Как правильно пишется остеомиелит

Остеомиелит

Остеомиелит — лечение в Москве

From Wikipedia, the free encyclopedia

Osteomyelitis
Other names	Bone infection
Osteomyelitis of the 1st toe
Specialty	Infectious disease, orthopedics
Symptoms	Pain in a specific bone, overlying redness, fever, weakness[1]
Complications	Amputation[2]
Usual onset	Young or old[1]
Duration	Short or long term[2]
Causes	Bacterial, fungal[2]
Risk factors	Diabetes, intravenous drug use, prior removal of the spleen, trauma to the area[1]
Diagnostic method	Blood tests, medical imaging, bone biopsy[2]
Differential diagnosis	Charcot’s joint, rheumatoid arthritis, infectious arthritis, giant cell tumor, cellulitis[1][3]
Treatment	Antimicrobials, surgery[4]
Prognosis	Low risk of death with treatment[5]
Frequency	2.4 per 100,000 per year[6]

Osteomyelitis (OM) is an infection of bone.^[1] Symptoms may include pain in a specific bone with overlying redness, fever, and weakness.^[1] The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus,^[7] while the feet, spine, and hips are most commonly involved in adults.^[2]

The cause is usually a bacterial infection,^[1][7][2] but rarely can be a fungal infection.^[8] It may occur by spread from the blood or from surrounding tissue.^[4] Risks for developing osteomyelitis include diabetes, intravenous drug use, prior removal of the spleen, and trauma to the area.^[1] Diagnosis is typically suspected based on symptoms and basic laboratory tests as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).This is because plain radiographs are unremarkable in the first few days following acute infection.^[7][2] Diagnosis is further confirmed by blood tests, medical imaging, or bone biopsy.^[2]

Treatment of bacterial osteomyelitis often involves both antimicrobials and surgery.^[7][4] In people with poor blood flow, amputation may be required.^[2] Treatment of the relatively rare fungal osteomyelitis as mycetoma infections entails the use of antifungal medications.^[9] In contrast to bacterial osteomyelitis, amputation or large bony resections is more common in neglected fungal osteomyelitis, namely mycetoma, where infections of the foot account for the majority of cases.^[8][9] Treatment outcomes of bacterial osteomyelitis are generally good when the condition has only been present a short time.^[7][2] About 2.4 per 100,000 people are affected each year.^[6] The young and old are more commonly affected.^[7][1] Males are more commonly affected than females.^[3] The condition was described at least as early as the 300s BC by Hippocrates.^[4] Prior to the availability of antibiotics, the risk of death was significant.^[10]

Signs and symptoms[edit]

Symptoms may include pain in a specific bone with overlying redness, fever, and weakness and inability to walk especially in children with acute bacterial osteomyelitis.^[7][1] Onset may be sudden or gradual.^[1] Enlarged lymph nodes may be present.^[11]
In fungal osteomyelitis, there is usually a history of walking bare-footed, especially in rural and farming areas. Contrary to the mode of infection in bacterial osteomyelitis, which is primarily blood-borne, fungal osteomyelitis starts as a skin infection, then invades deeper tissues until it reaches bone.^[8]

Cause[edit]

In children, the metaphyses, the ends of long bones, are usually affected. In adults, the vertebrae and the pelvis are most commonly affected.^[7]

Acute osteomyelitis almost invariably occurs in children who are otherwise healthy, because of rich blood supply to the growing bones. When adults are affected, it may be because of compromised host resistance due to debilitation, intravenous drug abuse, infectious root-canaled teeth, or other disease or drugs (e.g., immunosuppressive therapy).^[7]

Osteomyelitis is a secondary complication in 1–3% of patients with pulmonary tuberculosis.^[13] In this case, the bacteria, in general, spread to the bone through the circulatory system, first infecting the synovium (due to its higher oxygen concentration) before spreading to the adjacent bone.^[13] In tubercular osteomyelitis, the long bones and vertebrae are the ones that tend to be affected.^[13]

Staphylococcus aureus is the organism most commonly isolated from all forms of osteomyelitis.^[13]

Bloodstream-sourced osteomyelitis is seen most frequently in children, and nearly 90% of cases are caused by Staphylococcus aureus. In infants, S. aureus, Group B streptococci (most common^[14]) and Escherichia coli are commonly isolated; in children from one to 16 years of age, S. aureus, Streptococcus pyogenes, and Haemophilus influenzae are common. In some subpopulations, including intravenous drug users and splenectomized patients, Gram-negative bacteria, including enteric bacteria, are significant pathogens.^[15]

The most common form of the disease in adults is caused by injury exposing the bone to local infection. Staphylococcus aureus is the most common organism seen in osteomyelitis, seeded from areas of contiguous infection. But anaerobes and Gram-negative organisms, including Pseudomonas aeruginosa, E. coli, and Serratia marcescens, are also common. Mixed infections are the rule rather than the exception.^[15]

