Chronic Hematogenous Osteomyelitis Research Articles

Surgical treatment of patients with total chronic hematogenous osteomyelitis of tubular bones

Surgical treatment of patients with total chronic hematogenous osteomyelitis of tubular bones

Total ankle arthroplasty in an adolescent who suffered hematogenous osteomyelitis of tibia

Introduction Acute hematogenous osteomyelitis can persist as chronic infection in pediatric patients due to delayed diagnosis and treatment. An extended bone defect of the limb caused by osteomyelitic destruction is a rare clinical scenario in pediatric surgery. Metaepiphyseal and articular involvement suggests specific and long-term treatment with a high risk of disability.The objective was to report a clinical case of a teenager who suffered chronic hematogenous osteomyelitis of the tibial bones and raise awareness of primary diagnosis and treatment.Material and methods A clinical case of a teenager treated for extensive destruction of the tibial bones caused by chronic hematogenous osteomyelitis is reported. Clinical and functional evaluation of the effectiveness was produced at the stages of treatment.Results A positive functional result was achieved due to staged surgical treatment including radical debridement of the chronic infection nidus followed by total ankle arthroplasty.Discussion Acute hematogenous osteomyelitis persisting as chronic infection could be caused either by a wait-and-see strategy when the patient first sought medical help or a long-term follow-up. There is no consensus on the use of reconstruction or replacement of large long bone defects extended to the joints caused by chronic infection. Staged treatment including total joint replacement with custom-made endoprosthesis can be one of the options.Conclusion Staged surgical treatment including radical debridement followed by delayed total joint replacement with custom-made endoprosthesis provided satisfactory functionality for the limb without signs of infectious and inflammatory activity at a follow-up period of more than a year.

Microbiological Evaluation of Paediatric Chronic Haematogenous Osteomyelitis in a Tertiary Care Hospital in Northern India and its Association with Radiological Appearance: A Retrospective Study

Introduction: Chronic osteomyelitis in the paediatric age group is a frequent complication of improperly treated acute haematogenous osteomyelitis, leading to devastating complications such as pathological fractures and deformities in affected children. There is a growing need to comprehend the disease process and develop improved treatment strategies. Aim: To evaluate bacterial culture and antibiotic sensitivity patterns in children and adolescents with chronic haematogenous osteomyelitis in North India and to explore associations between radiological patterns and antibiotic sensitivity. Materials and Methods: The present retrospective study was conducted in the Department of Orthopaedics of tertiary care centre, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, North India, from July 2018 to June 2020. Total 100 children and young adolescents with chronic osteomyelitis who reported to OPD of hospital with pus discharge from an extremity persisting for more than six weeks, along with radiological features indicative of chronic osteomyelitis. Parameters such as site of infection, illness duration, blood parameters, bacteriological culture reports, etc., were examined. Radiological evaluation was performed using the Beit CURE (BC) classification. Data were analysed and represented in the form of frequencies and percentages. The Chi-square test was used to compare proportions, with significance set at p-value<0.05. Results: The median age of the study population was 13 years, there were 32 (32%) females and 68 (68%) males. The majority of cases (70%) belonged to the B1-B3 group. Staphylococcus aureus was responsible for 86 (86%) cases, followed by Pseudomonas aeruginosa in 7 (7%) cases. Out of the 86 Staphylococcus aureus (S. aureus) isolates, 58 (67.44%) were Methicillin-resistant Staphylococcus aureus (MRSA). Multidrug resistance was observed among gram-negative species, as well. Pseudomonas aeruginosa showed resistance to fluoroquinolones in 4 (57%) cases, aminoglycosides in 2 (28%) cases, and carbapenem in 1 (14%) case, which is considered highly effective in treating serious infections caused by multidrug resistant Gram-negative species. No significant association was found between drug sensitivity patterns and radiological features in the present study. Conclusion: Staphylococcus aureus remains the most predominant organism isolated from deep tissue cultures. Among S. aureus isolates, MRSA was the most frequently identified. Identifying the causative organism may be challenging in some cases. Among cases where the offending microbe was identified, drug resistance was widespread among both Gram-negative and Gram-positive specimens. No significant relationship was found between the radiological appearance of infected bone and the pattern of antibiotic resistance.

