Osteomyelitis is an inflammation of the bone marrow, spreading to all bone elements, spongy and compact substance and periosteum. This means that this disease includes periostitis and. It can be caused by various pathogenic microflora, that is, viruses, protozoa, bacteria and fungi. The main causes are staphylococci, streptococci and pneumococci. The causes determine the type of disease. According to ICD 10, osteomyelitis is listed under code M86.

Causes and classification

To understand the reasons, it is necessary to delve a little deeper into the classification of the disease. The classification includes quite a lot of its types. Let's briefly consider the main and special types in order.

• Specific osteomyelitis that develops with bone tuberculosis, syphilis, brucellosis and so on.
• A nonspecific type caused by pyogenic bacteria.
• Hematogenous osteomyelitis. Pathogens of purulent infection penetrate through the blood from infected wound, abrasion, or a remote focus, for example, with an abscess, phlegmon, and so on. Acute hematogenous osteomyelitis is characterized by a progressive process in which inflammation becomes similar to phlegmon. Bone marrow necrosis develops. The process involves spongy tissue and lamina compacta. On the third or fourth day from the onset of the disease, pustules begin to form, after which the process spreads to the periosteum and soft fabrics. At timely treatment and a favorable course, the abscess may not develop, while the inflammation stops until the moment when areas of necrosis form. Cysts may form at the site of large foci of inflammation.

If acute hematogenous osteomyelitis has an unfavorable course, encapsulation of the abscesses into the bone occurs. Dead bone tissue does not dissolve and remains dense. Gradually, the dead areas are torn away from the surrounding bone tissue and create an obstacle to the healing of the source of the disease. They do not resolve on their own.

If osteomyelitis in this form continues to develop, intoxication is enhanced by dead bone parts deprived of nutrition. Inflammation from the tissues passes to the bone capable of life. If there are cracks in the bone, inflammation will spread along them below and above the injury, and sometimes can spread to the cavity of a vessel located nearby.

When the fracture heals, a callus forms in the damaged area, however, with osteomyelitis this does not happen at all or the process is very slow. Secondary fractures may form or occur.

• Classification of osteomyelitis according to ICD 10:
• M86.0 – acute hematogenous osteomyelitis;
• M86.1 – other forms of acute osteomyelitis;
• M86.2 - subacute;
• M86.3 – chronic multifocal;
• M86.4 – chronic osteomyelitis with drained sinus;
• M86.5 – other chronic hematogenous forms;
• M86.6 – other chronic osteomyelitis;
• M86.8 – another type;

M86.9 – unspecified type.

Symptoms

Symptoms of osteomyelitis depend on the severity of the disease and its nature. In the initial stages, it is difficult to identify the disease. Often clinical picture characterized by an acute onset of the disease, in which toxic and septic symptoms . High temperature. Older children experience chills, rapid heart rate, and lethargy. In the first days, osteomyelitis from the clinical side is not very pronounced, and the symptomatic picture may be limited to the general serious condition

• sick. A person may complain of bone pain that gets worse. The injured bone is sensitive to pressure. After a few days, swelling and local redness become noticeable. If an abscess ruptures, which is located under the periosteum, there is a decrease in pain, swelling, redness and fluctuation. Hematogenous form. Osteomyelitis in this form develops in children, mainly in boys under the age of one year. Cases of the development of this form in adults are usually considered relapses of an illness suffered in childhood. Acute hematogenous osteomyelitis is characterized by general malaise, muscle pain and aching limbs. These symptoms usually last for two days. After this, chills and a persistent increase in temperature begin, fatigue, weakness, severe headache . Vomiting is sometimes observed. The general condition of the patient is serious, convulsions may appear, consciousness is confused, appetite disappears. Such osteomyelitis also manifests itself as a dry, coated tongue, the appearance of delirium, sunken eyes, low blood pressure,, low urine output. From the first days of the disease, the pain is tearing and bursting. With small jolts in bed, children scream in pain, so they lie motionless.
• Post-traumatic osteomyelitis. It manifests itself as headache, fatigue, and weakness. In the area of ​​the fracture, the tissue is swollen, sharply painful and hyperemic. A lot of pus comes out of the wound.
• Traumatic form. If it is a firearm form, there will be elevated temperature, malaise, weakness, headaches, redness and swelling of the wound. There is usually no severe pain. In the acute traumatic form, a large, deep wound is formed. It quickly catches up. If the inflammation has spread to the bone, the person experiences pain outside the wound. Intoxication is expressed in varying degrees.
• Odontogenic osteomyelitis is manifested by poor health, general weakness, poor sleep, chills, headache, and fever. If intoxication with an anaerobic infection has occurred, the patient may initially be alert, even if he has heat body, however, after this a sharp loss of strength and blood pressure may occur. May appear cold sweat and other signs of the disease. This speaks of increased danger diseases.

The tongue is coated, you can feel it bad smell from the mouth, difficulty swallowing. The mucous membrane of several teeth is swollen and painful. Pus may ooze from under the gums. Acute odontogenic osteomyelitis lasts from 10 to 12 days, then a subacute stage begins. If the form of the disease is diffuse, acute period can last three weeks.

Diagnostics

First, the doctor must find out about all the symptoms that bother the patient. In addition, he personally checks the skin over and near the affected bone for sensitivity. To confirm osteomyelitis, it is important to get a blood test.

The doctor may biopsy the bone using a needle suction or through surgery. If he is performing aspiration, a needle is inserted through the skin into the bone and then a small piece of bone is removed for testing. The following research methods can be used to identify osteomyelitis and its form.

• X-ray;
• MRI or CT;
• PET - positron emission tomography, which is highly accurate for determining the chronic form of the disease.

Treatment

Complex treatment of osteomyelitis is carried out in inpatient conditions. It includes conservative and surgical methods. Conservative methods are based on the use of several types of drugs and therapies.

Surgical treatment of osteomyelitis is based on sanitation of the purulent focus and removal of areas of dead bone tissue. Also held recovery operations. There are no dietary restrictions. It is very important that the patient has a nutritious diet that contains plenty of proteins and carbohydrates.

Prevention

To prevent osteomyelitis, you should always clean cuts and wounds with alcohol and avoid touching them with your hands. After serious injuries and fractures, you should immediately consult a doctor.

Prevention of osteomyelitis, with an existing disease, includes preventing complications and the transition of the disease to the chronic stage. This means that it is necessary to consult a doctor promptly at the first signs. Self-medication is not an option; it will only worsen the patient’s condition. You must adhere to all doctor's recommendations and be attentive to your health.

