Acute and chronic osteomyelitis in children. Acute hematogenous osteomyelitis in children Osteomyelitis in children treatment rehabilitation

Any inflammatory and purulent process in a child’s body it is always very difficult. Osteomyelitis in children is very dangerous and serious disease, which can occur at almost any age. This pathology is characterized by purulent-necrotic damage to the bone marrow, bone tissue itself and periosteum with the involvement of surrounding soft tissues in the process. This disease is difficult to diagnose in the early stages of development, which often does not allow doctors to start etiotropic therapy in time, i.e. aimed at eliminating the causal agent.

Epiphyseal osteomyelitis that occurs in a child is highly likely to lead to changes in the structure and shape of the bone. And subsequently this predisposes to problems that require orthopedic treatment and corrections.

The tubular bones of a child, which are most often susceptible to osteomyelitis, consist of 3 sections:

1. Epiphyseal parts. These are the ends of bones that have anatomical structures to connect to other bones, form joints, and attach ligaments and muscles.
2. Diaphyseal part. This is the middle part of the bone that contains the channel for the bone marrow.
3. Metaepiphyseal parts. They contain growth plates that allow the baby's bones to grow in length.

The bone is also covered with periosteum, which provides its nutrition and growth in thickness. Due to the vessels that pass directly into the bone marrow canal, the so-called endosseous blood supply (intraosseous) occurs.

It is precisely this feature of the trophism of tubular bones in the human body that becomes a prerequisite for the occurrence of an isolated focus of purulent-necrotic inflammation in bone marrow, which is limited by bone from surrounding soft tissue.

Based on the routes of infection into the bone, there are: following types diseases:

• Hematogenous osteomyelitis. The pathogen enters the child’s bone marrow through the bloodstream, most often from another source infectious process in the child's body. This type of disease occurs most often in children.
• Post-traumatic osteomyelitis. It develops as a result of trauma (hematoma, bone fracture, disruption of the integrity of soft tissues) followed by purulent inflammation. Pathological process can spread, including to bone tissue and the brain contained there.
• Iatrogenic osteomyelitis. A purulent-necrotic process in the bone occurs as a consequence medical interventions(operations on bone tissue, intraosseous injections, etc.).
• Other types of disease, associated mainly with contact migration of infection into the bone from nearby areas of affected soft tissue.

There is a fairly wide range of reasons that can provoke osteomyelitis in a child. They are mainly associated with the presence of another chronic focus of inflammation, the pathogen from which migrates in the body with the bloodstream.

Reasons for the development of osteomyelitis in children

The main cause of the disease is the entry of infectious agents (bacteria or viruses) into the cavity of the bone marrow canal.

According to the results of various studies, in children, in the vast majority of cases of hematogenous osteomyelitis, Staphylococcus aureus. For disseminated forms of the disease (when multiple foci are observed purulent inflammation in bones) more typical pathogens are anaerobic infections.

As a rule, the reasons for the development of osteomyelitis in a child are:

1. Presence of a focus of infectious process, which becomes the source of migration of disease pathogens into bone tissue. Such a primary focus is not always easily identified by a doctor during examination. Dental caries, chronic tonsillitis, otitis, sinusitis, enterocolitis and other diseases can serve as a source of bacteria that, migrating with the bloodstream, affect the bone marrow.
2. Congenital infection in a child. In some cases, the occurrence of osteomyelitis in newborns is associated precisely with intrauterine infection or the entry of an infectious agent into the child’s body during childbirth.
3. General decrease in activity immune system. This condition can be caused by both congenital and acquired immunodeficiency syndromes in a child. Particularly often, a decrease in immunity is observed with viral diseases or with certain bacterial infections(tuberculosis, brucellosis, etc.), as well as in oncological processes.
4. Local decrease in blood flow to the bone and decrease in local activity immune defense. Such conditions are provoked mainly by hypothermia, inflammation of soft tissues in the bone area, etc.
5. Traumatic effects on bone and soft tissue. This process not only causes the development of an inflammatory reaction, the formation of hematoma and edema, accompanied by impaired bone blood flow. It also provokes the development of an infectious process.

Thus, the development of osteomyelitis in a child is associated with the presence in the body of a potential causative agent of purulent-necrotic inflammation (most often in the form of an already existing focus of inflammation in the body), as well as general and local disorders of the vascular and immune systems.

