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
Laser osteoperforation
Laser osteoperforation in
the patient with nonunion of tibial bone complicated with fistulous osteomyelitis.
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.
Results of treatment of acute hematogenous osteomyelitis
Results of treatment of chronic hematogenous osteomyelitis
Results of treatment of chronic posttraumatic osteomyelitis