Infectious inflammatory process involving everyone structural elements bones - periosteum, spongy and compact substance, bone marrow.

Osteomyelitis is a disease difficult character, leading to the development of serious complications and disability. In the development of the disease, 3 main factors play a significant role: the general condition of the body, its immunological defenses; infection as a trigger for the development of the disease; local circulatory and other morphological changes in the bones, contributing to the localization and development of infection.

Causes of osteomyelitis

Osteomyelitis is most often caused by the following bacteria:

• streptococcus;
• staphylococcus;
• salmonella;
• coli.

Less commonly, bone inflammation can occur as a complication of tuberculosis, syphilis, leprosy and some other diseases.

In order to get into the bone, bacteria have only two ways: internal and external.

In the first case, the infection is transferred along with the bloodstream from a distant pathogenic focus (hematogenous osteomyelitis). This can happen with caries, sinusitis, sore throat, intestinal fistula, etc.

In the second, trauma is the trigger. The infection penetrates the bone when open fractures, gunshot wounds, deep injuries and non-sterile surgical operations (traumatic osteomyelitis).

Classification of osteomyelitis

Based on their origin, they distinguish nonspecific osteomyelitis, the causative agents of which are most often cocci, and specific osteomyelitis, the development of which is caused by specific (tuberculosis, etc.) microflora.

The difference in the routes of pathogen penetration into the bone led to the identification of hematogenous (acute hematogenous and primary chronic) and non-hematogenous (traumatic, gunshot) osteomyelitis.

Hematogenous osteomyelitis is caused by internal microflora brought with the bloodstream from a distant focus; non-hematogenous is caused by external microflora entering the bone during wounds and operations. In addition, it is possible that inflammation can directly transfer to the bone from neighboring organs.

Clinically, acute and chronic osteomyelitis is distinguished, as well as primary chronic, including atypical forms, and osteomyelitis in certain infectious diseases (tuberculosis, etc.).

In most cases, the causative agent of acute nonspecific osteomyelitis is pyogenic coccal microflora, primarily staphylococci; less commonly, the disease is caused by streptococci and pneumococci.

The role of gram-negative microflora is also great, among which (in association with cocci or as a monoculture) Pseudomonas aeruginosa and coli, Proteus vulgaris, Klebsiella and some other microorganisms. Viruses also play a certain role, contributing to a decrease in the immunity of the macroorganism and an increase in the aggressiveness of microbes.

The chronic form of long-term osteomyelitis is usually caused by gram-negative microflora. The entry points for infection in hematogenous osteomyelitis can be the mucous membranes of the nasopharynx and mouth, the pharyngeal ring and the skin; at infants they are often umbilical wounds and skin rash. Foci of chronic infection are of great importance in the development of osteomyelitis.

Among the pathogenetic factors hematogenous osteomyelitis highlight the structural features and blood supply of bones, the phenomenon of sensitization (increased sensitivity) of the body by hidden bacterial microflora, immune deficiency, homeostasis disorder, changes in the properties of blood and blood flow, microvascular spasms, oxygen deficiency.

The development of non-hematogenous osteomyelitis is facilitated by trauma, increased sensitivity of bone tissue to infection, decreased overall resistance of the macroorganism, etc.

Acute hematogenous osteomyelitis begins with widespread inflammation in the bone marrow. Subsequently, the process progresses, inflammation takes on the character of phlegmon, bone marrow necrosis, involvement of spongy tissue and even the compact lamina are noted.

As a result of purulent melting and simultaneous delimitation of foci of inflammation, ulcers form already on the 3rd - 4th day from the onset of the disease. Further, the inflammation spreads to the periosteum (periosteum) and soft tissues.

With a favorable course of the disease, adequate treatment, early use antibiotics and high resistance of the macroorganism, the development of an abscess may not occur; inflammation stops before the formation of areas of necrosis. Cysts often form at the site of large inflammatory foci. In children, all traces of inflammation may disappear.

A less favorable course ends with encapsulation of ulcers in the bone. Dead bone tissue does not undergo resorption (resorption) and remains dense.

The process of rejection of the dead areas in the abscess cavity from the surrounding bone tissue, characteristic of osteomyelitis, gradually develops. As a result, such areas end up lying freely in the cavity of the abscess. They interfere with the healing of the osteomyelitis lesion and do not resolve on their own. Radiologically, foci of necrosis are detected by the 3-4th week of illness.

Chronic osteomyelitis develops as a result of ongoing inflammation in the bone. In a chronic process, clearly demarcated ulcers containing dead areas form in the bone. Exacerbations chronic osteomyelitis lead to complex bone damage and deformation.

Symptoms of osteomyelitis

The clinical picture is usually characterized by a hyperacute onset of the disease with septic, toxic symptoms. The temperature is high; in older children, osteomyelitis begins with chills; the pulse is rapid, the child is very lethargic and gives the impression of being seriously ill.

In the first days local symptoms Osteomyelitis is sometimes not expressed; the severe general condition completely determines the clinical picture.

The patient usually complains of bone pain; the pain intensifies, the affected bone becomes sensitive to pressure. Local redness and swelling are not early symptoms osteomyelitis, but after 2-3 days from the onset, when a subperiosteal abscess occurs, these signs are striking.

When an abscess located under the periosteum breaks through, the pain decreases and redness, swelling, and fluctuation are detected. There is high leukocytosis in the blood, there is a shift in the leukocyte formula to the left, but in a very severe cases At first, leukopenia is also observed.

Hemoculture of blood taken before the start of antibiotic therapy in the first days of the disease is usually positive. In the first 8-10 days X-ray bone does not reveal changes, since thickening of the periosteum and bone thinning appear later.

As the process drags on, the appearance of bone necrosis can often be detected only when the patient’s health and general condition are already good.

Descriptions of symptoms of osteomyelitis

Treatment of osteomyelitis

Osteomyelitis, which begins hyperacutely, with severe toxic effects, should now be considered a life-threatening disease. With early targeted treatment of osteomyelitis, the general condition quickly improves, but even now the disease lasts for weeks.

Osteomyelitis must be differentiated from purulent arthritis, rheumatism, and in the case of less pronounced general symptoms - from Ewing's sarcoma. In the initial acute period, before the development of local symptoms of osteomyelitis, a suspicion of a malignant infection arises.

Treatment of acute osteomyelitis

Complex treatment of acute osteomyelitis includes the triad:

• surgical treatment local pathological process;
• targeted effect on the causative agent of the disease;
• increasing the overall resistance of the body.