The structural features of the vessels that feed the bone in the epiphysis zone (they end blindly, without connecting with other vessels) determine the occurrence of epiphyseal osteomyelitis.

Symptoms of the disease

The disease usually begins and progresses acutely. Less commonly, osteomyelitis can be chronic with periodic episodes of exacerbation of symptoms. Hematogenous osteomyelitis in children occurs with the following clinical picture:

1. A sharp increase in body temperature (up to 40-41 degrees), fever.
2. Severe weakness and intoxication caused by high concentration bacterial or viral toxins in the blood.
3. Increasing, severe pain in the bone, which intensifies with palpation, axial load, walking, etc.
4. Local skin changes (redness, swelling, etc.) are not always characteristic of the first day of the disease.
5. In parallel, inflammatory phenomena can be observed in the primary infectious focus (in the tonsils, maxillary sinuses, carious teeth, etc.).
6. If the infectious focus is located in the epiphysis of the bone, arthritis may occur - inflammatory process in the joint.

How is the disease diagnosed?

Diagnosis of a disease such as acute hematogenous osteomyelitis in children, on the first day - this is a guarantee get well soon. The earlier the pathology is identified, the faster comprehensive measures will be taken for local sanitation of the purulent focus and systemic therapy antibacterial drugs. Therefore, after assessing the child’s symptoms, the doctor urgently prescribes the following tests to confirm the diagnosis:

• X-ray of the area of ​​bone in which osteomyelitis is suspected to develop. Unfortunately, at the beginning of the disease, which is caused by direct infection in the bone marrow canal, such a study is not very informative. However, in the future, with the progression of osteomyelitis, X-ray changes in the bone leave no doubt about this diagnosis in the child.
• Grade clinical analysis blood. Osteomyelitis is characterized by a significant increase in the level of leukocytes and pronounced changes in leukocyte formula. These signs indicate the presence of an inflammatory process of an infectious nature in the body.
• Blood culture determination is a procedure for culturing blood to assess the presence of bacteria in it, as well as subsequently determining their sensitivity to antimicrobial drugs.
• Ultrasound of bones and soft tissues in the suspected zone of disease development. It allows for early stages identify indirect signs osteomyelitis.

Some forms of the disease, for example acute odontogenic osteomyelitis, are distinguished by the fact that they begin and proceed as normal inflammation of the tissues around the diseased tooth, and then suddenly become complicated by the transition of the process to the bone marrow. Most often, according to this scenario, events develop in the lower jaw.

Chronic osteomyelitis in children occurs with episodes of minor exacerbation of the process, but with pronounced phenomena of destruction of bone tissue and the frequent formation of purulent fistulas (pus can come out onto the skin) and bone sequesters (areas of bone that have separated from the main mass). Often this form of the disease is causally related to purulent processes in the teeth and their buds. This leads to the development of diseases such as chronic osteomyelitis jaw bones.

Diagnosis and treatment of osteomyelitis of any form in children is carried out only in conditions surgical department under constant medical supervision.

Treatment of osteomyelitis in children

Therapy for this disease should begin as early as possible. It is this feature of the treatment of osteomyelitis that allows you to avoid bone destructive changes, as well as the development of sepsis and shock states (septic shock). Treatment of osteomyelitis is based on three main principles:

1. Sanitation and provision of access to all foci of purulent inflammation in the bone through surgery. To do this, osteoperforation is performed - special punctures are made and holes and channels are formed to the pathological focus. This allows you to introduce antibiotics and antiseptics there, as well as reduce intraosseous pressure, which causes severe pain. Osteomyelitis of the jaw also requires sanitation oral cavity and removal of problematic teeth that serve primary focus inflammation and infection.
2. Intravenous administration antibacterial drugs taking into account the sensitivity of microflora to them. Unfortunately, the exact spectrum of osteomyelitis pathogens, as well as their response to various antimicrobials can only be established by examining a blood culture or culture of pus from the source of infection. But the result will be obtained only after 5-7 days. Therefore, treatment of the disease begins with several strong antibiotics wide range actions to inactivate a very large list of potential pathogens of the infectious process.
3. Maintaining homeostasis and providing symptomatic therapy. For this purpose, infusions of various intravenous solutions, whose task is to correct water-electrolyte balance child, equalize the pH of the blood, and also remove toxins that accumulate in the blood from the body. To relieve (eliminate) fever, as well as pain non-steroidal anti-inflammatory drugs with pronounced antipyretic and analgesic properties are used. To improve local blood microcirculation in the bones, vascular drugs are prescribed.
4. Limb immobilization, in which osteomyelitis occurred. This event is especially important for young children, since functional rest of the bone reduces the severity of pain and reduces inflammatory edema. However, immobilization should not exceed an average of 4 weeks to prevent local violations tissue trophism and the occurrence of muscle atrophy.