Vitamin D deficiency triggers intrinsic apoptosis by impairing SPP1-dependent antiapoptotic signaling in chronic hematogenous osteomyelitis

Chronic hematogenous osteomyelitis (CHOM) is a common bone disease characterized by the development of sequestra after bacterial infection. Emerging evidence has shown that vitamin D (VD) deficiency raises the risk of osteomyelitis, but the underlying mechanisms remain obscure. Here, we establish a CHOM model in VD diet-deficient mice by intravenous inoculation of Staphylococcus aureus. Whole-genome microarray analyses using osteoblast cells isolated from sequestra reveal significant downregulation of SPP1 (secreted phosphoprotein 1). Molecular basis investigations show that VD sufficiency activates the VDR/RXR (VD receptor/retinoid X receptor) heterodimer to recruit NCOA1 (nuclear receptor coactivator 1) and transactivate SPP1 in healthy osteoblast cells. Secreted SPP1 binds to the cell surface molecule CD40 to activate serine/threonine-protein kinase Akt1, which then phosphorylates forkhead box O3a (FOXO3a), blocking FOXO3a-mediated transcription. By contrast, VD deficiency impairs the NCOA1-VDR/RXR-mediated overexpression of SPP1, leading to the inactivation of Akt1 and the accumulation of FOXO3a. FOXO3a then upregulates the expression of the apoptotic genes BAX (Bcl2-associated X-protein), BID (BH3 interacting death domain), and BIM (Bcl2-interacting mediator of cell death), to induce apoptosis. Administration of the NCOA1 inhibitor gossypol to the CHOM mice also promotes the occurrence of sequestra. VD supplementation can reactivate the SPP1-dependent antiapoptotic signaling and improve the outcomes of CHOM. Collectively, our data reveal that VD deficiency promotes bone destruction in CHOM by the removal of SPP1-dependent antiapoptotic signaling.

Clinical effects of early debridement, internal fixation, and Masquelet technique for childhood chronic haematogenous osteomyelitis of long bones

BackgroundChildhood chronic haematogenous osteomyelitis (CCHOM) is a severe condition in paediatric patients. The optimal timing of debridement and the subsequent method of bone reconstruction in CCHOM patients remain controversial. The purpose of this study was to assess the treatment efficacy of Masquelet technique with early debridement and internal fixation in CCHOM of long bones.MethodsBetween January 2016 and January 2021, a total of 21 patients (18 males, 3 females) with CCHOM of long bone were included. The mean age was 10.4 years (range, 2–18 years). All cases were treated by a two-stage surgical protocol of Masquelet technique. In the first stage, aggressive debridement, sequestrectomy, and inducing membrane by bone cement spacer were performed after definite diagnosis. In the second stage, cement spacer was removed, and autologous and allogeneic bone was grafted. Internal fixation was used for the first and/or second stage depending on stability requirements. The patients’ clinical and imaging results were retrospectively analysed.ResultsThe mean follow-up was 31.7 months (range, 21–61 months). None of the patients experienced recurrence of infection. Radiographic bone union time was 4.3 months (range, 2.5–11 months). Five cases underwent re-operation due to complications such as bone resorption or refracture. By the last follow-up visit, bones had healed and all of the patients had resumed daily living and sports activities.ConclusionThe Masquelet technique with early debridement and internal fixation is a viable surgical method for the management of large long bone defects of CCHOM patients.

Analysis of the epidemiological status, microbiology, treatment methods and financial burden of hematogenous osteomyelitis based on 259 patients in Northwest China.