Systemic mycotic infections may also cause osteomyelitis. The two most common are Blastomyces dermatitidis and Coccidioides immitis.^{[citation needed]}

In osteomyelitis involving the vertebral bodies, about half the cases are due to S. aureus, and the other half are due to tuberculosis (spread hematogenously from the lungs). Tubercular osteomyelitis of the spine was so common before the initiation of effective antitubercular therapy, it acquired a special name, Pott’s disease.^{[citation needed]}

The Burkholderia cepacia complex has been implicated in vertebral osteomyelitis in intravenous drug users.^[16]

Pathogenesis[edit]

In general, microorganisms may infect bone through one or more of three basic methods

• Via the bloodstream (haematogeneously) – the most common method^[17]
• From nearby areas of infection (as in cellulitis), or
• Penetrating trauma, including iatrogenic causes such as joint replacements or internal fixation of fractures, leading to a fracture-related infection,^[18] or secondary periapical periodontitis in teeth.^[13]

The area usually affected when the infection is contracted through the bloodstream is the metaphysis of the bone.^[17] Once the bone is infected, leukocytes enter the infected area, and, in their attempt to engulf the infectious organisms, release enzymes that lyse the bone. Pus spreads into the bone’s blood vessels, impairing their flow, and areas of devitalized infected bone, known as sequestra, form the basis of a chronic infection.^[13] Often, the body will try to create new bone around the area of necrosis. The resulting new bone is often called an involucrum.^[13] On histologic examination, these areas of necrotic bone are the basis for distinguishing between acute osteomyelitis and chronic osteomyelitis. Osteomyelitis is an infective process that encompasses all of the bone (osseous) components, including the bone marrow. When it is chronic, it can lead to bone sclerosis and deformity.^{[citation needed]}

Chronic osteomyelitis may be due to the presence of intracellular bacteria.^[19] Once intracellular, the bacteria are able to spread to adjacent bone cells.^[20] At this point, the bacteria may be resistant to certain antibiotics.^[21] These combined factors may explain the chronicity and difficult eradication of this disease, resulting in significant costs and disability, potentially leading to amputation. The presence of intracellular bacteria in chronic osteomyelitis is likely an unrecognized contributing factor in its persistence.^{[citation needed]}

In infants, the infection can spread to a joint and cause arthritis. In children, large subperiosteal abscesses can form because the periosteum is loosely attached to the surface of the bone.^[13]

Because of the particulars of their blood supply, the tibia, femur, humerus, vertebrae, maxilla and the mandibular bodies are especially susceptible to osteomyelitis.^[22] Abscesses of any bone, however, may be precipitated by trauma to the affected area. Many infections are caused by Staphylococcus aureus, a member of the normal flora found on the skin and mucous membranes. In patients with sickle cell disease, the most common causative agent is Salmonella, with a relative incidence more than twice that of S. aureus.^[12]

Diagnosis[edit]

The diagnosis of osteomyelitis is complex and relies on a combination of clinical suspicion and indirect laboratory markers such as a high white blood cell count and fever, although confirmation of clinical and laboratory suspicion with imaging is usually necessary.^[23]

Radiographs and CT are the initial method of diagnosis, but are not sensitive and only moderately specific for the diagnosis. They can show the cortical destruction of advanced osteomyelitis, but can miss nascent or indolent diagnoses.^[23]

Confirmation is most often by MRI. The presence of edema, diagnosed as increased signal on T2 sequences, is sensitive, but not specific, as edema can occur in reaction to adjacent cellulitis. Confirmation of bony marrow and cortical destruction by viewing the T1 sequences significantly increases specificity. The administration of intravenous gadolinium-based contrast enhances specificity further. In certain situations, such as severe Charcot arthropathy, diagnosis with MRI is still difficult.^[23] Similarly, it is limited in distinguishing avascular necrosis from osteomyelitis in sickle cell anemia.^[24]

Nuclear medicine scans can be a helpful adjunct to MRI in patients who have metallic hardware that limits or prevents effective magnetic resonance. Generally a triple phase technetium 99 based scan will show increased uptake on all three phases. Gallium scans are 100% sensitive for osteomyelitis but not specific, and may be helpful in patients with metallic prostheses. Combined WBC imaging with marrow studies has 90% accuracy in diagnosing osteomyelitis.^[25]

Diagnosis of osteomyelitis is often based on radiologic results showing a lytic center with a ring of sclerosis.^[13] Culture of material taken from a bone biopsy is needed to identify the specific pathogen;^[26] alternative sampling methods such as needle puncture or surface swabs are easier to perform, but cannot be trusted to produce reliable results.^[27][28]

Factors that may commonly complicate osteomyelitis are fractures of the bone, amyloidosis, endocarditis, or sepsis.^[13]

Classification[edit]