Only A complex approach in the treatment of osteomyelitis in children of any age, which includes all of the above measures, helps prevent the development of severe complications of this disease. Timely detection of osteomyelitis in children of any age is the key to stopping the disease at a stage when destructive changes in the bone have not developed, which may affect the function and appearance limbs.

Osteomyelitis is a serious bone disease, when all structures - themselves, the bone marrow, and the periosteum - are affected by infection, in them and in the surrounding soft tissues purulent-necrotic formations appear.

Osteomyelitis in a child is most often observed before the age of one year.

The infection begins at the ends of long bones, since it is there that the arteries form loops with slow blood flow - an ideal environment for the development and activity of bacteria brought along with the blood.

The infection can begin when blood carries bacteria into the bone tissue. Also, the impetus for pyogenic processes can be an infection that has entered the body through the wound surface, or an infection that has passed from inflamed soft tissue to the bone.

The main carriers of the disease through the blood are staphylococci and streptococci.

In case of injury accompanied by a wound, the causative agents are several different microorganisms, one of which may be the dangerous Pseudomonas aeruginosa.

Hematogenous (spread through the bloodstream) osteomyelitis arises after an infectious disease:

• purulent sore throat;
• otitis;
• suppuration in diseased teeth;
• panaritium;
• furunculosis;
• inflammation of the umbilical ring in infants;
• pneumonia, etc.

Osteomyelitis in newborns can develop due to weak body resistance before the age of one year.

Symptoms of osteomyelitis

In the first days after infection there are no signs of the disease. Subsequently, all its manifestations depend on how old the patient is, what kind of immunity he has, what type of bacteria the infection occurred, as well as on the location of the affected bone and the degree of its involvement in the inflammatory process.

Signs of osteomyelitis:

• very high temperature;
• chills;
• cardiopalmus;
• severe pain in a certain area of ​​the bone;
• Swelling and redness of the soft tissues begin around the diseased bone.

With post-traumatic osteomyelitis in children, there are the following symptoms:

• wound or injury accompanied by suppuration of the wound surface;
• swelling, redness of soft tissues;
• severe pain in the damaged area;
• temperature.

Acute manifestations of the disease can become chronic over time, when signs of intoxication disappear, the temperature subsides, and the pain is not so intense. The focus of inflammation around the bone becomes covered with purulent fistulas, which indicate that the disease has progressed to chronic stage, when periods of decline and exacerbation will alternate.

Any wound on a child’s body can lead to post-traumatic osteomyelitis

Relapse begins at the moment when the fistulas close, pus is no longer released, but goes into the cavity that has formed around the infected bone.

In newborns, the disease primarily affects cartilage tissue.

Diagnose this infection very difficult, since the child cannot explain what and how it hurts, and X-ray cannot show any pathologies because they appear at later stages.

What you need to pay attention to:

• the child worries for no reason;
• pale skin;
• refuses to eat;
• temperature;
• the child is lethargic;
• sometimes vomiting and diarrhea begin;
• the child protects the limb and screams in pain if it is touched;
• the skin around the affected area is hyperemic, and within a week the hyperemia spreads to the entire limb;
• a blood test shows leukocytosis, a blood culture (culture of microbes) is isolated from the blood;

If parents are careless about the child’s health and do not consult a doctor in a timely manner, then ulcers and fistulas can spread throughout the baby’s entire body.

Treatment method for osteomyelitis

Even at the end of the 19th century, surgeons had to resort to amputation of the affected limb or radical trepanation, when the bone canal was opened with a chisel to the bone marrow and manually cleared of purulent-necrotic contents.

