moistened with alcohol was placed on the wound. The wound healed, there were no more relapses. (Source: newspaper "Bulletin of Healthy Lifestyle" 2008, No. 23, p. 25)

  

• Treatment of osteomyelitis with horseradish is a popular folk remedy.
  With osteomyelitis, with small fistulas, horseradish can be used. Grate it, attach to the fistula. It will burn strongly, keep no more than 30 minutes, otherwise there will be a burn. (Source: newspaper "Vestnik ZOZH" 2008, No. 3, p. 33)

  

• A decoction of nettle and currant.
  After the war, a 2.5-year-old child fell ill with osteomyelitis. The doctor said that the child can only go out at home and gave a prescription: take currant branches and nettles in equal amounts, fill the bucket 1/3, add 500 g of salt, pour water so that the branches are covered, simmer in the oven for 8 hours. Pour this decoction into a bath and hold the diseased limb there, massaging the places where fistulas form. The child had 3 fistulas, for a month they performed this procedure every day, the disease disappeared. (

Osteomyelitis is an inflammation of the bone marrow, in which all elements of the bone (periosteum, spongy and compact substance) are affected. According to statistics, osteomyelitis after injuries and operations is 6.5% of all diseases of the musculoskeletal system. Depending on the etiology of osteomyelitis, it is divided into nonspecific and specific (tuberculous, syphilitic, brucellosis, etc.); post-traumatic, hematogenous, postoperative, contact. Clinical picture depends on the type of osteomyelitis and its form (acute or chronic). The basis of the treatment of acute osteomyelitis is the opening and sanitation of all abscesses, in chronic osteomyelitis - the removal of cavities, fistulas and sequesters.

Symptoms of osteomyelitis

The most dangerous osteomyelitis, the cause of which is an internal infection. The disease develops in just 2 days. During these days, the symptoms of the disease are hardly noticeable. Perhaps a general malaise, muscle pain, discomfort in the joints, a person does not even suspect that he is developing osteomyelitis. Then the body temperature rises to forty degrees. There is severe pain in the area of ​​the affected bone. When moving, the pain intensifies, the movement becomes limited. The disease further develops rapidly. Very often this whole process is accompanied by sharp deterioration, nausea and urge to vomit.

The main danger of asymptomatic osteomyelitis is the lack of treatment and the possible transition of the disease from local form to generalized, from acute to chronic. Therefore, any unusual sensations, increase in body temperature without other accompanying symptoms require diagnosis and investigation.

With osteomyelitis with a toxic form of the disease, pressure drops, pain in the heart is felt, convulsions and loss of consciousness are possible. The face becomes pale, the eyes sink, the skin turns yellow, the lips turn blue. When a traumatic form of osteomyelitis appears, it is very important to immediately consult a doctor, otherwise the person may die.

Traumatic osteomyelitis is characterized by acute symptoms. Both high temperature and severe pain in the area of ​​injury are possible, after which all these symptoms are replaced by chronic ones. A person feels more or less normal, various purulent discharges are excreted through the fistulous passages that occur in the wound area and are the first cause of traumatic osteomyelitis. A severe form of osteomyelitis can result in blood poisoning.

According to clinical manifestations, osteomyelitis is divided into two types: local and generalized.

The following symptoms are characteristic of the local course of the disease:

• Increase in body temperature up to 38.5 degrees.
• The formation of swelling, elevations in the damaged area.
• Aches, pain that is bursting in nature.
• The skin on the problem area heats up and turns red.
• The appearance of abscesses.
• Discharge of pus through the skin.
• Pain and limited movement.

The generalized form is manifested by several other signs:

• the temperature rises to 39–40 degrees;
• the pain intensifies, becomes permanent;
• general intoxication increases (general poor health);
• chills appear, sticky sweat, hoarse shortness of breath;
• neurological lesions (convulsions, delirium, loss of consciousness);
• kidney disorders (painful and frequent urination);

Causes of osteomyelitis

The main cause of the development of this disease are bacterial pathogens:

• Staphylococcus aureus,
• epidermal staphylococcus,
• streptococci,
• gram-negative enterobacteria,
• Pseudomonas aeruginosa,
• haemophilus influenzae,
• Mycobacterium tuberculosis (Koch's wand).

