OSTEITIS

From Big Medical Encyclopedia

OSTEITIS (ostitis, osteitis; Greek osteon a bone + - itis) — an inflammation of a bone. The term is applied seldom. Acute and chronic purulent posttraumatic O., and also hematogenous O., at to-rykh marrow is always surprised, it is accepted to call osteomyelitis (see); Islands with preferential damage of a periosteum call osteoperiostitis (see); at distribution patol, process on all layers of a bone speak about a panosteitis. In nek-ry sources the term «osteitis» unreasonably designate the diseases which are not relating to inflammatory (the deforming Pedzhet's osteitis, a disease of Recklinghausen).

The etiology

Most often O. arises at an injury of a bone (an open change or after operation for the closed change) owing to hit of purulent microflora in a wound. Less often O. is caused by specific microflora (tubercular, syphilitic O.). Extremely seldom O. is observed at a leprosy, gonorrhea, a pseudorheumatism, a brucellosis, a paratyphoid.

Pathological anatomy

At O. the education in marrowy cavities of granulyatsionny fabric which is followed by more or less expressed phenomena of a rassasyvaniye of bone substance and a reactive osteogenesis is characteristic. Manifestations acute and hron, inflammations of a bone are possible.

At acute O. as a result of dominance of processes of a rassasyvaniye of a bone tissue over processes of its education the centers of destruction of a bone appear. At hron. The lake granulyatsionny fabric has not gnoynonekrotichesky, but proliferative character. Depending on dominance of processes of a rassasyvaniye or an osteogenesis hron. The lake shares on rarefitsiruyushchy and ossifying. Etiol, rarefitsiruyushchy O.'s factor most often is a specific infection (tuberculosis, syphilis, a leprosy). At tubercular, syphilitic and leprose O. granulyatsionny fabric has characteristic signs. Ossifying O., or an inflammatory osteosclerosis, is observed at syphilis (in the tertiary period acquired and late cases of inborn). Often it is accompanied by an osteoperiostitis.

The clinical picture, the diagnosis

Klin, a picture of various forms O. is described in articles Osteomyelitis (see), Osteoperiostitis (see). Most often O. is localized in an epiphysis, metaphyses or a diaphysis of long tubular bones, is more rare in vertebras and short tubular bones.

Roentgenograms of bones of the lower extremity at an osteitis: and — the roentgenogram of a diaphysis of a femur with bone abscess (1 — the oval center of destruction in reinforced cortical substance of a bone, 2 — fresh periosteal imposings); — the roentgenogram of bones of a shin of the girl of 9 years with inborn syphilis (the ossifying osteitis of a tibial bone — a diaphysis is thickened, sharply condensed, the marrowy channel is narrowed).

In O.'s diagnosis, in addition to studying the wedge, symptoms, is important retgenol. a research of the respective site of a skeleton at least in two standard (direct and side) projections. The basic rentgenol, O.'s sign is the destruction of bone substance which is shown on roentgenograms an enlightenment of its shadow. Depression of bone substance at O. has focal character. The destructive center slowly increases in sizes (from several millimeters to several centimeters); on the periphery of the center reactive develops osteosclerosis (see). Education in a destructive cavity of the bone sequester is characteristic of osteomyelitis and tubercular O. At tomographies (see) sometimes find the small destructive centers, invisible on usual roentgenograms, or receive more evident picture of destruction. The lake causes in most cases productive reaction of a periosteum, and sometimes and an endosteum. In this case inflammatory process is characterized by existence of destructive defect in cortical substance of the periosteal imposings causing a thickening of a bone (fig., a). At ossifying O. the bone on the roentgenogram looks condensed and thickened (fig., b). Such picture is observed at Garre's osteomyelitis, syphilis.

Treatment

O.'s Treatment complex is also defined by its etiology. It usually includes operative measures: necretomy (see), sequestectomy (see), longitudinal and segmented resections of bones, pumping out and processing of a bone cavity by means of ultrasound, the constant pritochno-sucking-away drainage; antimicrobic therapy (antibioticotherapias), sulfanylamidotherapy, chemotherapy effective antiseptic agents, including specific, applied according to indications intravascularly, intramusculary, locally and inside); wide use of proteolytic enzymes (chymotrypsin, papain, etc.); passive and active immunization; physical therapy and fortifying treatment, and also an immobilization of the affected extremity (see. Immobilization ) at the infected changes and nearthroses.

The general principles of prevention of often found traumatic O. include first of all high-quality radical primary surgical treatment of open changes and the most strict observance of an asepsis during the carrying out an osteosynthesis of the closed changes. Specific O.'s prevention consists in early rational treatment inf. diseases.

See also Bone .



Bibliography: Eighth congress of traumatologists-orthopedists of Ukraine, Kiev, 1979; Goryachev A. N., From a yta of N of JI. In, and And yes d An I am V. V N. Intra arterial infusions of antibiotics at posttraumatic purulent processes of the lower extremities, Ortop, and travmat., No. 5, page 53, 1975, bibliogr.; Grinev M. V. Osteomyelitis, D., 1977, bibliogr.; P. P's bugs. Complications of open diaphyseal changes and their prevention, Ortop, and travmat., No. 8, page 13, 1967; Zedgenid-3 E. And., Gratsiansky V. P. and Sivenko F. F. Radiodiagnosis of bone and joint tuberculosis, JI., 1958; Kornev P. G. Clinic and treatment of bone and joint tuberculosis, M., 1959; Pavlov I. P. and Smelnits-k and y P. S. K to a question of treatment of patients with osteomyelitis of tubular bones, in book: Pyoinflammatory having got sick, soft tissues and bones, under the editorship of V. I. Yukhtin, page 83, M., 1976; P and sh to about in B. M. Late inborn syphilis, page 82, M., 1955; Reynberg S.A. Radiodiagnosis of diseases of bones and joints, book 1 — 2, M., 1964; Shaposhnikov Yu. G., P e sh e of t-nikove.a. if austovar. B. The differentiated treatment of chronic osteomyelitis, Vestn, hir., t. 118, No. 1, page 71,1977, bibliogr.; D e and with k P. Diagno-stik der Knochen und Gelenkkrankheiten nach fuhrenden Rontgensymptomen, Budapest, 1966; Harle A. Die Behandlung der Osteomyelitis mit dem Gentamycin — PMMA, Orthop. Prax., S. 765, 1978; M u 1-1 e r K. H. Der Stellenwert anaerober Keime bei der Osteomyelitis, Unfallheil-kunde, S. 123, 1980; O ren di G. Knochen-, Gelenk-und Weichteilerkrankungen im Rontgenbild, Jena, 1968; O v e r t o n L. M. a. T u 1 1 y W. P. Surgical treatment of chronic osteomyelitis in long bones, Amer. J. Surg., Y. 126, p. 736, 1973; W e i s e K. u. Weller S. Indikationsstellung und Anwendung der PMMA — Kugelkette bei der chroni-schen Osteitis, Akt. Traumat., Bd 10, S. 57, 1980.


O. M. Markova; G. I. Lavrishcheva (stalemate. An.), S. A. Sviridov (rents.).

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