Now treatment of osteomyelitis in children is carried out using various radical methods:

1. The body must get rid of the infection that causes the disease. In the fight against osteomyelitis, antibiotics are used, for example, gentamicin or fusidine. More simple antibiotics, for example, penicillin, cannot cope with such a powerful infection.
2. At the same time, the body is cleansed of intoxication - plasma is transfused or blood is purified by hemosorption, passing through a column with activated carbon or other sorbent.
3. Produced local treatment the diseased area of ​​the limb with the help of physiotherapy and fixation with a plaster splint.
4. Increases the patient's immunity various methods, with the help of vitamins, immune stimulants.
5. In some cases, surgical intervention occurs - the bone is trephinated, cleansed of purulent-necrotic secretions, fistulas are removed, and drainage is installed. In severe advanced cases, the area of ​​bone that has become the source of the disease is removed.

If left untreated, the entire musculoskeletal and musculoskeletal system will be affected by infection. Bacteria spread throughout the body through the bloodstream and attack different areas bones.

Over time, irreversible changes will occur in all internal organs. The consequences of osteomyelitis in newborns are especially terrible - the young body will not be able to defeat such strong bacteria, which will lead to surgical intervention or disability.

Even surgery with drainage of purulent foci and intraosseous rinsing with antibiotics cannot always save the limb.

Chronic osteomyelitis can only be cured with surgery. It should be noted that in such diseases it is extremely rarely fatal.

Preventive actions

To prevent infection, you should follow simple rules:

1. All the wounds, cuts, open fractures must be treated with alcohol or other antiseptic.
2. Do not touch open wound surfaces with dirty hands.
3. For any injuries accompanied open wound, consult a doctor.
4. All foci of chronic infection must undergo regular thorough sanitation.
5. You should treat your health with care and follow the rules of basic safety and personal hygiene.

Prevention of osteomyelitis in newborns helps to avoid serious consequences - it is not without reason that such strict rules hygiene. The simplest inflammation of the umbilical ring in a baby, which is not treated in time by a careless mother, can lead to tragedy.

Untreated, combed wounds after a mosquito bite, which a child touches with dirty hands, open the gates to terrible microorganisms. A seemingly simple abscess in a child’s sore tooth, which the parents did not pay attention to, can ruin his entire life.

It is important to always properly treat your child's wounds.

Osteomyelitis does not tolerate being taken lightly; it lurks where you don’t expect it. Do not neglect the simplest safety measures - consult a doctor in time for quick diagnostics illness, so that later you don’t have to resort to severe surgery. Of course, in modern world osteomyelitis rarely becomes a reason for fatal outcome, but it is worth remembering about the threat of becoming disabled.

Osteomyelitis in children develops more often due to the fact that children have a larger number of bone zones containing bone marrow, and also due to the fact that the bones have an active blood supply for full active growth. The most susceptible to damage are the shoulder and lower leg, thigh, jaw, and vertebrae. With the development of osteomyelitis, a purulent process occurs with destruction (necrosis) of bone tissue, damage to the bone marrow and surrounding soft tissues. The causes of development are infection with microbes capable of forming pus. The process can be acute and chronic course, with the latter, severe skeletal deformations with bone growth problems can occur.

For reasons, osteomyelitis can be nonspecific - it is a lesion by microbes of the opportunistic and pathogenic group (staphylococci, streptococci, Proteus, etc.). In case of specific damage, the causes of purulent straightening of the bones will be tuberculosis and brucellosis microbes.

The infection can penetrate the bone area hematogenously, with the bloodstream the pathogens settle in the bone tissue. There may also be other ways - with wounds, injuries, the transition of inflammation from the tissues surrounding the bones.

Osteomyelitis occurs more often in boys, due to their greater tendency to injury; odontogenic osteomyelitis can become a separate option - the transfer of infection to the jaw bones from the cavity of carious teeth.

Symptoms

Manifestations of osteomyelitis are quite obvious, especially in children after 1-2 years. They manifest themselves acutely, with chills and high temperature reaching critical levels, increased heart rate, severe weakness with pallor, lethargy and malaise. Acute pain occurs in the joint and limb affected by the process; older children may notice pain inside the bone, which gradually intensifies and prevents them from making habitual movements. Over the course of a couple of days, pronounced swelling and local redness occur at the site of the lesion, an abscess is formed, which can literally disappear after a few days with a decrease in pain, which leads to increased swelling of the redness. The mobility of the affected area is sharply limited, the child spares the area of ​​edema. At the site where the pus breaks out, a fistula may remain, a duct through which pus flows out or the wound closes. If the acute process is not treated, the purulent focus remains inside the bone and tissues, leading to slow destruction of the bone and deformation of the limb, tissues, pathological fractures and tissue disfigurement.