The definition of OM is broad, and encompasses a wide variety of conditions. Traditionally, the length of time the infection has been present and whether there is suppuration (pus formation) or osteosclerosis (pathological increased density of bone) are used to arbitrarily classify OM. Chronic OM is often defined as OM that has been present for more than one month. In reality, there are no distinct subtypes; instead, there is a spectrum of pathologic features that reflects a balance between the type and severity of the cause of the inflammation, the immune system and local and systemic predisposing factors.^{[citation needed]}

• Suppurative osteomyelitis
  • Acute suppurative osteomyelitis
  • Chronic suppurative osteomyelitis
    • Primary (no preceding phase)
    • Secondary (follows an acute phase)
• Non-suppurative osteomyelitis
  • Diffuse sclerosing
  • Focal sclerosing (condensing osteitis)
  • Proliferative periostitis (periostitis ossificans, Garré’s sclerosing osteomyelitis)
  • Osteoradionecrosis

OM can also be typed according to the area of the skeleton in which it is present. For example, osteomyelitis of the jaws is different in several respects from osteomyelitis present in a long bone. Vertebral osteomyelitis is another possible presentation.^{[citation needed]}

Treatment[edit]

Osteomyelitis often requires prolonged antibiotic therapy for weeks or months. A PICC line or central venous catheter can be placed for long-term intravenous medication administration. Some studies of children with acute osteomyelitis report that antibiotic by mouth may be justified due to PICC-related complications.^[29][30] It may require surgical debridement in severe cases, or even amputation. Antibiotics by mouth and by intravenous appear similar.^[31][32]

Due to insufficient evidence it is unclear what the best antibiotic treatment is for osteomyelitis in people with sickle cell disease as of 2019.^[33]

Initial first-line antibiotic choice is determined by the patient’s history and regional differences in common infective organisms. A treatment lasting 42 days is practiced in a number of facilities.^[34] Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes.^[35] Open surgery is needed for chronic osteomyelitis, whereby the involucrum is opened and the sequestrum is removed or sometimes saucerization^[36] can be done. Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis.^[37][38]

Before the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean.^[39][40]

There is tentative evidence that bioactive glass may also be useful in long bone infections.^[41] Support from randomized controlled trials, however, was not available as of 2015.^[42]

Hemicorporectomy is performed in severe cases of Terminal Osteomyelitis in the Pelvis if further treatment won’t stop the infection. ^[43]

History[edit]

The word is from Greek words ὀστέον osteon, meaning bone, μυελός myelos meaning marrow, and -ῖτις -itis meaning inflammation.

In 1875, American artist Thomas Eakins depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in an oil painting titled The Gross Clinic.^[44]

Canadian politician and premier of Saskatchewan Tommy Douglas suffered from osteomyelitis as a child, and in 1910, underwent several surgeries, which the surgeon performed for free in exchange for allowing his medical students to observe the procedures (which Douglas’s parents could not have otherwise afforded). This experience convinced him that medical care should be free for everyone.^[45] Douglas became known as the Canadian «Father of Medicare.»^[46]

Fossil record[edit]

Evidence for osteomyelitis found in the fossil record is studied by paleopathologists, specialists in ancient disease and injury. It has been reported in fossils of the large carnivorous dinosaur Allosaurus fragilis.^[47] Osteomyelitis has been also associated with the first evidence of parasites in dinosaur bones.^[48]

See also[edit]

References[edit]

External links[edit]

• 00298 at CHORUS

• Acosta, Chin; et al. (2004). «Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine» (PDF). Neurosurg Focus. 17 (6): E2. doi:10.3171/foc.2004.17.6.2. PMID 15636572.

From Wikipedia, the free encyclopedia

Osteomyelitis
Other names	Bone infection
Osteomyelitis of the 1st toe
Specialty	Infectious disease, orthopedics
Symptoms	Pain in a specific bone, overlying redness, fever, weakness[1]
Complications	Amputation[2]
Usual onset	Young or old[1]
Duration	Short or long term[2]
Causes	Bacterial, fungal[2]
Risk factors	Diabetes, intravenous drug use, prior removal of the spleen, trauma to the area[1]
Diagnostic method	Blood tests, medical imaging, bone biopsy[2]
Differential diagnosis	Charcot’s joint, rheumatoid arthritis, infectious arthritis, giant cell tumor, cellulitis[1][3]
Treatment	Antimicrobials, surgery[4]
Prognosis	Low risk of death with treatment[5]
Frequency	2.4 per 100,000 per year[6]

Osteomyelitis (OM) is an infection of bone.^[1] Symptoms may include pain in a specific bone with overlying redness, fever, and weakness.^[1] The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus,^[7] while the feet, spine, and hips are most commonly involved in adults.^[2]