Surgical treatment involves osteoperforation of 2-3 areas along the length, which allows not only to open and drain the medullary canal, but also to achieve decompression, reduce pain, improve blood circulation in the affected area, and also prevent the spread of the process.

Antibiotics are prescribed taking into account the sensitivity of the microflora isolated from the wound; preference is given to broad-spectrum agents, since the process is often caused by microbial associations.

Often resort to combined use antibiotics, including agents that can act on anaerobes. Typically, long-term use of antibiotics in the treatment of osteomyelitis dictates the need for repeated antibiograms.

Increasing the general resistance of the body involves proper nutrition, the prescription of vitamins, microelements and immunostimulants, and adequate detoxification and symptomatic therapy.

Treatment of chronic osteomyelitis

Treatment of chronic osteomyelitis is aimed at eliminating the focus of bone destruction, which is only possible with a combination of radical surgical intervention And complex therapy(immunobiological, use of physical methods).

The leading role belongs to surgical treatment; and only decompensation cardiovascular activity, kidney or liver may be a contraindication for surgical intervention.

Questions and answers on the topic "Osteomyelitis"

Question:At the age of 6, I had osteomyelitis of the leg bones, which was cured. Now 66 years old, it makes itself felt. Can it resume?

Answer: Hello. This is possible, but to make a diagnosis and prescribe treatment, you should consult a doctor in person.

Question:Osteomyelitis metatarsal I have been suffering from diabetic foot for a year now. Tell effective method treatment. Is laser treatment possible?

Answer: Hello. Antibiotic therapy produces positive results in most patients, but diabetes mellitus There are usually concomitant liver dysfunctions, which contributes to frequent development side effects such treatment. The main therapeutic factor in the treatment of any disease associated with diabetes is compensation for high blood sugar using drugs to lower it - insulin or tablets. Laser osteoperforation is used to treat fistulous and contact forms of diabetic osteomyelitis.

Question:Hello, from 12 to 17 years old I had chronic hematogenous osteomyelitis of the femur, now I am 25 and I am 7 months pregnant. My leg hurts and it hurts to bend and straighten it, sometimes the temperature rises to 37. And 37.1, the surgeon said that this could be due to the load, I feel pain in the bone, what could it be?

Answer: Hello. This is a common occurrence. First of all, a woman’s weight increases, which puts stress on her legs. In addition, the center of gravity shifts, which also causes pain in the legs. Massage and physiotherapy help relieve pain and help prevent blood clots and blood stagnation. Swimming has great benefits.

Question:The fact is that my mother (56 years old) has one unpleasant systemic disease- lupus erythematosus, which greatly complicates her life, but now everything is much more important - a matter of life and death. About two months ago, she began to have difficulty walking, her temperature rose several times, an ambulance was called and she was taken to the hospital where she remains to this day. At first she walked, but now she doesn’t walk at all, the doctors did an MRI and diagnosed it as inflammation of the intervertebral discs in the area of ​​the shoulder blades and osteomyelitis, they injected her with several antibiotics, but there are no positive changes, she no longer walks at all and cannot feel her legs. It is impossible to operate with SLE. Please give me some advice on how to treat it? What antibiotics should I inject to get my mother back on her feet?

Answer: Good afternoon. Yes, osteomyelitis is treated with the introduction of antibiotics, taking into account the sensitivity of microorganisms, treatment of SLE is carried out with the use of NSAIDs and also with the use of hormonal drugs. Doses are prescribed individually, so I will not name specific drugs. In any case, the attending physician will prescribe what is necessary.

Question:Hello! I have chronic osteomyelitis of my left foot. In 2003, I underwent necrectomy surgery on the bones of my left foot. after that the disease did not make itself felt. In 2011, the wound opened. They put him in the hospital. During the examination they said that it was a callus and had nothing to do with osteomyelitis. In 2012, history repeated itself. Now the wound is healing but opening again. At the same time, at times the temperature rises to 37.5. After taking pictures, we found out that there were no changes in the bones. Tell me what this could be and how it can affect the development of the fetus. 15 weeks of pregnancy.

Answer: Good afternoon. Treatment of osteomyelitis is carried out with long courses of antibiotics and vascular drugs, and also, if necessary, include non-steroidal anti-inflammatory drugs, vitamins, and calcium supplements. Not all medications can be taken during pregnancy. Therefore, emphasis should be placed (where possible) on local treatment.

Question:On October 11, 2012, I had an operation to open the hip phlegmon, was given antibiotics for 9 days, wound drainage, and was discharged with recommendations for dressings. The wound healed, and two weeks later it became inflamed again and a fistula opened. Had an MRI. I have been diagnosed with: Chronic hematogenous osteomyelitis of the thigh, acute stage, fistulous form. She refused surgery and was prescribed a course of antibiotic therapy. The causative agent is Staphylococcus aureus. I have already been injected with Lincomycin, Sulperacef, Fortum for 10 days. The swelling went away and the wound closed. Tell me how long you can inject antibiotics, because... next clindamycin, then another MRI.

Answer: Good afternoon. Staphylococcus aureus (some of its strains) is extremely resistant to many known antibiotics, and it is extremely difficult to eliminate it from bone tissue, so the course of treatment can take up to 4 months, and subsequently it will be necessary to take short courses of antibiotics for prevention. I think it would be very necessary to “clean” the cavity in femur to mechanically remove most of the affected tissue.

Question:Please tell me what effective procedures to undergo in case of chronic ostiomilitis in order to stop further development of the disease, and Perhaps, as the doctors told me, I lost my arm? In which medical institution is it best to undergo effective treatment? And what procedures should I be offered in a hospital, during treatment at the local level, prevention?

Answer: For this disease, I recommend that you undergo a course of anti-inflammatory laser therapy for 15 sessions, take a three-week break and repeat the course. I think that in the end it will be possible to get good effect for recovery, and I think that this will lead to the fact that you will not have to undergo any surgical operations that could lead to the loss of your arm. But you will definitely need to be under the supervision of a doctor - an orthopedic surgeon, who will observe you and adjust your treatment.

Question:I am 23 years old. In September 2011, a diagnosis of subacute odontogenic osteomyelitis was made. lower jaw. In 2012, 3 operations were performed (in May, August, November) for marginal resection of the lower jaw. No further treatments were carried out by the hospital doctors. The tumor still persists, the pain is daily, I have been on painkillers for more than three years. In December I went for a consultation to Moscow at CENIIS, they were put on a waiting list for surgery: neuroma and discharge ternary nerve using microsurgical techniques. There is no 100% guarantee that the pain will go away. Tell me, please, where can I get help or treatment? Which medical institution, in which city, where else can you go with this disease? Maybe there are other methods of cure besides surgery, or other types of operations. And another question: is it possible to give birth with chronic osteomyelitis without harm to the child? After all, this is not life, but some kind of horror.