Diagnosis of osteomyelitis in a child

The basis of diagnosis is typical complaints and the clinical picture; it is necessary to confirm the source of infection using tests. The blood test will reveal leukocytosis as a sign purulent infection, changes biochemical analysis blood. When inoculating the discharge or blood, the pathogen that gives rise to a purulent focus will be identified. It is important to take an X-ray of the bones to identify areas of bone thinning and destruction, and thickening of the periosteum. It is often necessary to distinguish manifestations of osteomyelitis from cancerous bone lesions, the development of rheumatism, and purulent arthritis. For these purposes, CT and MRI of the affected areas and specific studies can be used.

Complications

Osteomyelitis is dangerous due to complications in the form of joint instability and bone deformations, pathological dislocations, changes in bone growth processes, and arthritis. At improper treatment or its absence, the process becomes chronic with progressive skeletal deformation. Damage to the spine can lead to profound disability with immobilization; damage to the jaws threatens changes in the face and the spread of infection to the cranial cavity. Damage to the hip leads to immobility.

Treatment

What can you do

Osteomyelitis is a dangerous purulent disease that has serious complications, self-medication is unacceptable. At the first symptoms you need immediate appeal to the doctor.

What does a doctor do

It is important to simultaneously influence both the pathogen and the child’s body in order to stimulate it to fight infection and restore bone tissue. All activities are carried out only in the hospital. Held immune treatment, stimulation of the immune system, as well as the introduction of vitamins and antibiotics to which the pathogen is sensitive. Antibiotics are injected into large doses, intravenously or into a muscle, in combination with drugs to protect the intestinal microflora. Local decompression is also indicated - pressure on the bone marrow and its vessels is removed, pathological tissue is eliminated. The affected area is fixed in a special way, special periostomy operations are performed - the periosteum is dissected and separated from the bone, the focus of suppuration is drained with the removal of dying tissue and pus. After the purulent focus is eliminated, the condition returns to normal, further rehabilitation methods are necessary - physical therapy and massage, sanitation of foci of infection, exposure to climatotherapy and hydrotherapy (sanatorium). Then twice a year they are treated with immunostimulating drugs, antiallergic and anti-inflammatory, as well as physical therapy to stimulate bone growth and restore tissue integrity. This includes laser therapy, magnetotherapy, vitamins, electrophoresis with antibiotics. It is important to regularly conduct x-rays to monitor the healing for three years; rehabilitation is required within the framework of sanatoriums.

Prevention

The basis of prevention is healthy image life and treatment of foci of chronic infection, prevention of injuries, good nutrition and strengthening the immune system.

Osteomyelitis is a serious bone disease that is quite common in childhood. Due to increased physical activity and frequent injuries, the disease is often diagnosed in children under one year of age. Clinical picture pathology can be mild, which makes it difficult to diagnose osteomyelitis at an early age.

What is osteomyelitis

Osteomyelitis is a purulent-necrotic inflammation of the bone, bone marrow, and nearby soft tissues, which occurs when pyogenic bacteria penetrate the bone.

Causes of the disease

The causative agents of osteomyelitis are most often streptococcal, staphylococcal infection, pneumococci, less often fungi, Proteus, salmonella, coli and other microorganisms that produce pus.

The entry points for infection are primarily wounds and lesions on the skin.

In addition, inflammation of bone tissue can develop against the background of an existing source of infection in the body - furunculosis, burns, otitis media, purulent tonsillitis, dental caries. Bacteria can reach any bone through the bloodstream, but most often in children the jaws, spine, shins, humerus and femurs are affected.

Osteomyelitis in newborns usually appears in the first 2 weeks of life and is the result of insufficient care, minor infected injuries or mastitis in the mother.

The infection begins to progress in the bone, then moves to the periosteum and cartilaginous tissue. An abscess occurs, which can turn into necrosis with late intervention.

Symptoms of osteomyelitis in a child

Acute osteomyelitis in infants can be easily confused with other diseases, since its main symptoms are:

• fever;
• vomiting, diarrhea;
• lethargy, weakness;
• anxiety;
• loss of appetite.