The cause is usually a bacterial infection,^[1][7][2] but rarely can be a fungal infection.^[8] It may occur by spread from the blood or from surrounding tissue.^[4] Risks for developing osteomyelitis include diabetes, intravenous drug use, prior removal of the spleen, and trauma to the area.^[1] Diagnosis is typically suspected based on symptoms and basic laboratory tests as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).This is because plain radiographs are unremarkable in the first few days following acute infection.^[7][2] Diagnosis is further confirmed by blood tests, medical imaging, or bone biopsy.^[2]

Treatment of bacterial osteomyelitis often involves both antimicrobials and surgery.^[7][4] In people with poor blood flow, amputation may be required.^[2] Treatment of the relatively rare fungal osteomyelitis as mycetoma infections entails the use of antifungal medications.^[9] In contrast to bacterial osteomyelitis, amputation or large bony resections is more common in neglected fungal osteomyelitis, namely mycetoma, where infections of the foot account for the majority of cases.^[8][9] Treatment outcomes of bacterial osteomyelitis are generally good when the condition has only been present a short time.^[7][2] About 2.4 per 100,000 people are affected each year.^[6] The young and old are more commonly affected.^[7][1] Males are more commonly affected than females.^[3] The condition was described at least as early as the 300s BC by Hippocrates.^[4] Prior to the availability of antibiotics, the risk of death was significant.^[10]

Signs and symptoms[edit]

Symptoms may include pain in a specific bone with overlying redness, fever, and weakness and inability to walk especially in children with acute bacterial osteomyelitis.^[7][1] Onset may be sudden or gradual.^[1] Enlarged lymph nodes may be present.^[11]
In fungal osteomyelitis, there is usually a history of walking bare-footed, especially in rural and farming areas. Contrary to the mode of infection in bacterial osteomyelitis, which is primarily blood-borne, fungal osteomyelitis starts as a skin infection, then invades deeper tissues until it reaches bone.^[8]

Cause[edit]

In children, the metaphyses, the ends of long bones, are usually affected. In adults, the vertebrae and the pelvis are most commonly affected.^[7]

Acute osteomyelitis almost invariably occurs in children who are otherwise healthy, because of rich blood supply to the growing bones. When adults are affected, it may be because of compromised host resistance due to debilitation, intravenous drug abuse, infectious root-canaled teeth, or other disease or drugs (e.g., immunosuppressive therapy).^[7]

Osteomyelitis is a secondary complication in 1–3% of patients with pulmonary tuberculosis.^[13] In this case, the bacteria, in general, spread to the bone through the circulatory system, first infecting the synovium (due to its higher oxygen concentration) before spreading to the adjacent bone.^[13] In tubercular osteomyelitis, the long bones and vertebrae are the ones that tend to be affected.^[13]

Staphylococcus aureus is the organism most commonly isolated from all forms of osteomyelitis.^[13]

Bloodstream-sourced osteomyelitis is seen most frequently in children, and nearly 90% of cases are caused by Staphylococcus aureus. In infants, S. aureus, Group B streptococci (most common^[14]) and Escherichia coli are commonly isolated; in children from one to 16 years of age, S. aureus, Streptococcus pyogenes, and Haemophilus influenzae are common. In some subpopulations, including intravenous drug users and splenectomized patients, Gram-negative bacteria, including enteric bacteria, are significant pathogens.^[15]

The most common form of the disease in adults is caused by injury exposing the bone to local infection. Staphylococcus aureus is the most common organism seen in osteomyelitis, seeded from areas of contiguous infection. But anaerobes and Gram-negative organisms, including Pseudomonas aeruginosa, E. coli, and Serratia marcescens, are also common. Mixed infections are the rule rather than the exception.^[15]

Systemic mycotic infections may also cause osteomyelitis. The two most common are Blastomyces dermatitidis and Coccidioides immitis.^{[citation needed]}

In osteomyelitis involving the vertebral bodies, about half the cases are due to S. aureus, and the other half are due to tuberculosis (spread hematogenously from the lungs). Tubercular osteomyelitis of the spine was so common before the initiation of effective antitubercular therapy, it acquired a special name, Pott’s disease.^{[citation needed]}

The Burkholderia cepacia complex has been implicated in vertebral osteomyelitis in intravenous drug users.^[16]

Pathogenesis[edit]

In general, microorganisms may infect bone through one or more of three basic methods

• Via the bloodstream (haematogeneously) – the most common method^[17]
• From nearby areas of infection (as in cellulitis), or
• Penetrating trauma, including iatrogenic causes such as joint replacements or internal fixation of fractures, leading to a fracture-related infection,^[18] or secondary periapical periodontitis in teeth.^[13]

The area usually affected when the infection is contracted through the bloodstream is the metaphysis of the bone.^[17] Once the bone is infected, leukocytes enter the infected area, and, in their attempt to engulf the infectious organisms, release enzymes that lyse the bone. Pus spreads into the bone’s blood vessels, impairing their flow, and areas of devitalized infected bone, known as sequestra, form the basis of a chronic infection.^[13] Often, the body will try to create new bone around the area of necrosis. The resulting new bone is often called an involucrum.^[13] On histologic examination, these areas of necrotic bone are the basis for distinguishing between acute osteomyelitis and chronic osteomyelitis. Osteomyelitis is an infective process that encompasses all of the bone (osseous) components, including the bone marrow. When it is chronic, it can lead to bone sclerosis and deformity.^{[citation needed]}