The incidence of hematogenous osteomyelitis is on the rise, and the prognosis is poor. There has been no large-scale epidemiological analysis of hematogenous osteomyelitis in the world, and the treatment method is still controversial. A retrospective case study method was used to collect and analyze clinical data obtained from patients with hematogenous osteomyelitis in a tertiary hospital in Northwest China from January 1, 2011, to December 31, 2020. The aim of this study was to investigate the epidemiological status, microbiological characteristics, treatment and financial burden of hematogenous osteomyelitis in Northwest China to explore the therapeutic effects of different treatment methods, elucidate the epidemiological characteristics of hematogenous osteomyelitis and to provide a basis for the choice of treatment. We included 259 patients with hematogenous osteomyelitis, including 96 patients with acute hematogenous osteomyelitis and 163 patients with chronic hematogenous osteomyelitis. The cause of the disease was not obvious in most patients, the sex ratio of males to females was 1.98, and the three most common infected sites were the tibia, femur and phalanx. Regarding preoperative serum inflammatory markers, the rate of positivity for ESR was the highest at 67.58%. Among pathogenic microorganisms, Staphylococcus aureus was the most common. Regarding the financial burden, the median total cost per patient was 25,754 RMB, and medications accounted for the largest proportion of the main costs. The most common pathogen associated with HO infection was MSSA. Oxacillin has good PK and PD and is recommended as the first-line drug. Some blood-borne bone infections may lead to complications, such as pulmonary infection through bacteremia, which requires early detection to avoid a missed diagnosis. Regarding surgical intervention, debridement plus absorbable calcium sulfate bone cement and calcium sulfate calcium phosphate bone cement exclusion have achieved good therapeutic effects, but they are worthy of further in-depth research. Regarding the financial burden, the median total cost per patient was 25,754 RMB. The financial burden of blood-borne osteomyelitis was lower than that of traumatic osteomyelitis. Among the main costs, drugs accounted for the largest proportion.

Observation of role of orthofix limb reconstruction system in with non-union with bone loss shortening due to fresh fractures

The nonunion can develop after an open fracture, after 1oUs open reduction and internal fixation (ORIF), or as a sequela to chronic hematogenous osteomyelitis. The incidence also seems to be increasing especially in view of increasing high velocity trauma, which is usually treated by internal fixation. It is difficult to treat infected nonunion, because of the following reasons. Aim of the study is to observe the role of Orthofix limb reconstruction system as a treatment in non-union with bone loss with shortening due to fresh fractures. In the last twenty-five months we had the opportunity to treat thirteen cases of non-union and two cases of shortening With Limb reconstruction system. Out of thirteen patients eight patients had infected nonunion following open fracture and three patients had infected nonunion following previous surgeries with internal fixation for closed fractures and two patients had nonunion following treatment with traditional bone setters for closed fractures. Our follow up of cases varied from six to fifteen months. The results were divided into bony results and functional results, according to the classification of the ASAMI (Association for the study and application of the method of Ilizarov).

Muscle plastics in the complex treatment of chronic hematogenous osteomyelitis of long bones

The necrobiotic substrate is removed from the inflammatory focus, and a bone cavity is formed, which should be most expediently filled.

Culture-negative chronic hematogenous osteomyelitis in a two months old girl: a case report

BackgroundPrevious articles have focused on the diagnosis and treatment of acute hematogenous osteomyelitis. Here, we present a case of chronic hematogenous osteomyelitis in a 2-month-old girl. The diagnostic procedure was unusual and difficult due to negative culture results.Case presentationA girl aged 2 months and 23 days had fever and swelling in her right lower leg for 7 days. On the basis of her medical history, physical, and histological examination results; and radiologic and magnetic resonance imaging findings, a diagnosis of chronic osteomyelitis was made. The patient underwent surgical treatment and was discharged successfully. The patient showed good recovery and no sequelae at the 12-month follow-up.ConclusionHematogenous osteomyelitis in babyhood is different from that at any other age. Hematogenous osteomyelitis-related bone destruction in babyhood is more serious and occurs faster. The transition from acute hematogenous osteomyelitis to chronic hematogenous osteomyelitis takes only 7 days. To the best of our knowledge, this chronic hematogenous osteomyelitis patient is the youngest ever reported.