Upon examination, you can see redness of the skin in the affected area. The child spares the injured limb and tries not to move it or touch it.

At an older age, children complain of gradually increasing pain in the bone, which worsens with palpation or movement.

Redness and swelling of the infection site appears 3–4 days after infection. An abscess forms under the periosteum. With a breakthrough, the pain subsides, fluctuation, swelling, and redness are revealed.

Chronic osteomyelitis develops as a result of improper or incorrect treatment acute form. It is characterized by periods of remission and exacerbation, during which the above-described symptoms appear against the background of relative well-being. Cellulitis or fistulas may form in the area of ​​the affected limb, from which pus periodically appears.

With the development of acute odontogenic (inflammation of the jaw bones) osteomyelitis in children, the following symptoms appear:

• fever, chills;
• general malaise;
• elevation of the causative tooth above the dentition;
• loosening of adjacent teeth;
• hyperemia and severe swelling in the affected area;
• bad breath;
• sharp pain when closing the jaws;
• lymphadenitis, lymph node abscesses.

Types of disease

According to etiology, osteomyelitis is divided into:

1. Specific (syphilitic, tuberculosis, brucellosis).
2. Nonspecific (caused by pus-forming bacteria).

Depending on the method of penetration of bacteria into the body, the following types of osteomyelitis are distinguished:

1. Hematogenous:

• spicy;
• chronic.

1. Secondary:

• firearm;
• traumatic;
• spreading to the bone from another source of infection.

The disease can occur in two forms:

1. Acute (toxic, local, septicopyemic osteomyelitis).
2. Chronic (primary chronic osteomyelitis or a consequence of acute inflammation).

Complications and consequences

The most common complication of the disease is arthritis of the extremities. In addition, osteomyelitis can lead to the following consequences:

• bone deformation;
• destructive dislocation;
• poor posture;
• violation of musculoskeletal functions in general;
• bone growth disorder;
• complete immobilization;
• death as a result of sepsis.

Diagnosis and examination of the child

At the first signs of illness, it is necessary to show the child to a traumatologist. You may need to consult a surgeon. X-ray of the affected limb is not a reliable diagnostic method, since bone changes in children are initial stage inflammation (the first 2 weeks) is not visible in the picture. To confirm the diagnosis, the following examinations are used:

• general clinical blood test - indicates an inflammatory process;
• bone puncture followed by intraosseous thermometry and tonometry - the disease is indicated by an increase in the temperature inside the bone above 37.2 C and a pressure of more than 100 mm of water. St.;
• study of the leukocyte composition of bone marrow puncture;
• measurement of local temperature - temperature above inflamed area higher than the general one by 2 – 4C;
• electroradiography – reveals bone changes on the 3rd – 5th day of illness;
• DSA – diagnoses the focus of inflammation.

How to cure osteomyelitis

Treatment of the disease is based on a complex effect on the source of inflammation and the body as a whole. In most cases, hospitalization is indicated. Approximate treatment regimen for osteomyelitis:

1. Stimulation of immunity – Immudon, Immunal, vitamin therapy.
2. Desensitization – staphylococcal antiphagin or toxoid, filtrate, staphylococcal or streptococcal vaccine, bacteriophages.
3. Antibacterial therapy is the most effective antibiotic– Gentamicin, Kefzol, Lincomycin, Fuzidin.
4. Fixation of the affected area with a plaster splint.
5. When an abscess forms, it is opened and sanitized under local anesthesia. The pus can be pumped out immediately or a drainage can be installed for constant drainage of fluid.
6. In case of odontogenic osteomyelitis, the diseased tooth (the source of infection) is removed, the subperiosteal abscess is opened and the lesion is sanitized.

Rehabilitation after treatment

After discharge, the child is prescribed massage, exercise therapy, and balneotherapy. Twice a year preventive treatment is carried out:

1. Vitamins.
2. Immunomodulators.
3. Electrophoresis with antibiotic on the affected limb.
4. Laser and magnetic therapy.

Dispensary observation lasts for 3 years.

For complete healing of the limb, sanatorium-resort treatment is also important.

Prevention of pathology

Since osteomyelitis in children often develops after injury, it is necessary:

• protect the child from falls;
• immediately treat damaged tissue after injury.

To prevent the disease, it is also important to promptly eliminate foci of chronic infection (treat chronic tonsillitis, caries and other bacterial infections).