Chronic osteomyelitis may be due to the presence of intracellular bacteria.^[19] Once intracellular, the bacteria are able to spread to adjacent bone cells.^[20] At this point, the bacteria may be resistant to certain antibiotics.^[21] These combined factors may explain the chronicity and difficult eradication of this disease, resulting in significant costs and disability, potentially leading to amputation. The presence of intracellular bacteria in chronic osteomyelitis is likely an unrecognized contributing factor in its persistence.^{[citation needed]}

In infants, the infection can spread to a joint and cause arthritis. In children, large subperiosteal abscesses can form because the periosteum is loosely attached to the surface of the bone.^[13]

Because of the particulars of their blood supply, the tibia, femur, humerus, vertebrae, maxilla and the mandibular bodies are especially susceptible to osteomyelitis.^[22] Abscesses of any bone, however, may be precipitated by trauma to the affected area. Many infections are caused by Staphylococcus aureus, a member of the normal flora found on the skin and mucous membranes. In patients with sickle cell disease, the most common causative agent is Salmonella, with a relative incidence more than twice that of S. aureus.^[12]

Diagnosis[edit]

The diagnosis of osteomyelitis is complex and relies on a combination of clinical suspicion and indirect laboratory markers such as a high white blood cell count and fever, although confirmation of clinical and laboratory suspicion with imaging is usually necessary.^[23]

Radiographs and CT are the initial method of diagnosis, but are not sensitive and only moderately specific for the diagnosis. They can show the cortical destruction of advanced osteomyelitis, but can miss nascent or indolent diagnoses.^[23]

Confirmation is most often by MRI. The presence of edema, diagnosed as increased signal on T2 sequences, is sensitive, but not specific, as edema can occur in reaction to adjacent cellulitis. Confirmation of bony marrow and cortical destruction by viewing the T1 sequences significantly increases specificity. The administration of intravenous gadolinium-based contrast enhances specificity further. In certain situations, such as severe Charcot arthropathy, diagnosis with MRI is still difficult.^[23] Similarly, it is limited in distinguishing avascular necrosis from osteomyelitis in sickle cell anemia.^[24]

Nuclear medicine scans can be a helpful adjunct to MRI in patients who have metallic hardware that limits or prevents effective magnetic resonance. Generally a triple phase technetium 99 based scan will show increased uptake on all three phases. Gallium scans are 100% sensitive for osteomyelitis but not specific, and may be helpful in patients with metallic prostheses. Combined WBC imaging with marrow studies has 90% accuracy in diagnosing osteomyelitis.^[25]

Diagnosis of osteomyelitis is often based on radiologic results showing a lytic center with a ring of sclerosis.^[13] Culture of material taken from a bone biopsy is needed to identify the specific pathogen;^[26] alternative sampling methods such as needle puncture or surface swabs are easier to perform, but cannot be trusted to produce reliable results.^[27][28]

Factors that may commonly complicate osteomyelitis are fractures of the bone, amyloidosis, endocarditis, or sepsis.^[13]

Classification[edit]

The definition of OM is broad, and encompasses a wide variety of conditions. Traditionally, the length of time the infection has been present and whether there is suppuration (pus formation) or osteosclerosis (pathological increased density of bone) are used to arbitrarily classify OM. Chronic OM is often defined as OM that has been present for more than one month. In reality, there are no distinct subtypes; instead, there is a spectrum of pathologic features that reflects a balance between the type and severity of the cause of the inflammation, the immune system and local and systemic predisposing factors.^{[citation needed]}

• Suppurative osteomyelitis
  • Acute suppurative osteomyelitis
  • Chronic suppurative osteomyelitis
    • Primary (no preceding phase)
    • Secondary (follows an acute phase)
• Non-suppurative osteomyelitis
  • Diffuse sclerosing
  • Focal sclerosing (condensing osteitis)
  • Proliferative periostitis (periostitis ossificans, Garré’s sclerosing osteomyelitis)
  • Osteoradionecrosis

OM can also be typed according to the area of the skeleton in which it is present. For example, osteomyelitis of the jaws is different in several respects from osteomyelitis present in a long bone. Vertebral osteomyelitis is another possible presentation.^{[citation needed]}

Treatment[edit]

Osteomyelitis often requires prolonged antibiotic therapy for weeks or months. A PICC line or central venous catheter can be placed for long-term intravenous medication administration. Some studies of children with acute osteomyelitis report that antibiotic by mouth may be justified due to PICC-related complications.^[29][30] It may require surgical debridement in severe cases, or even amputation. Antibiotics by mouth and by intravenous appear similar.^[31][32]

