Prilog problemu hematogenog osteomielitisa

Abstract

The author first expounds the patho­anatomical changes and patho­physiological processes in acute hematogenous osteomyelitis, then follows is report on the clinical picture and his own treatment of the disease; the new therapy was successfully tried out and tested in a series of cases, 3 of which are fully dealt with here.

The material comprises 261 clinical oases treated in the course of 7 years.

From his long practical experience, the author comes to the conclusion:

a) that the hematogenous osteomyelitis is a septic disease that affects all organs simultaneously, yet having a special predisposition for the development of an inflammatory and destructive process in the long tubular bones of the extremities;

b) that it also affects the cardiovascular, hormonal and endocrine systems, which is especially manifest during the first, week of the disease and in the period of establishment of adaptational balance of the organism;

c} that any radical treatment in an acute stage of the disease does more harm than good, since the carrying out f trepanation and ­removal of a part, of bone tissue produces a severe shock which reacts harmfully upon the organism at a time reacts when it is spending all its power of 'resistance and adaptation in order to recover its balance in face of the infection attacking it;

d) that surgical interventions performed in an acute stage of osteomyelitis only damage the reactive· elements of the organism thus preventing a vigorous reproduction of the period and formation of a new bone to replace the delayed one, for the regenerating power will have spent itself in the fight with the operative shock and efforts to regain the balance;

e) that a surgical intervention performed some months later may cause a deficient formation of the new bone, as the periost is apt to lose its reactive and proliferative capacity owing to a protracted infection.

In consideration of the above, the author gives his views on the treatment as follows:

I. The treatment of hematogenous osteomyelitis should be conservative in the beginning, i.e. during the septic stage. All surgical interventions should be avoided except for a minimal incision of the subcutaneous, i.e. subperiosteal abscess, if necessary. The treatment consists in immobilization, administration of .antibiotics, vitamins, sulphonamides, cardiacs and frequent, but not strong, blood transfusions. The results are rather unsatisfactory except in a few cases when the therapy starts at an early of the disease, e. g. during the first 24 or 48 hours.

II. As a rule, the conservative treatment results in a partial success only, i.e. in an abatement of the acute clinical symptoms and improvement  in the general condition; however, the destructive process in the bone proceeds unimpeded until, 5­­6 weeks later, the greater part of the diaphysis, or even the whole of it, becomes affected. Only too often it happens that the acute symptoms reappear, too, when antibiotics therapy is discontinued.

III. When the process in the bone seizes upon one part or the whole diaphysis, and the acute symptoms disappear, a radical removal. of the diseased bone is proceeded with, i.e., a partial or total diaphysectomy is performed.

IV. In place of the removed diaphysis we implant a plaster tube, previously prepared, containing 2,000.000 i. e. of penicillin and 5­­12 gr. of sulphanimides, or better still, those antibiotics to which the agents of the disease are found to be sensitive.

The plaster tube with the drugs mentioned serves for several proposes:

a) it prevents a shortening of the extremities through muscle spasm, access to diaphysis, and irregular development of the new bone;

b) the antibiotics and sulphanimides, situated in all parts of the plaster tube, serve to keep this spot bacteriostatic during the period of bone­formation;

c) the remaining periost which is to grow the new bone rests on a strong calcium base stimulating its proliferation and ossification;

d) most of the calcium introduced into the organism, especially that of the children, may prove of great use stimula.thi.6 as it does the general resistance of the organism and the growth of the new bone;

e) the plaster tube becomes resorbed in 3-4 months leaving in its place a narrow cavity as medullary groove. As a result, the new formation has all the properties of a normal bone.

The results of this treatment were as follows:

1. Children were found to be free from fever the day following the operation;

2. The periost developed fairly quickly without a trace of pseudoarthrosis, which seldom happened formerly;

3. The new bone, which had developed along the plaster tube, was normal and regular in shape;

4. The period of treatment, which used to last one and a half years, was reduced to six months.