Doctor pays attention

1. Previously, osteomyelitis was considered a fatal disease, but now, with the widest choice of antibacterial drugs, the disease can be cured in a short time.
2. During treatment of the disease, the child should drink plenty of fluids and adhere to a plant-based diet.

Pediatric osteomyelitis is a serious problem that should not be neglected. The earlier the diagnosis is made, the more effective the treatment will be. If you do not contact a specialist in a timely manner, osteomyelitis may have severe consequences, even death.

Video for the article

The acute form of hematogenous osteomyelitis in children is serious illness with an acute onset and long period recovery. Takes up 25% of all purulent diseases occurring in childhood. The problem remains relevant, and approaches to treatment are constantly changing.

The disease mainly occurs in children aged 6-8 years. Boys get sick twice as often as girls. The disease affects both the epiphysis-epiphysiolysis (epiphyseal osteomyelitis) and the metaepiphysis (metaphyseal osteomyelitis). The localization of the process depends on the presence or absence of an ossification nucleus. In the first, the growth zone of the bone is affected. This causes the bone to stop growing in length.

In the twentieth century, there was a consensus that the cause of osteomyelitis is Staphylococcus aureus. Now pediatric surgeons are of the opinion that any microbe can lead to the development of the disease. Due to the rapid development of pharmacological science and the introduction into practice of many new antibiotics, this problem has lost ground a little. But this led to the emergence of osteomyelitis caused by microbial associations resistant to antibiotics.

Among the causative agents of the disease, the leading positions are occupied by:

• staphylococcus;
• streptococcus;
• coli.

IN skeletal system In middle-aged children, the microbe enters from the endogenous (internal) source of infection. The following can serve as a reservoir for microorganisms:

• carious teeth;
• tonsillitis and tonsillitis;
• purulent skin lesions;
• pneumonia;
• abscesses of internal organs.

Osteomyelitis in newborns can occur when infection occurs through the umbilical wound. Mothers of small children should be especially attentive and properly care for the child’s navel.

Concomitant factors for the development of the disease are immunodeficiency states, injuries, surgical interventions on the bones. The onset of the disease is also influenced by viral diseases, which significantly inhibit the reactivity of the child’s body. Favorable for the development of inflammation in the bone marrow is the presence of many capillaries through which microbes enter the bone. There are theories that the disease occurs only in sensitized children who have already had prolonged contact with the microorganism.

Symptoms of the disease

The clinical picture of the disease and symptoms of osteomyelitis in children have a variety of manifestations. There are many factors that picture a patient's symptoms and condition. What matters is the microorganism that penetrated the bone, the reactivity of the patient’s immune system, age, localization of the source of inflammation in the bone, the term of the disease, the measures taken to treat the patient.

There are three main forms of osteomyelitis:

• Toxic (adynamic) rapidly flowing form, reminiscent of bacterial toxic shock. Body temperature rises to high numbers (40-41 degrees), episodes of loss of consciousness are possible, severe vomiting and seizures. Shortness of breath, tachycardia, decreased blood pressure, and arrhythmia are observed. Pinpoint rashes appear on the skin, which are hemorrhages from the capillaries. The tongue is coated, the stomach is swollen and painful. Dysuric phenomena are present. Because of this turbulent overall picture, osteomyelitis is difficult to diagnose. Local manifestations are masked behind a mask of multiple organ damage. It is this form that most often ends in death.
• Septic-pyemic form. General phenomena remain strongly expressed. But the onset of the disease is not so rapid; it begins with pain in the affected limb and a rise in body temperature to 39-40 degrees. Manifestations of the disease increase as bacteria multiply and the amount of pus inside the bone increases.
• Local form. This form is characterized by the prevalence local symptoms over the general manifestations of the disease. TO local form include atypical manifestations. The onset is acute, manifests itself strongly, acute pain in the infected limb. Children can indicate the exact location of pain. Body temperature remains high (39-40 degrees). The child tries not to move the limb; even the slightest movement leads to increased pain. The child is lethargic, with signs of intoxication: headache, loss of appetite, apathy.

A local increase in temperature and redness of the skin in the affected limb develops in the later stages of the disease.

Chronic osteomyelitis in children has sluggish symptoms. It appears after the start of bone tissue repair. The main symptoms of chronic osteomyelitis in children include: a long course with remissions and exacerbations; during exacerbations, the temperature rises, fistulas appear, from which pus flows from time to time. Old fistulas may become scarred. The skin over the lesion is pale.