Reliability of the Penny and Beit CURE Radiologic Classifications of Pediatric Patients with Chronic Hematogenous Osteomyelitis in the Philippine General Hospital

Objective. This study aimed to evaluate the inter- and intraobserver reliability of the Penny and Beit CURE radiologic classifications of pediatric patients with Chronic Hematogenous Osteomyelitis (CHOM) in the Philippine General Hospital (PGH).
 Methods. Thirty-four pre-operative radiographs of PGH pediatric patients with CHOM were classified by seven orthopedic surgeons using both Penny and Beit CURE Classification systems. Two sets of radiographs were sent to the surgeons twice, four weeks apart, to classify. The Fleiss and Cohen κ statistics were used to determine inter- and intraobserver reliabilities, respectively.
 Results. The Penny Classification had a slight to fair interobserver reliability (Fleiss κ = 0.17 and 0.24) and a fair intraobserver reliability (Cohen κ =0.35) with a 49.58% average intraobserver agreement. The interobserver reliability when including all Beit CURE classification subtypes was fair (κ = 0.28 and 0.31). This improved to moderate (κ = 0.41 and 0.54) when using only the four main types of the Beit CURE classification with a 77.31% intraobserver agreement.
 Conclusion. The Beit CURE classification for pediatric CHOM had higher inter- and intraobserver agreement rates than the Penny classification. Further improvement in reliability can be made by combining B2 and B3 subtypes under the Beit CURE classification.

Generalized form of thoracic vertebral bodies chronic hematogenous osteomyelitis

The article presents a clinical observation of thoracic vertebrae bodies chronic hematogenous osteomyelitis, which proceeded with the formation of right-sided pyothorax, an abscess of the retroperitoneal space, an external fistula through an anatomically weak place of the posterior abdominal wall, complicated by severe sepsis. Complex staged surgical debridement of purulent foci in combination with intensive drug therapy led to the patient's recovery.

Treatment of Chronic Hematogenous Osteomyelitis in Children With Antibiotic Impregnated Calcium Sulphate.

The purpose of this study was to evaluate the clinical and radiologic outcome of chronic hematogenous osteomyelitis (CHOM) in children, treated with single-stage debridement and dead space management using antibiotic impregnated calcium sulphate pellets. The authors retrospectively evaluated a consecutive series of 34 patients who presented with CHOM from 2011 to 2017. In each case, CHOM was classified according to the Beit CURE classification. Following thorough surgical debridement, the resulting dead space in the bone was filled with the antibiotic impregnated beads before primary closure. Of the 31 patients available for follow up, effective regeneration of bone was confirmed in all cases, with radiographic bone healing typically observed at around 12 weeks. None of the children required reoperation for infection and none had recurrence of infection at the time of final review. The beads were completely absorbed within 3 months. No systemic adverse reactions to the local delivery of antibiotics were observed in this study. The authors found that single-stage debridement in conjunction with antibiotic impregnated calcium sulphate was an effective means of treating CHOM in children, with effective eradication of infection in every case. Level IV-Retrospective case series. See instructions for authors for a complete description of levels of evidence.

КЛИНИКО-МОРФОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА ХРОНИЧЕСКОГО РЕЦИДИВИРУЮЩЕГО ГЕМАТОГЕННОГО ОСТЕОМИЕЛИТА

The studied material of scanning and transmission electron microscopy were bone fragments of 40 patients obtained during surgery from various pathologically altered sections of the affected tubular bones. Morphological studies revealed microscopic foci of necrosis, leukocyte infiltrates and microabscesses both in the main focus and in other parts of the bone marrow canal. Microabscesses detected by microscopy represent the morphological basis of chronic hematogenous osteomyelitis, can be located at a considerable distance from the main necrotic purulent focus and, under appropriate conditions, cause a relapse of the disease. Morphological studies have shown that surgical debridement of the lesion with ultrasonic cavitation of the lesion and the medullary canal contributes to a significant reduction in the degree of microbial contamination, followed by a decrease in pathological changes in bone tissue.