Pathogenic microorganisms can enter the body and cause the development of osteomyelitis in several ways:

• exogenous - with direct contact of the pathogen into the bone during trauma, injury, open fracture, purulent inflammation of nearby tissues or during surgery;
• endogenous (hematogenous) - with blood flow in the presence of a focus of chronic infection in the body (tonsillitis, caries).

Depending on the mechanism of occurrence of osteomyelitis, there are:

• hematogenous,
• gunshot,
• postoperative,
• post-traumatic,
• contact.

In most cases, the cause of osteomyelitis is Staphylococcus aureus, which is often the cause of tonsillitis, caries or omphalitis in newborns.

Most often, the causative agent of osteomyelitis damages:

• tubular bones of the upper and lower extremities,
• bones of the upper jaw
• skull bones,
• ribs and spine.

Factors contributing to the development of osteomyelitis:

• bone fractures,
• joint transplant,
• kidney and liver failure,
• diseases that cause weakness defensive forces body (diabetes mellitus, AIDS, chemotherapy, organ transplant),
• avitaminosis,
• frequent temperature changes
• addiction,
• diseases peripheral vessels and nerves.

When bone is damaged pathogenic microorganisms, leukocytes migrate to the inflamed places, which secrete lytic enzymes that decompose the bone. Pus spreading through blood vessels, contributes to the rejection of necrotic bone tissue, thereby creating favorable conditions for the growth and reproduction of pathological microflora. There is an acute purulent inflammation, which can go into the phase of chronic inflammation.

Gunshot, post-traumatic and postoperative inflammation is a consequence of infection of the bone wound. In this case, the inflammatory process develops in the place of crushed bone fragments, and not in the closed medullary canal. Bone marrow becomes infected from infected nearby tissues. The fragments die off and become the cause of suppuration and the formation of purulent cavities and fistulas. These pathological processes prevent the formation of normal callus.

Treatment of osteomyelitis that has arisen after fractures, as well as metal osteosynthesis operations, is carried out by traumatologists. In other cases (hematogenous osteomyelitis, contact osteomyelitis), you should seek the help of a surgeon at an on-duty surgical hospital or a polyclinic surgeon. Often, in the case of hematogenous osteomyelitis, patients end up in non-core departments, in particular, in infectious or therapeutic department. However, after the onset of symptoms of bone damage, they are transferred to the surgical department.

Testing for suspected osteomyelitis

To diagnose osteomyelitis, you will need to undergo next survey. Pass general analysis blood and urine, a blood test for glucose levels (in order to detect diabetes mellitus). If possible, you need to donate blood for C-reactive protein, which is a sensitive indicator of the presence of inflammation. In the presence of an open purulent wound or a fistulous tract, the purulent discharge from them is cultured in order to determine the pathogen and its sensitivity to antibiotics.

To visually confirm the presence of osteomyelitis, an x-ray of the affected area of ​​the body is performed. However, it should be remembered that the radiological picture of the disease is 2 weeks behind the clinical picture, therefore, in the case of acute osteomyelitis, there may not be obvious changes at the onset of the disease.

A more sensitive diagnostic method is computed tomography, which allows a more detailed examination of bone tissue defects. The possibilities of computed tomography exceed magnetic resonance imaging. The latter allows to differentiate soft tissue diseases from the affected bone, to determine the extent of non-viable tissues. Therefore, when choosing between computed tomography and magnetic resonance imaging, the latter should be preferred.

It is possible to perform an ultrasound examination. It allows you to identify the accumulation of pus in soft tissues, the presence and length of fistulous passages, changes in the periosteum, and also to assess the blood supply to the limb. Most modern way diagnostics of osteomyelitis – radionuclide diagnostics. The method is based on the use of radioactive pharmaceuticals that specifically accumulate in the focus of inflammation, which allows for early stage determine the presence of bone destruction. Unfortunately, this is an expensive study that requires high-tech equipment and a special room, so it is only available in large medical centers.