Due to insufficient evidence it is unclear what the best antibiotic treatment is for osteomyelitis in people with sickle cell disease as of 2019.^[33]

Initial first-line antibiotic choice is determined by the patient’s history and regional differences in common infective organisms. A treatment lasting 42 days is practiced in a number of facilities.^[34] Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes.^[35] Open surgery is needed for chronic osteomyelitis, whereby the involucrum is opened and the sequestrum is removed or sometimes saucerization^[36] can be done. Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis.^[37][38]

Before the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean.^[39][40]

There is tentative evidence that bioactive glass may also be useful in long bone infections.^[41] Support from randomized controlled trials, however, was not available as of 2015.^[42]

Hemicorporectomy is performed in severe cases of Terminal Osteomyelitis in the Pelvis if further treatment won’t stop the infection. ^[43]

History[edit]

The word is from Greek words ὀστέον osteon, meaning bone, μυελός myelos meaning marrow, and -ῖτις -itis meaning inflammation.

In 1875, American artist Thomas Eakins depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in an oil painting titled The Gross Clinic.^[44]

Canadian politician and premier of Saskatchewan Tommy Douglas suffered from osteomyelitis as a child, and in 1910, underwent several surgeries, which the surgeon performed for free in exchange for allowing his medical students to observe the procedures (which Douglas’s parents could not have otherwise afforded). This experience convinced him that medical care should be free for everyone.^[45] Douglas became known as the Canadian «Father of Medicare.»^[46]

Fossil record[edit]

Evidence for osteomyelitis found in the fossil record is studied by paleopathologists, specialists in ancient disease and injury. It has been reported in fossils of the large carnivorous dinosaur Allosaurus fragilis.^[47] Osteomyelitis has been also associated with the first evidence of parasites in dinosaur bones.^[48]

See also[edit]

References[edit]

External links[edit]

• 00298 at CHORUS

• Acosta, Chin; et al. (2004). «Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine» (PDF). Neurosurg Focus. 17 (6): E2. doi:10.3171/foc.2004.17.6.2. PMID 15636572.

У детей, остеомиелит чаще всего поражает длинные кости ног и верхней части руки, в то время как у взрослых более часто происходит развитие остеомиелита костей позвоночника (позвонков). У людей, страдающих диабетом, может развиваться остеомиелит в нижних конечностях, если имеются трофические язвы на ногах.
Если раньше остеомиелит считался неизлечимым заболеванием, то в настоящее время это заболевание успешно лечится. Большинству пациентов с остеомиелитом требуется операция по удалению омертвевших костных тканей на фоне интенсивной антибиотикотерапии (сильные антибиотики вводятся парентерально в течение минимум 6 недель). При остеомиелите позвоночника происходит инфицирование позвонков. Это довольно редкая причина болей в спине, особенно у молодых здоровых взрослых людей.

Как правило, инфекция попадает в тело позвонка гематогенно (с током крови). Вены в нижней части позвоночника дренируют также таз (венозное сплетение Ватсона) и таким образом инфекции легко попадают в позвоночник. Поэтому, в большинстве случаев причиной остеомиелита позвонков является инфекции, которые возникают после урологических процедур (например, цистоскопии).

Факторы риска

Костная ткань, как правило, устойчива к инфекции. Для возникновения остеомиелита необходимы условия, которые увеличивают уязвимость костей к инфекции.

Наличие травм или операций, которые произошли недавно. При тяжелых переломах костей или глубоких пункциях происходит проникновение инфекции в кость или близлежащую ткань. Хирургическая репозиция костных отломков или операции по эндопротезированию могут также случайно способствовать заносу инфекции в кости.

Нарушение кровообращения.Когда кровеносные сосуды повреждены или нарушен ток крови по ним, то возникают условия для дефицита иммунных клеток отвечающих за противодействие микробам и не позволяющих небольшому количеству случайно попавших микробов в ткани размножаться. То, что начинается как небольшой разрез, может прогрессировать до глубокой язвы, которая может охватить глубжележащие ткани и даже кости. Заболевания, которые приводят к нарушению циркуляции крови, включают в себя:

• Сахарный диабет
• Заболевания периферических артерий, часто связанных с курением
• Серповидно-клеточная анемия

Медицинские катетеры

Медицинский катетер соединяет внешний мир с внутренними органами. И хотя эти катетеры необходимы для некоторых состояний они могут служить проводниками инфекций в организм. Поэтому катетеры увеличивают риск инфицирования, в том числе и остеомиелита. Примеры включают в себя:

• Катетеры для диализа
• Катетеры мочевого пузыря
• Внутривенные катетеры, которые необходимо для длительного введения медикаментов (месяцы или даже годы)

Внутривенное введение наркотиков

Люди, которые употребляют наркотики внутривенно, имеют большой риск развития остеомиелита, потому что они обычно используют нестерильные иглы и не обрабатывают кожу перед инъекциями.