Transdiaphyseal osteomyelitis: Review of literature and our experience at a tertiary care center

Chronic haematogenous osteomyelitis persists to be a key reason of musculoskeletal morbidity globally. It has remained a perennial dilemma for the orthopedic surgeon which levies a considerable healthcare burden. With regards to the treatment of chronic transdiaphyseal osteomyelitis numerous issues still remain unresolved. This was a retrospective study at a tertiary care centre from May 2015 to July 2019, analysing 13 patients (9 males and 4 females, mean age 21 years) who were diagnosed with chronic transdiaphyseal osteomyelitis. The clinical records of all patient were retrospectively evaluated and the data recorded. Osseous stabilizations in the form of intramedullary nails or external fixators were essential in 4 cases and plastic surgery reconstructions were required in 9 cases. Our objective in this article was to study the magnitude of the problem and to emphasize areas wherein optimum research might enhance the management of this condition. We have also reviewed the literature to summarise the existing research. We would like to report our experiences in the treatment of transdiaphyseal osteomyelitis patients admitted to our hospital.

Reactivation of chronic haematogenous osteomyelitis in HIV-infected patients

Background: The aim of the study is to determine the prevalence of HIV infection among adult patients with reactivation of haematogenous chronic osteomyelitis. Methods: A retrospective analysis of prospectively collected data from 143 adult patients with chronic osteomyelitis. Results: A total of 143 patients were included in the study group, with a mean age of 38 years (range 14–78 years). Twenty-two per cent (n=31) of patients were diagnosed with reactivation of chronic haematogenous osteomyelitis, while 78% of patients had contiguous chronic osteomyelitis (29% [n=42] post-operative and 49% [n=70] post-traumatic, respectively). Forty (28%) patients were found to be HIV positive with a mean CD4 count of 414 cells/mm³ (range 13–1 034 cells/mm³). Twenty-four (60%) of patients with HIV were on antiretroviral therapy at time of diagnosis. The prevalence of HIV infection among patients with contiguous (post-operative or post-traumatic) infections was 32%, in comparison to 13% in the group with reactivation of chronic haematogenous infections (p=0.04; OR 3.2; 95% CI 1.0–9.8). Conclusion: The prevalence of HIV infection among patients with reactivation of chronic haematogenous osteomyelitis appeared to be lower than that seen in patients with chronic osteomyelitis from other causes and lower than that seen in the general population in South Africa. Level of evidence: Level 4

Evaluation of the Operative Treatment in Chronic Haematogenous Pyogenic Osteomyelitis by Sequestrectomy and Saucerisation in Children

Background: Complete resolution occurs in many other types of infections with the use of antibiotics but not always with chronic pyogenic osteomyelitis.Objective: The aim of the present study was to evaluate the effectiveness of most conventional method of surgical treatment of chronic pyogenic osteomyelitis by sequestrectomy and saucerisation in Children.Methodology: This present study was a prospective study conducted at Bangabandhu Shekh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2015 to December 2016 for a period of two (2) years. Patients aged up to 16 years were included in the study. Purposive sampling was done. Only chronic osteomyelitis of haematogenous origin were included after proper selection of the patients. Sequestrectomy and saucerisation was done. Wound was kept open and allowed to heal from bottom and sides of the wound.Result: A total 36 patients aged up to 16 years were included in the study. Among the cases two third were male 26(72.23%) and rest were female 10(27.77%). The male female ratio was 2.6:1.Therefore the incident was significantly high in males (p<0.01). Most of the patients 28(77.77%) were in 6 to 16 age group, which was significantly high (p<0.01) and mean age was 9.83years. Average time taken for wound healing was 3.75 weeks. Regarding antibiotics, Cap Flucloxacillin was the maximum choice. Patients were followed up to maximum 2 years and evaluated clinically and radiologically. Maximum patients 31(86.10%) had satisfactory (good and fair) outcome, but only 5(13.88%) patients had poor outcome. There was a significant association among sequestrectomy and saucerisation with final outcome (p<0.001).Conclusion: It was concluded that describing operative technique is still method of choice for surgical treatment of chronic haematogenous pyogenic osteomyelitis.Bangladesh Journal of Infectious Diseases 2018;5(1):15-20