Treatment of osteomyelitis

The treatment of osteomyelitis is complex, it is possible only in a hospital in a trauma or surgical departments, includes conservative and surgical measures.

Conservative treatments include:

• antibacterial therapy with broad-spectrum antibiotics - usually 2-3 drugs are prescribed (Ceftriaxone, Lincomycin, Gentamicin) for a long time (3-4 weeks), replacing them with drugs from other groups (for example, Ciprofloxacin, Abaktal, etc.);
• detoxification therapy (intravenous administration of saline solutions and plasmapheresis, ultraviolet and laser irradiation blood - purification of blood plasma from toxins);
• immunotropic therapy - the use of pharmaceuticals that increase the activity of the immune system (polyoxidonium);
• the appointment of probiotics - drugs that normalize the intestinal microflora. Due to massive antibiotic therapy, dysbacteriosis develops. For its correction, Linex, Bifiform are prescribed;
• the appointment of drugs that improve blood microcirculation (Pentoxifylline, Trental);
• local wound treatment - dressings with antiseptic ointments (Levomekol, Levosin, 5% dioxidine ointment) and proteolytic enzymes (Trypsin, Chymotrypsin), which help cleanse and heal the wound.

Surgical treatment of osteomyelitis consists in sanitizing the purulent focus (opening and draining purulent cavities), removing sequesters - areas of non-viable bone tissue and performing restorative operations. The latter is necessary due to the formation of defects in the skin and bone tissue. Restorative operations include closure of defects with local tissues, bone filling various drugs and performing osteosynthesis (for example, with the Ilizarov apparatus).

There are no dietary restrictions after surgery. Necessary good nutrition, rich in vitamins and proteins. Volume physical activity should be discussed with the attending physician individually. It is advisable to stop drinking alcohol, smoking - they slow down the wound healing process. In the presence of diabetes, blood sugar levels should be monitored; if it rises, a relapse of the disease is possible. IN postoperative period and after discharge from the hospital physiotherapy and physiotherapy treatment (electrophoresis, phonophoresis, magnetotherapy).

Possible Complications of Osteomyelitis

Complications of osteomyelitis can be local and general.

TO local complications relate:

• abscess and phlegmon of soft tissues - accumulation of pus and purulent impregnation of soft tissues surrounding the affected bone;
• purulent arthritis - purulent inflammation of the joint located next to the osteomyelitis focus;
• spontaneous fractures - occur at the slightest load due to loss of bone tissue strength;
• contractures - a violation of mobility due to the formation of scars in the muscles surrounding the purulent focus;
• ankylosis - loss of mobility in joints affected by purulent arthritis;
• development of malignant tumors.

Common complications include:

• sepsis - blood poisoning;
• secondary anemia - anemia, develops due to inhibition of hematopoiesis against the background of chronic inflammation;
• amyloidosis - autoimmune disease, which primarily affects the kidneys, is difficult to treat.

Prevention of complications of osteomyelitis

talk about effective treatment osteomyelitis is possible only if a relapse has been avoided within 2-3 years after the first detection of the disease. But, as one of the main commandments of medicine says: "It is easier to prevent a disease than to treat it later." To prevent osteomyelitis, you must:

• lead a healthy and active lifestyle,
• provide good sleep and rest
• avoid stress,
• eat balanced,
• strengthen the immune system,
• treat foci of infection in time (caries, sinusitis),
• in case of injuries or injuries, it is necessary to seek medical help in a timely manner,
• with an increase in body temperature and the appearance of other symptoms, you need to go to the hospital so that, by self-medicating, you do not cripple the rest of your life.

Osteomyelitis is a serious infectious disease that requires efforts not only from the attending physician, but also from the patient himself. As he says folk wisdom: "The salvation of the drowning is the work of the drowning themselves." To defeat this serious illness insufficient adequate treatment and efforts on the part of the medical staff. A full and healthy life directly depends on the patient's morale and faith in his own recovery.