Answer: Unfortunately, the chronic form of osteomyelitis can only be effectively treated surgically. You need a personal consultation with a maxillofacial surgeon. Only a gynecologist can determine the safety of childbirth during a personal consultation (depending on your general condition health).

Osteomyelitis is a disease that includes inflammation of the bone (ostitis), periosteum (periostitis), and bone marrow (myelitis). The route of infection into bone tissue can be hematogenous (with blood flow). This type of bone osteomyelitis is more common in childhood and adolescence. Hematogenous osteomyelitis usually develops after infections (otitis media, sinusitis, measles, scarlet fever, caries, pneumonia). There are 3 possible forms of the process: septic-pyemic, local, adynamic (toxic).

Exogenous entry of infection is possible - from the external environment. This is observed in open injuries with damage to bone tissue, gunshot wounds, after surgery on bones using metal structures(post-traumatic osteomyelitis) and when the inflammatory process moves from soft tissue to bone (contact), this occurs with an abscess and phlegmon. Let us consider in detail how osteomyelitis is treated, what kind of disease it is, and how to recognize it.

The causative agents of hematogenous osteomyelitis are most often streptococci and staphylococci. With the post-traumatic development of infection, it can be a combination of microorganisms, often Pseudomonas aeruginosa, Escherichia coli.

Factors contributing to the development of osteomyelitis:

• smoking, drug addiction, alcoholism;
• vascular diseases (atherosclerosis, varicose veins);
• foci of chronic infections;
• oncological diseases;
• splenectomy;
• elderly age;
• decreased immunity;
• prolonged hypothermia;
• stress;
• malnutrition.

According to the variants of the course, acute, chronic, fulminant, protracted, and also primary chronic osteomyelitis, including atypical forms, are distinguished. These include Brody's abscess, Ollier's albuminous osteomyelitis, Garre's sclerosing osteomyelitis, and antibiotic osteomyelitis.

According to the localization of the process, osteomyelitis of tubular, flat, mixed bones. Osteomyelitis of tubular bones is divided according to location into diaphyseal, metaphyseal, epiphyseal, mixed (metaphyseal, etc.), total.

Clinic

There are general and local symptoms of osteomyelitis. General manifestations nonspecific, they are caused by bacteremia. These are chills, increased body temperature, tachycardia, weakness, fatigue, decreased performance, and drowsiness.

After a few days, local signs of osteomyelitis appear in the affected area: redness of the skin, swelling, local rise in temperature, limitation of movements, pain, a feeling of bursting inside the bone in the affected area. The pain syndrome increases with movements and tapping on the bone.

Later, fistulas with purulent discharge appear. After the fistula breaks through, pain and other signs of inflammation decrease. In chronic osteomyelitis, the presence of old fistula tracts can be seen.

Atypical forms differ in their characteristics. Brody's abscess is characterized by a poor clinical picture. This form of osteomyelitis develops with good immunity. Localization of the pathogen is formed by encapsulating an intraosseous abscess. Pain is detected when the bone is tapped. The X-ray picture is specific - periostitis is weakly expressed, a cavity is found in the bone.

In albuminous osteomyelitis, the soft tissue around the bone becomes saturated with fibrin. Radiologically, the picture of periostitis is not clearly expressed; fibrinous deposits are detected.

Antibiotic osteomyelitis occurs when antibiotics are taken irrationally. The concentration of the drug is insufficient to destroy the microbe. It is encapsulated. The clinic is sluggish, asymptomatic.

With sclerosing osteomyelitis, a subacute onset is noted, with an increase in temperature to subfebrile levels. Periods of remission are followed by exacerbation. Sclerosis of the bone marrow canal occurs, which is confirmed by x-ray.

Diagnostics

In addition to examining the patient, questioning complaints, and ascertaining the medical history, laboratory examinations (CBC, urine, blood biochemistry), and radiography are carried out.

A blood test determines an increase in the level of leukocytes, a shift in the leukocyte formula to the left, increase in ESR. These changes are characteristic of inflammation.

X-ray changes do not appear immediately. They are delayed by 10–14 days compared to the clinic.

An x-ray can identify signs of periostitis, osteoporosis of bone tissue, and sequestration. Against this background, there may be a pathological fracture.

In addition to radiography, there are more accurate diagnostic methods that can detect pathology at an early stage. These are CT and MRI. And on computed tomography You can only see the layer-by-layer structure of bone tissue, and MRI, in addition, will also give an idea of ​​the condition of the soft tissues. MRI is the method of choice for diagnosing osteomyelitis.

An additional examination method is ultrasound, which allows one to determine the presence of purulent leaks, fistulas, the condition of the periosteum, and blood circulation.

When performing fistulography, a contrast agent is injected into the fistulous tract and pictures are taken. Thus, it is possible to identify the true size and direction of the fistula.

Radionuclide diagnostics is a modern, expensive research method for osteomyelitis. It is based on the ability of radioactive drugs to accumulate in the lesion of bone tissue.

After confirming the symptoms of osteomyelitis with data instrumental methods examinations begin to treat him.

Treatment

Treatment of osteomyelitis is carried out in an inpatient setting at a specialized O departments (traumatology, surgery), follow-up treatment is possible on an outpatient basis. The patient must be provided with adequate nutrition containing sufficient amounts of proteins, fats, carbohydrates, vitamins and minerals.

A set of measures is used, including conservative and surgical treatment. Let's consider conservative methods.

Antibiotic therapy - broad-spectrum drugs are prescribed. Lincomycin has the ability to penetrate bone tissue. It is the drug of choice in the treatment of osteomyelitis. In severe cases of the disease, a combination of 2-3 drugs is used.

If there is such a possibility, then the sensitivity of the causative agent of osteomyelitis to various antibiotics is determined and treatment is carried out taking this into account. It is better to use the injection method of administering antibiotics (intravenous, intraarterial, intramuscular). It is more effective compared to taking tablet forms. Intraosseous administration of drugs during surgery is also used.

Immobilization of the damaged area. For this purpose, a plaster splint is applied. Creating immobility of the affected area helps reduce inflammation.

Normalization of microbial flora. To do this, in parallel with taking antibacterial drugs, Bifiform, Linex and other drugs that restore intestinal biocenosis are prescribed.