Palpation of the limb is slightly painful. Symptoms of general intoxication are noted.

Types of osteomyelitis

Depending on the location of the process, osteomyelitis of tubular and flat bones is distinguished. Tubular bones are affected much more often than flat bones. Among the tubular bones, they are affected femur, humerus, shin bones. Among the flat bones, the vertebrae are affected, upper jaw and pelvic bones.

By localizing the process in tubular bone highlight:

• hematogenous metaepiphyseal osteomyelitis;
• hematogenous epiphyseal osteomyelitis.

In infants, the onset of osteomyelitis occurs in the metaphysis, but due to the absence of an ossification nucleus, pus easily penetrates the growth zone and passes into the epiphysis and joint capsule, causing destruction of the cartilaginous surface of the joint.

Exist atypical forms illness, they are also called sluggish or asymptomatic. These include:

• Brody's abscess;
• local diffuse osteomyelitis;
• sclerosing osteomyelitis;
• albuminous osteomyelitis;
• antibiotic osteomyelitis.

Features of diagnosis in children

Diagnosis of osteomyelitis in a child includes a set of measures aimed at establishing the causes of the process and its localization.

• Objective examination. On examination, the limb is swollen, with a pronounced venous pattern. The pain intensifies with percussion of the affected area of ​​the bone. The presence of fluctuations and changes in skin color over the affected area indicates long-term and advanced osteomyelitis and an unfavorable prognosis.
• Laboratory diagnostics. In the blood test there is a sharp leukocytosis (20-30 * 109) with a shift of the formula to the left, toxic granularity of leukocytes, an increase in SOE and C-reactive protein.

To quickly make a diagnosis, use the method of measuring intraosseous pressure. Establishing the fact of its increase even without the presence of pus indicates the presence of osteomyelitis.

The most early method diagnosis is a method of radionuclide scanning of damaged bone. To carry out this examination, a substance called Technetium is used.

X-ray examination will be useful only from 10-15 days; benefit earlier can only be obtained with very high-quality X-ray machines. The most reliable sign osteomyelitis on x-ray is linear periostitis.

Treatment methods

Neonatal osteomyelitis requires immediate treatment. It is very important to prevent destruction of the growth zones.

Treatment different forms Osteomyelitis in children consists of three main principles:

• impact on the macroorganism;
• impact on the causative agent of the process;
• sanitation of the source of the disease.

The effect on the macroorganism is to combat intoxication, replace necessary nutrients and microelements. For detoxification, solutions of dextrose with insulin, dextran and aminophylline are used. Calcium preparations and chloropyramine are used for desensitization. The body is actively immunized by introducing hyperimmune staphylococcal plasma. Stimulates increased reactivity of the body.

The influence on the pathogen is carried out by prescribing antibiotics. If a known strain of the pathogen is observed, an antibiotic to which it is most sensitive is prescribed. In the absence of information about the microbe introduced into the body, broad-spectrum antibiotics are prescribed.

Sanitation of the lesion consists of reducing intraosseous pressure and removing pus and necrotic masses from the bone canal. To do this, make 2-4 perforations with a diameter of 4-5 mm. A drainage is installed in the holes, through which the bone is washed with antibacterial solutions.

Treatment of chronic osteomyelitis

Chronication of the process occurs after incomplete treatment acute osteomyelitis. At chronic form treatment consists of trephination of the bone, removal of sequestration and purulent granulations. After this, the cavity is treated with iodine. Antibiotics are prescribed. If a large bone cavity needs to be filled, a filling is made from the patient's blood and antibiotics, and then placed into the resulting cavity inside the bone.

In case of severe injuries, the injured limb is always immobilized after surgery.

Complications and consequences

Sometimes even with the right and timely treatment arise possible complications that worsen the patient’s quality of life.

TO frequent complications include the following:

• bone deformation;
• arthrosis and ankylosis;
• destruction of the bone growth zone;
• migration of microbes from bone to internal organs;
• chronicity of the process;
• damage to nearby tissues by pus;
• with vertebral osteomyelitis - damage to the spinal cord.

To maintain the health of children, it is necessary to carefully monitor their condition. If your baby develops symptoms, you should seek qualified help without self-medicating at home.