The Spectrum of Pediatric Osteoarticular Infections: A Comparative Study

Background There is a paucity of data relating to pediatric subacute or chronic hematogenous osteomyelitis (SCHO), non-hematogenous osteoarticular infections (NHO), and osteoarticular hardware infections (HI). A comparative analysis of the entire spectrum of pediatric osteoarticular infections was conducted to identify distinguishing clinical features and biological markers.Methods Using ICD9/10 code searches, we identified pediatric patients ≤18 years of age at Hasbro Children’s Hospital (2006–2016) and Nationwide Children’s Hospital (2015–2016) with osteoarticular infections. Cases of Lyme arthritis or ENT-related infections were excluded. Eligibility criteria were confirmed by reviewing medical records and clinical and laboratory data were collected systematically.Results428 children met inclusion criteria: 211 (49%) had acute hematogenous osteomyelitis (AHO), 61 (14%) suppurative arthritis (SA), 42 (10%) SCHO, 60 (14%) NHO, and 54 (13%) HI. The age distribution differed significantly across the five infection types: AHO (median, 9.2 years), SA (5.0), SCHO (10.2), NHO (11.5), and HI (14.5); P < 0.001. Median initial CRP values were significantly higher (P < 0.001) in AHO (65 mg/dl) and SA (44) compared with SCHO (15), NHO (15) and HI (24). An ESR >19 mm/hours at presentation was more sensitive than a CRP >8.0 mg/dl in identifying SCHO (80% vs. 64%; P = 0.035). Bacteremia occurred more frequently in AHO (42%) and SA (25%) compared with SCHO (7%), NHOI (5%) and OHI (4%); P < 0.001. Patients with HI had significantly more complications as reflected by more ICU admissions (33% vs. ≤3% for other groups), and longer antibiotic treatment durations (median, 65 vs. ≤37 days for other groups); P < 0.001 for each comparison. S. aureus was the most common organism isolated for all infections, but the proportion of other Gram- and Gram-negative pathogens was significantly higher in SCHO, NHO, and HI compared with AHO and SA (P < 0.001). The ratio of MSSA to MRSA among isolates was 3:1, and did not differ significantly across the infection types.Conclusion SCHO, NHO, and HI commonly present with minimal evidence of inflammation, and differ in the spectrum of causative pathogens compared with AHO and SA. Further studies are required to optimize the diagnosis and management of non-acute, non-hematogenous osteoarticular infections.Disclosures All authors: No reported disclosures.

Chronic haematogenous osteomyelitis of fibula diaphysis with pathological fracture and review of literature

Trochanteric femoral fractures are among the most common injuries necessitating hospital admission. Regardless the type of fracture, trochanteric fractures can lead to substantial morbidity and mortality, especially in elderly patients [1, 2]. Surgery is the mainstay of the treatment for both displaced and non displaced trochanteric fractures, to allow early mobilization of the patient, depending on the stability of the reduction and fixation achieved [4]. Dynamic Hip Screw [DHS] as extramedullary and Proximal Femoral Nail [PFN] as intramedullary systems are established and standard in treatment of trochanteric femoral fractures [5, 6]. Aim: To compare the results of Dynamic Hip Screw and Proximal Femoral Nail in the treatment of intertrochanteric fractures. Materials & Methods: In our study we compared DHS with PFN in a group of 60 patients admitted in a tertiary care hospital between August 2013 – December 2016. Patients with intertrochanteric fractures without having concomitant shaft femur or neck femur fractures were included. The preoperative morbidity was evaluated using Parker’s mobility scale. Salvati and Wilson’s scoring helped in measuring overall functional outcome at 16 & 24 weeks between the two study groups. Results: The preoperative Parker’s mobility scale was comparable between two study groups. Salvati and Wilson’s score at 16 & 24 weeks was significantly better with PFN group. The functional outcome based on SWS score was Fair in 39% of patients operated with DHS at 16 weeks while for PFN it was Fair to Good in 79% of patients. At 24 weeks it was Fair to Good in 84% patients operated with DHS while in case of PFN the score was Fair to Good in 59% of the patients & Excellent in 38% of the patients. Conclusion: Our conclusion from this study supported the use of PFN for both stable and unstable pertrochanteric fractures over DHS due to its lesser operation time, lesser blood loss, early weight bearing, limited open reduction & better functional outcome.