Plasmapheresis, hemosorption, ultraviolet or laser irradiation of blood are carried out to stimulate the body's defenses and remove toxins.

The abscess is opened surgically, washed, drained, sequestered, purulent, and fistulas are removed. Bone perforation (osteoperforation) is performed in several places, and the bone marrow canal is washed with antiseptics.

This helps to decompress the medullary canal, reduce pain, improve blood supply to areas of inert tissue, and stimulate bone tissue regeneration. Replenishment of the bone defect is carried out by performing osteosynthesis with an Ilizarov apparatus, filling bone tissue, and autotransplantation of its fragments.

After the acute process subsides, in rehabilitation period exercise therapy, physical therapy are prescribed ((lack of movement), contracture (limited mobility) in the joints arises due to long-term immobilization, formation of scar adhesions due to purulent inflammation in the joints;

• Are common:
• sepsis;
• anemia due to chronic disease;

Amyloidosis internal organs(usually kidneys), developing as a result of a long course of the infectious process. Preventing the development of complications is to seek medical help early. It is necessary to promptly diagnose and properly treat the disease.

Video: About the most important thing: osteomyelitis

Sources

1. Traumatology and orthopedics. Textbook for students medical institutes edited by Yumashev G.S. Publishing house "Medicine" Moscow. ISBN 5-225-00825-9.

Inside the bones is Bone marrow. When it becomes inflamed, osteomyelitis develops. The disease spreads to the compact and spongy bone substance, and then to the periosteum.

What it is

Osteomyelitis is an infectious disease that affects the bone marrow and bone. The causative agents of the disease penetrate the bone tissue through the bloodstream or from neighboring organs. Infectious process may primarily occur in the bone when it is damaged due to a gunshot wound or.

In pediatric patients, the disease mainly affects the long bones of the upper or lower limbs. In adult patients, the incidence of osteomyelitic process in the spine increases. In people with diabetes, the disease can affect the bones of the feet.

This pathology was considered incurable before the invention of antibiotics. Modern medicine deals with it quite effectively using surgical removal necrotic part of the bone and a long course of potent antimicrobial agents.

There are several theories about the development of the disease. According to one of them, proposed by A. Bobrov and E. Lexer, an accumulation of microbes (embolus) forms in a distant focus of inflammation. Through the blood vessels it enters the narrow terminal arteries of the bones, where the speed of blood flow slows down. Microorganisms settled in this place cause inflammation.

It is also assumed that the basis of the disease is allergization of the body in response to a bacterial infection.

If microbial agents are weakened and the body’s immune response is strong enough, osteomyelitis can become primary chronic without suppuration and bone destruction.

The development of inflammation in the bone substance causes the formation of sequestration - a specific sign of osteomyelitis. This is a dead part that is spontaneously rejected. Vascular thrombosis occurs around the sequestration, and blood circulation and bone nutrition are disrupted.

Immune cells accumulate around the sequestration, forming a granulation shaft. It manifests itself as thickening of the periosteum (periostitis). The granulation shaft well distinguishes dead tissue from healthy tissue. Periostitis, along with sequestration, is a specific sign of osteomyelitis.

Classification

Clinical classification of osteomyelitis is carried out according to many criteria. The more precise the diagnosis, the clearer the treatment tactics become.

Types of disease depending on the pathogen:

• caused by nonspecific microflora (gram-positive or gram-negative): staphylococcus, pneumococcus, streptococcus, proteus, Escherichia coli and Pseudomonas aeruginosa, less commonly anaerobes:
• caused by one type of microbe (monoculture);
• associated with association 2 or 3 different types microorganisms.
• specific for infectious pathology:
• syphilitic;
• leprous;
• tuberculosis;
• brucellosis;
• other.
• no pathogen was detected.

Exist clinical forms diseases:

• hematogenous:
• after an infection of another organ;
• post-vaccination;
• other.
• post-traumatic:
• after fractures;
• after operation;
• when using spoke devices.
• firearms;
• radiation;
• atypical (primary chronic):
• Brody's abscess;
• Ollier and Garré osteomyelitis;
• tumor-like.

Flow options:

• generalized:
• septicotoxic;
• septicopyemic;
• isolated toxic.
• focal:
• fistulous;
• fistulaless.

Character of the current:

• acute (in particular, lightning);
• subacute;
• primary chronic;
• chronic.

The following stages of the osteomyelitic process are distinguished:

• acute;
• subacute;
• ongoing inflammation;
• remission;
• exacerbation;
• recovery;
• convalescence.

Defeat phases:

• intramedullary (only the bone marrow is affected);
• extramedullary.

Based on localization, osteomyelitis of tubular and flat bones is distinguished. In long tubular bones, different parts can be affected: epiphysis, diaphysis, metaphysis. Among the flat bones affected are the skull, vertebrae, shoulder blades, sit bones and ribs.

Local complications of osteomyelitis:

• sequestration;
• fracture;
• bone, paraosseous or soft tissue phlegmon;
• pathological dislocation;
• formation of a false joint;
• ankylosis;
• joint contractures;
• violation of bone shape and development;
• bleeding;
• fistulas;
• vascular complications;
• neurological complications;
• muscle and skin disorders;
• gangrene;
• malignancy.

Variants of the disease with common complications:

• amyloid damage to the kidneys and heart;
• severe pneumonia with lung collapse;
• inflammation of the pericardium;
• sepsis;
• other.

The most common variants of the disease are acute hematogenous (in childhood) and chronic post-traumatic (in adult patients).

The disease most often affects certain bones of the human body.

Osteomyelitis of the thigh

It is observed in people of any age, most often of hematogenous origin, but often develops after surgery on the bones. Accompanied by swelling of the thigh, fever and impaired mobility of adjacent joints. A large fistula forms on the skin, through which pus is discharged.

Osteomyelitis of the leg bones

It is observed more often in adolescents and adults, and often complicates the course of tibia fractures. Accompanied by redness and swelling of the lower leg, severe pain, the formation of fistula tracts with purulent discharge. First affected tibia, but then the fibula always becomes inflamed. The patient cannot step on his foot.

Osteomyelitis of the calcaneus

Unlike the forms described above, it usually has a long course and often complicates infectious diseases feet, for example, with diabetes. The main signs are pain and swelling in the heel, redness of the skin, and the formation of an ulcer with the release of purulent contents. The patient may have difficulty walking while resting on the front of the foot.

Osteomyelitis of the shoulder

It often occurs in childhood, has an acute course, accompanied by fever, swelling, and pain in the arm. As the disease progresses, pathological fractures are possible.

