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Osteomyelitis is an infectious inflammation affecting bone marrow and then elements of bone tissue of one or several bones. This severe disease develops frequently after open fractures of tubular bones, operative treatment of the closed fractures of bones, gunshot fractures.

Most frequent forms of osteomyelitis are hematogenous and posttraumatic.

Hematogenous osteomyelitis develops usually in long bones (femoral, cannon, humeral). Pathogenes settle in fine branches of bone arteries where the blood flow is slow. This can be promoted by an insignificant trauma and concomitant edema. According to the clinical course osteomyelitis is subdivide into acute and chronic (developed from acute).

Posttraumatic osteomyelitis develops after open fractures. The main cause of disease is the extensive destruction of soft tissues and disturbance of blood supply in the bone with development of necrosis and suppuration centers.

According to the World Health Organization data (1999) osteomyelitis rates up to 7% among the musculoskeletal deseases. In 10 % of cases acute hematogenous osteomyelitis results in disturbance of joint function, affection of all anatomic formations of the joint, often with general body intoxication and development of sepsis.

In 25% of patients suffering from acute hematogenous osteomyelitis, process becomes chronic, frequently leading to disability, to disturbance of metabolism, liver and kidney functions. Lethality remains high (up to 9%).

Methods of treatment

Treatment of osteomyelitis is a difficult problem. Traditional methods of treatment are:

  • Surgical (exsicion of unviable sites of bone);
  • Mechanical osteoperforation (in the focus of lesion, the section of soft tissues is made and 5-7 holes are drilled in the bone for decompression of the medullar canal with the subsequent influx-and-extract drainage of paraossal spaces);
  • Infusion of broad spectrum antibiotics into the medullar canal;
  • Transosseous irrigation of osteomyelitis focus with antiseptic solutions.

Essential disadvantages of these methods are:

  • Disease often become chronic;
  • Methods are traumatic;
  • High frequency of bone reinfections;
  • Rough cosmetic and functional defects.

Scientists of the Center developed and introduced into clinical practice new low-traumatic treatment for various forms of osteomyelitis with laser surgery. The method is notable for small trauma of tissues, is well borne by patients, and suppresses inflammatory process in tissues quickly.

The laser osteoperforation is the most sparing method, not demanding a serious surgical intervention. Some holes in the zone of inflammation are perforated with high-power laser radiation, delivered through the thin quartz monofiber covered with special thermostable coating. Then the medullar channel thermotherapy with the lower power is fulfilled without extracting the light guide. Any additional incisions or drainage of soft tissues and medullar canal are not performed.

There were no deep thermal lesions of soft tissues and bones with the used modes of laser irradiation.

Scheme of laser osteoperforation for osteomyelitis

схема операции
Laser osteoperforation Laser osteoperforation in the patient with nonunion of tibial bone complicated with fistulous osteomyelitis.
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Dynamic bacteriological tests have shown fast debridement of the suppurative focus and decrease of pathogens number below the critical level. In all patients fast and stable positive effect of the treatment is marked. Complete recovery without turning into the chronic stage is achieved for acute hematogenous osteomyelitis; stable remission is received in more than 90 % of chronic osteomyelitis cases. During 2.5-4 years of observation, patients have been feeling well, neither relapses of diseases, nor exacerbation of the process have been marked. Purulent sinuses closed without assistance almost in all patients. In two patients having large sequesters and extensive bone lesions, it was not possible to eliminate the purulent process, but the treatment considerably improved their condition, reduced intoxication and allowed to prepare for operation and remove osteal sequesters successfully. It is necessary to note, that laser osteoperforation for osteomyelitis treatment does not demand antibiotics administration.

результаты лечения

Results of treatment of acute hematogenous osteomyelitis

результаты лечения

Results of treatment of chronic hematogenous osteomyelitis

результаты лечения

Results of treatment of chronic posttraumatic osteomyelitis

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