Частые причины остеомиелита.

Наиболее подвержены развитию остеомиелита следующие группы людей:

• Пациенты пожилого возраста
• Наркоманы, употребляющие наркотики внутривенн
• Пациенты с наличием ослабленной иммунной системы

Иммунная система может ослабляться в результате следующих состояний:

• Длительное применение кортикостероидов для лечения системных заболеваний, таких как ревматоидный артрит.
• Инсулинозависимый сахарный диабет
• Пациенты с наличием пересаженных органов
• Синдром приобретенного иммунодефицита (СПИД)
• Недоедание
• Рак

Внутривенные употребление наркотиков вызывает увеличение числа пациентов с инфекцией позвоночника. Как правило, микроорганизмом чаще всего поражающим позвоночник является золотистый стафилококк, а у наркоманов, использующих внутривенное введение наркотиков, нередко и синегнойная палочка является возбудителем спинальной инфекции. Для лечения этих двух возбудителей требуется различное лечение антибиотиками.

В недавнем прошлом микобактерия туберкулеза часто являлась причиной инфекции позвоночника. В настоящее же время в развитых странах туберкулез позвоночника практически не встречается и распространен он только в бедных отсталых странах с низким уровнем жизни. Но у наркоманов возможен туберкулезный генез инфекции.

Большинство инфекций тел позвонков встречаются в поясничном отделе позвоночника из-за особенности венозного кровотока. При туберкулезном поражении позвонков чаще страдает шейный и грудной отдел позвоночника.

Симптомы

Первым симптомом инфекции позвоночника является боль, но этот симптом бывает и при других заболеваниях позвоночника, и поэтому инфекция позвоночника развивается почти незаметно и в течение длительного времени. Кроме болей в спине могут быть симптомы общей интоксикации и воспаления организма, такие как повышение температуры, ознобы, потливость, похудание, усиление болей в ночные часы. Спинальная инфекция редко вовлекает нервные структуры.
Тем не менее, инфекция может перейти в спинномозговой канал и вызвать развитие эпидурального абсцесса, который в свою очередь может оказывать давление на нервные элементы. Если это происходит в шейном или грудном отделе позвоночника, это может привести к параплегии или квадриплегии.

Диагностика

Подчас поставить диагноз остеомиелита позвоночника на ранних стадиях довольно затруднительно. При подозрении на остеомиелит позвоночника необходимо провести диагностические инструментальные и лабораторные исследования. Иногда может потребоваться пункция для забора материала для бактериологического анализа и выявления культуры бактерий.

Диагностические исследования

Процесс диагностики позвоночника инфекция обычно начинается с рентгенографии.

Рентгенография может быть нормальной в течение 2-4 недель после начала инфекции. Для визуализации повреждений костной ткани требуется разрушение 50-60 % костной ткани позвонков. При вовлечении межпозвонковых структур (дисцита) отмечается уменьшение расстояния между позвонками и разрушение концевых пластин.

Наиболее информативно для диагностики остеомиелита МРТ исследование с контрастом. Инфекция приводит к увеличению кровотока в теле позвонка, и соответственно контраст будет больше накапливаться в поврежденных инфекцией позвонках.

Иногда применяется сцинтиграфия но, к сожалению, это метод не позволяет дифференцировать опухоль или другие заболевания от инфекции.

Лабораторные исследования

Посев крови позволяет определить возбудителя инфекции и соответственно подобрать необходимый антибиотик. Но посев крови позволяет высеять микроорганизм не более чем в половине случаев. Некоторые анализы (воспалительные маркеры) позволяют предположить наличие инфекции. Особенно это касается такого анализа, как СОЭ (скорость оседания эритроцитов), который будет повышен при остеомиелите в 80-90% случаев. Также имеет диагностическую ценность анализ лейкоцитарной формулы крови.

Если эти маркеры являются нормальными, то очень маловероятно, что у пациента есть инфекция.

Если эти маркеры повышены, то они играют диагностическую роль, а также являются критериями эффективности лечения. Снижение маркеров воспаления является хорошим показателем адекватности лечения инфекции.

Биопсия ткани может быть назначена при необходимости определить возбудитель инфекции, и проводится биопсия с помощью пункционной иглы и под контролем КТ. В отдельных случаях для диагностики может также потребоваться открытая биопсия.

Лечение

Лечение остеомиелита, как правило, консервативное и базируется в основном на использовании внутривенного лечения антибиотиками. Иногда может применяться хирургическое лечение для декомпрессии нервных структур, для санации поврежденной костной ткани, удаления некротизированной ткани или для стабилизации позвоночника.