Metatarsal osteomyelitis

Develops with insufficient care surgical treatment wounds resulting from a foot injury. It can also complicate the course of diabetes. Accompanied by pain and swelling of the foot, difficulty walking.

Vertebral osteomyelitis

Develops mainly in adults against the background of immunodeficiency or septic condition. Accompanied by back pain, headache, palpitations, weakness, fever.

Causes

The vast majority of cases of the disease are caused by staphylococci.

These microorganisms are widespread in external environment. They are found on the surface of the skin and in the nasal cavity of many healthy people.

Microbial agents can penetrate bone matter in different ways:

1. Through blood vessels. Bacteria that cause inflammation in other organs, for example, pneumonia or pyelonephritis, can spread through the vessels into the bone tissue. In children, the infection often penetrates into the growth areas - the cartilaginous plates at the ends of the tubular bones - the humerus or femur.
2. Infected wounds, endoprostheses. Microorganisms from punctures, cuts and other wounds enter muscle tissue, and from there they spread to the bone substance.
3. Fractures or operations when infectious agents enter directly into the bone substance.

The bones of a healthy person are resistant to the development of osteomyelitis. Factors that increase the likelihood of pathology:

• recent injury or surgery to bones or joints, including hip or knee replacement;
• implantation of a metal bracket or wires during osteosynthesis;
• animal bite;
• diabetes with high content blood sugar;
• peripheral arterial diseases, often associated with atherosclerosis and smoking, for example, atherosclerosis or obliterating endarteritis;
• the presence of an intravenous or urinary catheter, frequent intravenous injections;
• hemodialysis;
• chemotherapy for cancer;
• long-term use of glucocorticoid hormones;
• injection drug addiction.

Diagnostics

The doctor examines the area around the affected bone to determine if the tissue is red or tender. A blunt probe is used to examine fistulas.

Blood tests reveal signs of inflammation - an increase in ESR and the number of white blood cells. Blood and fistula discharge are subjected to microbiological examination to recognize the type of microorganism and determine antibacterial agents, effectively destroying it.

Basic diagnostic procedures for osteomyelitis - imaging tests.

X-ray of bones is used to identify necrotic areas of bone - sequestra. Fistulography - the introduction of a radiopaque substance into the fistula tract - is used to study internal structure fistula In the early stages of the disease, X-ray examination provides little information.

Computed tomography is a series x-rays taken from different positions. When analyzed, a detailed three-dimensional picture of the affected bone is formed.

Magnetic resonance imaging is a safe research method that allows you to recreate in detail the image of not only the bone, but also the soft tissue surrounding it.

A bone biopsy is performed to confirm the diagnosis. It can be performed in the operating room under general anesthesia. In this case, the surgeon cuts the tissue and takes a piece of the inflamed material. A microbiological examination is then carried out to identify the causative agent.

In some cases, a biopsy is taken under local anesthesia using a long, strong needle passed to the site of inflammation under X-ray guidance.

Symptoms of bone osteomyelitis

Signs of osteomyelitis:

• fever and chills;
• bone pain;
• swelling of the affected area;
• dysfunction of the affected limb - inability to raise an arm or step on the affected leg;
• the formation of fistulas - holes in the skin through which pus is released;
• poor health, in children - irritability or drowsiness.

Sometimes the disease occurs with almost no external manifestations.

You should seek medical help if you have a combination of fever and pain in one or more bones.

The doctor must conduct differential diagnosis with the following diseases:

• infectious arthritis;
• intermuscular hematoma, including festering;
• bone fracture.

Chronic osteomyelitis of bone

This form most often serves as the outcome of an acute process. A sequestral cavity is formed in the bone substance. It contains loose pieces of dead bone tissue and liquid purulent discharge. The contents of the sequestration box are released through the fistulas onto the surface of the skin.

The development of the disease is wave-like: the closure of the fistula is replaced by a new phase of inflammation and pus discharge. When the exacerbation subsides, the patient's condition improves. Skin temperature normalizes, pain disappears. Blood counts are approaching normal. At this time, new sequesters are gradually formed in the bone substance, which begin to be rejected and cause an exacerbation. The duration of remission can be several years.

Signs of relapse resemble acute osteomyelitis. Inflammation and pain occur in the affected area, a fistula opens, and soft tissue phlegmon may develop. The duration of relapse is determined by many conditions, primarily the effectiveness of treatment.

Primary chronic forms occur without signs of an acute stage. Brodie's abscess is a single round cavity in the bone substance, surrounded by a capsule and located in the bones of the leg. The abscess contains pus. Severe symptoms There is no inflammatory process, the disease is sluggish. During exacerbation, pain occurs in the leg, especially at night. Fistulas do not form.

Sclerosing osteomyelitis is accompanied by an increase in bone density and periosteal layers. The bone thickens and takes on a spindle shape. The medullary canal narrows. This form is difficult to treat.

Acute osteomyelitis

The most common variant of this process is hematogenous. It is observed mainly in boys. Phlegmonous inflammation of the bone marrow canal develops.

The toxic variant occurs at lightning speed and can lead to the death of the patient within a few days. The septicopyemic variant is characterized by the presence of ulcers not only in the bone substance, but also in the internal organs.

Most patients have local form diseases. The disease begins suddenly. There is a feeling of fullness and intense pain in the limb, more often near the knee, shoulder or elbow joints. It intensifies with movement. Body temperature rises.

There is pallor of the skin, rapid breathing and pulse, lethargy and drowsiness. The limb is in a bent position, movements in it are limited. Swelling and redness of the skin occurs above the area of ​​inflammation. There is severe pain when tapping in the affected area or in the direction along the bone axis.

X-ray changes appear only 2 weeks after the onset of the disease.

Treatment of bone osteomyelitis

In case of an acute process, urgent hospitalization is required. Treatment is carried out using surgery and medications.

The operation includes osteoperforation - creating a hole in the bone, cleaning and draining the cavity. In severe cases, purulent leaks in the muscles are opened and bone trephination is performed. After cleansing the bone of pus, intraosseous lavage begins - the introduction into the cavity through plastic catheters of antimicrobial substances - antibiotics, chlorhexidine, rivanol, as well as enzymes.

Complex conservative treatment includes:

• antibiotics in high doses;
• detoxification (injection into a vein of solutions of plasma, albumin, hemodez, rheopolyglucin), forced diuresis;
• correction of acid-base imbalances using intravenous infusion sodium bicarbonate;
• stimulation of tissue repair (methyluracil);
• immunomodulatory agents and vitamins.