Morphological characteristics and correlation of chronic hematogenous osteomyelitis with latent clinical course (Garre type)

One of the clinico-morphological variants of osteomyelitis with latent course is sclerosing hematogenous osteomyelitis of the Garre type. Objective: on the basis of pathomorphological and gradation-morphometric studies of bone lesion, establish statistical differences between individual forms and correlation links between the morphological indices of lesions of the bone of patients with sclerosing hematogenous osteomyelitis. Methods: fragments of affected bones of 25 patients with clinically es­tablished sclerosing hematogenous osteomyelitis were studied. On the basis of pathohistological study, morphological indi­ces were identified, with the use of which gradation-frequency and correlation analysis of nonparametric data was carried out with the calculation of the association coefficient. Results: despite the general similarity of morphological manifestations, differences in the forms of sclerosing hematogenous osteo­myelitis were established: about ⅔ of all cases corresponded to the fibrosing form of the focus without the presence of exuda­tive inflammation. In the remaining cases, in addition to fibrosis and osteosclerosis, the foci of osteomyelitis contained microab­scesses, within which small sequestrations were found. Forms of foci of sclerosing hematogenous osteomyelitis can eventu­ally move from one to another. Between the fibrotic with micro-abscess formation of sclerosing hematogenous osteomyelitis and the presence of microsequesters in the microabscesses, a re­liable positive correlation was found between the mean force (ra= +0.620). Sequesters in tissues were not observed in the foci of fibrosis. Conclusions: sclerosing hematogenous osteomyelitis is a clinical variant with a latent course mainly in adolescent patients, in which there is no macrodefective damage to the bone marrow and bone tissue by an infectious inflammatory process, namely: large abscesses, significant sequestration, parasseous abscesses and fistulas.

Ultrastructure of the Bone Tissue in Chronic Recurrent Hematogenous Osteomyelitis in Children

Одной из актуальных проблем в гнойно-септической хирургии детского возраста является хронический рецидивирующийгематогенный остеомиелит, развивающийся после перенесенного хронического гематогенного остеомиелита. Несмотряна успехи, достигнутые современной медициной, хирургией в частности, по прежнему остаётся высока частота неудов-летворительных результатов лечения (42-50%) и рецидивов заболевания (58-78%). В связи с этим пациенты нередко под-вергаются неоднократным оперативным вмешательствам (73,9-80%), оставаясь неизлеченными десятки лет. Наиболеенеблагоприятным исходом хронического остеомиелита часто бывают ортопедические осложнения, которые встреча-ются по данным литературы в 31-71% случаев. Инвалидность после данных осложнений составляет от 16,2-53,7%.Патоморфологические изменения при остеомиелите, в частности при острой и хронической формах в настоящее времяизучены достаточно хорошо. Однако требования к диагностике и лечению рецидивирующей формы заболевания диктуютнеобходимость нового осмысления этого вопроса. Исследования с использованием комплекса морфологических методовс применением электронной трансмиссионной и сканирующей микроскопии и изучением полутонких срезов практическине проводились.С морфологической точки зрения, хронический остеомиелит характеризуется наличием изолированных гнойных очагов ссеквестрами, патологическими грануляциями, выстилающими склерозированные ткани внутренней и наружной стенкисеквестральной капсулы.Работа посвящена изучению морфологической структуры костной ткани у детей с хроническим рецидивирующим гема-тогенным остеомиелитом с применением светооптической, электронной трансмиссионной и сканирующей микроскопии.Ключевые слова. остеомиелит, костная ткань, дети, хирургическое лечение.