Консервативное лечение включает в себя антибиотикотерапию общеукрепляющие препараты и покой.
В большинстве случаев остеомиелит позвоночника вызван Staphyloccocus Aureus, который, как правило, очень чувствителен к антибиотикам. Внутривенное лечение антибиотиками обычно занимает около четырех недель, а затем обычно назначается двухнедельный курс антибиотиков, которые принимают перорально. При инфекциях, вызванных туберкулезом, требуется прием антибиотиков в течение года. Фиксация позвоночника (с помощью корсета) необходима на период в течение 6-12 недель, пока на рентгене не будет отмечена положительная динамика. Предпочтение отдается жестким корсетам.

Хирургическое лечение

Хирургическая декомпрессия необходима, если эпидуральный абсцесс оказывает давление на нервные структуры. В связи с тем, что хирургическая декомпрессия часто дестабилизирует позвоночник еще больше, то обычно вместе с ней выполняют фиксацию позвонков. Хирургическая санация очагов инфекции необходима при резистентности к проводимой антибиотикотерапии.
Хирургическое лечение также может быть необходимо, если есть много костных разрушений с последующей деформацией и болью. Реконструкция костных элементов и стабилизация позвоночника могут помочь уменьшить боль и предотвратить дальнейшее разрушение позвоночника.

Осложнения

Остеомиелит может вызвать следующие осложнения:

• некроз костной ткани. Инфекция в костной ткани может приводить к нарушению циркуляцию крови в кости, что приводит к омертвению костной ткани. Если участки некроза небольшие, то их хирургическое удаление может привести к восстановлению ткани. При большом некрозе требуется удаление всей некротизированной ткани или конечности, если речь идет об остеомиелите конечностей.
• септический артрит. В некоторых случаях инфекция в костной ткани может распространиться на близлежащие суставы.
• Нарушение роста костей. У детей наиболее распространенной локализацией очагов остеомиелита являются зоны роста трубчатых костей, что может в дальнейшем приводить к нарушению роста костей..
• рак кожи. Если остеомиелит привел к открытой ране с выделением гноя, то резко увеличивается риск развития плоскоклеточного рака.

23.09.2021

Остеомиелит — это гнойная инфекция, которая поражает все слои кости. Часто инфекция также поражает мышцы и кожу. Симптомы этого заболевания зависят от вида, степени распространения воспаления, пути проникновения, а также локализации.

Прежде всего при остром остеомиелите (возникшем впервые) появляется жгучая, рвущая, сверлящая боль в очаге воспаления, наблюдается отечность в области воспалённой кости. Затем у пациента поднимается температура до высоких значений (39-40). Нередко происходит интоксикация организма, вследствие чего человек может испытывать сильные головные боли, тошноту и сонливость. В сложных случаях происходят перепады артериального давления, сбой сердечного ритма, потеря сознания.

Причинами остеомиелита являются:

• травма
• ожог
• обморожение
• респираторная вирусная инфекция (ОРВИ)
• поднятие тяжестей
• стресс и так далее

Диагностика остеомиелита. Проводя диагностику остеомиелита, основываются на выявлении симптомов заболевания, проводят рентгенографию, томографию для того, чтобы обнаружить гнойно-воспалительных очаги изменения в костной ткани.

Виды остеомиелита

• Острый гематогенный остеомиелит. Развивается при заносе патогенных микроорганизмов в сосуды внутри кости, где и возникает очаг воспаления. Чаще всего встречается с 3-14 лет, но также возможен среди новорожденных, людей в возрасте. Обычно возбудителем является золотистый стафилококк
• Посттравматический остеомиелит. Развивается при попадании патогенных микроорганизмов открытым путём при соприкосновении с загрязнёнными предметами. Течение этого вида заболевания полностью зависит от попавшего в рану возбудителя.
• Хронический остеомиелит. Наступает в результате любого вида заболевания, если бездействовать полтора месяца с появления симптомов остеомиелита.

Стадии остеомиелита

• Острый остеомиелит. Характеризуется острыми болями, отечностью, высокой температурой, судорогами, тошнотой, сильными головными болями. Продолжается 3-4 недели.
• Подострый остеомиелит. Состояние больного нормализуется, температура снижается, боли становятся ноющими. Продолжается 2-3 недели
• Хронический остеомиелит. Характеризуется общей интоксикацией организма, болями, как на острой стадии, отечностью, уплотнёнными мягкими тканями багрового оттенка в области воспалительного очага. Как раз на этой фазе формируются свищи-каналы, которые соединяют полость тела или полые органы с внешней средой. Также идёт долгое чередование обострений и ремиссий.

Лечение и профилактика остеомиелита

При остеомиелите обязательна госпитализация. Конечность обездвиживается, проводится антибиотикотерапия (при остром остеомиелите проводится 4-6 недель, при хроническом-больше). Гнойные очаги обязательно дренируют с промыванием антибиотиками полости.

Профилактики остеомиелита не существует. Людям, которые имеют повышенный риск гнойно-воспалительных заболеваний, необходимо обращать особое внимание на изменения кожных покровов и тщательно их обрабатывать.