If the disease is caused by staphylococcus, specific immunotherapy methods can be used to treat it - staphylococcal toxoid, staphylococcal vaccine, gamma globulin or hyperimmune plasma with increased content antimicrobial antibodies.

Immobilization of the limb using a splint is mandatory. After subsiding acute inflammation Physiotherapy procedures are prescribed - UHF, magnetic field and others. Hyperbaric oxygen therapy is one of the effective procedures for osteomyelitis. It involves inhaling an air-oxygen mixture in a special chamber under pressure. This helps not only to improve the blood supply to all tissues, but also to speed up the healing process of the purulent lesion.

The prognosis of the disease is usually favorable, and it ends in recovery. However, in some cases the disease becomes chronic course.

The basis of treatment for the chronic variant is sequesternecrectomy. During this operation, bone sequestra are removed, bone cavity is cleaned, the fistulas are excised. The resulting cavity is drained. You can close them with special plastic materials.

For pathological fractures, long-term osteomyelitic process, and limb shortening, the method of compression-distraction osteosynthesis using the Ilizarov apparatus is used. Surgeons first perform a sequesterectomy and process the edges of the bone, removing all foci of infection. Then several wires are passed through the bone above and below the pathological focus. The spokes are secured with metal rings surrounding the leg or arm. Metal rods are placed between adjacent rings, parallel to the axis of the limb.

Using knitting needles and rods, the bone fragments are pressed against each other. At their junction, a fusion gradually forms - a callus. Its cells are dividing quite actively. After fusion of the fragments, surgeons begin to gradually move the rings away from each other, increasing the length of the rods. Stretching of the callus leads to the growth of new bone and restoration of limb length. The treatment process is quite long, but this method has many advantages compared to other types of surgery:

• low morbidity;
• lack of plaster immobilization;
• the patient's ability to move;
• the ability for the patient to independently perform distraction (stretching) after a little training;
• restoration of healthy bone tissue, completely replacing the osteomyelitic defect.

In extreme cases, amputation of the limb is performed. It is indicated for the development of extensive phlegmon, especially caused by anaerobes, or gangrene of the limb.

After surgery, conservative treatment is prescribed. It includes the same drugs as for the acute form.

With proper treatment, the prognosis is favorable. However, relapses of the disease cannot be ruled out. Persisting osteomyelitis can lead to renal amyloidosis and other complications.

Antibiotics for osteomyelitis

The problem of adequate antibacterial therapy is the need to quickly select effective drug, acting on the maximum possible number of suspected pathogens, and also creating high concentration in bone tissue.

Osteomyelitis is most often caused by staphylococci. Most severe course The disease is associated with infection with Pseudomonas aeruginosa. In conditions of long-term osteomyelitis, surgical operations, associated diseases, microorganisms often become insensitive to broad-spectrum antibiotics, for example, cephalosporins and fluoroquinolones.

Therefore, linezolid is preferred for empirical therapy. A less good choice would be vancomycin, since many bacteria become resistant to it over time.

Linezolid is administered intravenously. It is well tolerated. The most common side effects include nausea, loose stool and headache. The medicine can be used in children of any age; it has almost no contraindications. It is released under trade names Zenix, Zyvox, Linezolid. Amizolid and Rowlin-Routek are available in oral forms.

Vancomycin is administered intravenously. It is contraindicated in the first trimester of pregnancy and during breastfeeding, with neuritis of the auditory nerve, renal failure, individual intolerance. The drug is available under trade names Vancomabol, Vancomycin, Vancorus, Vancocin, Vero-Vancomycin, Editsin.

In severe cases, the most modern antibiotics are used - Tienam or Meropenem. If the microbial association that caused the disease contains anaerobic microorganisms, metronidazole is added to therapy.

Before prescribing antibiotics, it is necessary to obtain material for microbiological research. After obtaining the results of the sensitivity of microorganisms, the drug can be replaced with a more effective one.

The duration of the course of antibiotics is up to 6 weeks.

Sometimes treatment begins with broad-spectrum antibiotics that affect staphylococci:

• protected penicillins;
• cephalosporins;
• fluoroquinolones;
• clindamycin and others.

However, such treatment must be supported by data on the sensitivity of the isolated microorganisms.

Simultaneously with long-term antibacterial therapy, it is necessary to prevent intestinal dysbiosis using such agents as Linex, Acipol, fermented milk products with live bacteria. If necessary, appointed antifungal drugs(nystatin).

Folk remedies for bone osteomyelitis

After treating osteomyelitis in a hospital and discharging the patient home, you can use some folk recipes to prevent the transition to a chronic form or the development of an exacerbation:

• make a decoction of oat grass (in a pinch, oat bran) and make compresses from it on the sore limb;
• do alcohol tincture lilac: pour a full three-liter jar of flowers or buds with vodka and leave in dark place within a week, use for compresses;
• take 3 kg walnuts, remove the partitions from them and fill these partitions with vodka, leave in a dark place for 2 weeks; take a tablespoon three times a day for 20 days;
• lubricate the affected area with aloe juice or make a compress from crushed leaves;
• grate a large onion, mix with 100 g of laundry soap; Apply the mixture to the skin near the fistula at night.

Complications

Osteomyelitis can cause complications from surrounding tissues or the entire body. They are associated with the direct spread of infection, circulatory disorders, intoxication, and changes in metabolism.

A pathological fracture occurs at the site of sequestration due to minor trauma. In this case, the patient cannot step on his foot, abnormal mobility of bone fragments appears, and pain and swelling are possible.

Cellulitis is a diffuse purulent inflammation that can involve the bone, periosteum or surrounding muscles. The disease is accompanied by fever, intoxication, pain and swelling of the limb. Without treatment, it can lead to blood poisoning - sepsis.

When the ends of the bones are destroyed, pathological dislocation in the hip, knee, shoulder, elbow and other joints is possible. It is accompanied by a violation of the shape of the limb, pain, and the inability to move an arm or leg.

One of frequent complications osteomyelitis – false joint. The free edges of the bone formed after surgery to remove a purulent focus do not fuse, but only come into contact with each other. In this place the bone remains mobile. There is dysfunction of the limb, pain in it, and sometimes swelling. Muscle weakness and atrophy occurs. Treatment for pseudarthrosis is quite long. The use of an Ilizarov apparatus is often necessary.

Ankylosis occurs during fusion articular surfaces bones affected by osteomyelitis, for example, due to long-term immobility of the limb. It is accompanied by a lack of movement in the joint.

As a result of excision of fistulas and compaction of surrounding tissues, joint contracture may develop - a decrease in its mobility.

Pathological fractures, false joints, ankylosis, contractures lead to deformation of the limb, the inability to walk or work with hands.

Arrosive bleeding may occur, accompanied by constant blood loss and the formation of an interstitial hematoma. Suppuration of the surrounding soft tissues leads to the development of diffuse purulent inflammation - phlegmon. This dangerous complication in some cases requires limb amputation.

In chronic osteomyelitis, the vessels and nerves passing near the bone are significantly affected. The blood supply to the final (distal) part of the leg or arm deteriorates, the tissues swell, and lack oxygen. Prolonged pain in the limb appears, possibly numbness and a feeling of tingling of the skin. Irritation by purulent discharge from the fistula leads to the development of dermatitis and eczema. When it becomes excessively dry, flaky, and itchy skin. If the patient begins to scratch the skin, secondary infection and suppuration often appear in the wounds.

In some cases, osteomyelitis develops malignant tumor bone - osteosarcoma, which has a high degree of malignancy and grows rapidly.

With a long course of osteomyelitis, metabolic processes in the body are disrupted. The tension of compensatory mechanisms leads to increased production of protein necessary for the healing of bone tissue. At the same time, pathological protein formations may appear, deposited in the kidneys and other organs. This is how a frequent complication of chronic osteomyelitis develops – amyloidosis. It is manifested mainly by symptoms of renal failure - edema, increased blood pressure, and impaired urination.

Pathogenic microorganisms from a purulent focus can enter any organ through the blood vessels, causing inflammation. One of the most common general complications is pneumonia. The outer sac of the heart, the pericardium, is also affected. Blood poisoning – sepsis – often occurs.

Prevention

If a patient has risk factors for osteomyelitis, he should be aware of them. It is necessary to take all measures to prevent various infections, avoid cuts and scratches, and treat skin injuries in a timely manner. People with diabetes need to constantly monitor the condition of their feet to prevent skin ulcers from developing.

Dental caries should be treated promptly chronic tonsillitis, cholecystitis, pyelonephritis. To increase the body’s nonspecific defense, it is necessary to monitor nutrition and physical activity, lead healthy image life.

Osteomyelitis is an inflammatory process in the bone marrow that spreads to the surrounding bone substance. It can have an acute or chronic course and is manifested by bone pain, fever, intoxication, the formation of cavities and fistulas with purulent discharge. Treatment includes surgery and massive antibiotic therapy.

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Treatment of osteomyelitis folk remedies may complement traditional drug therapy. Healing herbs have beneficial properties, leading to the cleansing of the inflammation from pus. Traditional treatment includes the use of other agents that have a pronounced antiseptic effect.

Why treatment must be approached with caution

Due to the entry of pyogenic bacteria into the bloodstream, and from there into the bone, surrounding tissue (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, septicopyemic form). The patient's condition can be characterized as moderate severity or satisfactory (local form and ).

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

A serious illness requires equally serious treatment. Only a doctor can make a correct diagnosis. Any self-medication may be pointless and harmful to the patient’s health, so consultation with specialists is necessary before starting to take any of the alternative medicines.

Traditional medicine has long used a number of medicinal plants that help reduce inflammation and necrosis. Natural substances such as propolis or mumiyo, which have wound healing and antiseptic properties. Properly combining antibiotics and strength natural medicines, you can achieve significant relief of the patient’s condition and overcome a complex disease.

Applications of plants

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

Plantain juice has just such properties. It is better to treat chronic osteomyelitis in winter pharmaceutical 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 small squares; it is better to find grass in the countryside or in the forest.

Fresh leaves need to be crushed into a paste in such quantity as to squeeze out 1 tbsp. l. juice

Plantain juice should be prepared for immediate use only. Take 1 tbsp fresh juice. l. 20–30 minutes before meals. The dose is repeated 3 times a day. The course of treatment with this remedy is limited only by its availability, since the herb has no toxic properties.

Other good remedy, which can also be prepared for the winter - comfrey root. The plant can be collected independently outside the city, in damp places (near streams or ponds, in ravines and bushes). Comfrey is easy to grow and summer cottage as a large and quite beautiful design element.

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

1. The decoction in milk is taken orally, 1 teaspoon 3 times a day before meals. To prepare a decoction, pour the powder from the dried root (1 tsp) with boiling milk (1 l) and simmer the drug in the oven for 4 hours at a temperature of +100ºC.
2. An alcohol tincture is prepared from 100 g of dry root powder and 500 ml of vodka. The product must be infused in the dark for 2 weeks, and then taken 50 drops (children 20 drops), diluted in 1 tbsp. l. water. Take 3 times a day before meals.
3. An ointment with comfrey root is also prepared for external use. To do this, take 1 part by weight of dry root powder, 0.5 parts of pine resin (resin), 3.5 parts of melted internal lard of a pig or poultry (goose, duck), badger fat. The components must be combined and kept in a water bath for 2.5 hours, stirring constantly. The ointment is applied to sore spot 2 times a day, applying the mass to a bandage and securing it to the body.

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

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

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

Home treatments

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

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

The healing properties of salt

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

The healing properties of cooking and sea ​​salt can also be used in the treatment of osteomyelitis. Salt dressings and baths will cleanse the fistula cavities well from pus, but if the inflammation is closed, they are ineffective. 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 secured with a bandage and changed as needed.

A bath salt solution is prepared in the volume necessary to immerse the sore limb in it. During your appointment salt bath massage the fistula area, helping the solution penetrate into its cavity. The procedure can be performed daily for 30 days.

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

How to use Vishnevsky ointment and soap?

Vishnevsky ointment includes:

• Birch tar;
• xeroform;
• Castor oil.

These components have 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 bone osteomyelitis with Vishnevsky ointment. To do this, the mass is applied to a bandage and the area of ​​inflammation is covered with it. When treating fistulas, tampons with ointment are placed in the cavity and bandaged. Bandages and tampons need to be changed 2-3 times a day. The total duration of treatment is 1–3 weeks.

Tar soap contains the same birch tar, which is one of the active components of Vishnevsky’s 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 the soap and mix with fresh onion pulp (100 g). Spread the composition on a cloth and apply to the site of inflammation or fistula, changing the dressings 2-3 times a day.

Believers can turn to God in prayer or read a spell against caries (as healers call osteomyelitis). Among the folk methods of getting rid of this painful illness, methods such as homeopathy are quite appropriate.

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