بررسي ويژگيهاي باليني و پاراكلينيك استئوميليت مزمن در جانبازان مراجعه كننده به بيمارستان ساسان در سال 1387 - 1385

Clinical and Paraclinical Features of Chronic Osteomyelitis in War Handicapped Patients in Sasan Hospital in 1385-1387

بيماري استئوميليت مزمن، يك عفونت استخوان است كه بيش از همه توسط باكتري هاي پيوژن و مايكوباكتري ها ايجاد مي شود. اين بيماري داراي خصوصيات مهمي چون سير باليني طولاني مدت، دوره هاي طولاني مدت خاموشي، موارد عود مكرر و عوارض جدي مي باشد كه درمان بيماري را بسيار مشكل مي نمايد و از لحاظ اقتصادي هزينه زيادي را در بر مي گيرد، نظر به آنكه تعداد زيادي از جانبازان جنگ تحميلي از عفونت مزمن استخوني رنج مي برند، هدف از اين مطالعه بررسي تظاهرات باليني و پاراكلينيك جانبازان جنگ تحميلي مبتلا به استئوميليت مزمن مي باشد. مواد و روش ها در اين مطالعه كه به روش مقطعي صورت پذيرفت، 40 نفر از جانبازان جنگ تحميلي كه با تشخيص قطعي استئوميليت مزمن در بيمارستان ساسان در طي سال هاي 1387 – 1385 بستري بودند مورد بررسي قرار گرفتند. جهت ثبت اطلاعات از فرم جمع آوري اطلاعات استفاده گرديد كه در آن مشخصات دموگرافيك، علايم كلينيكي و يافته هاي پاراكلينيك بهمراه سوابق بيماري هاي زمينه اي همراه ثبت گرديد. كليه اطلاعات توسط نرم افزار spss (نسخه14) آناليز گرديد. جهت بررسي رابطه بين سرعت سديمانتاسيون گلبول قرمز(ESR) قبل از درمان و نتيجه كشت از تست آماري مجذور كاي استفاده گرديد. نتيجه گيري با توجه به يافته هاي اين مطالعه، شايعترين علامت باليني استئوميليت مزمن، ترشح چركي در محل زخم و عمدتا«در استخوان هاي بلند مي باشد. آنمي بعنوان يك عارضه شايع در اين بيماران مطرح مي باشد. همچنين، شايعترين باكتري هاي رشد كرده در اين بيماران استافيلوكوك اورئوس و اشرشياكلي مي باشند كه مي توان جهت تعيين بهترين پوشش آنتي بيوتيكي در درمان هاي تجربي(Empiric) استفاده نمود.

Introduction. chronic osteomyelitis is the infection of the bone caused by pyogenic bacteria and mycobacteria. Regarding to the prolonged clinical progression, frequent recurrences and severe complications, treatment could be so complicated and the cost of treatment would be very high. considering the large amount of war handicapped patients suffer from the chronic infection of the bone, the aim of this study is to investigate clinical and paraclinical presentations of war handicapped patients infected to chronic osteomyelitis.Materials and Methods. This cross sectional study was performed in 40 war handicapped patients hospitalized in osteomyelitis center of Sasan Hospital from 1385 to 1387. all data including demographic properties, clinical and paraclinical findings with underlying diseases were extracted from medical records of each patient’s profile. Obtained data was analyzed by spss (Ver.14) software, in addition, chi-Square test was used to study the relation between pre-treatment ESR and the result of culture.Results. All 40 studied patients were male. The average age was 42.78+6.28 (X+S.D.) and the average duration of infection was 18.80+7.31. The most prevalent clinical presentations were discharge (90%) and pain (10%) as well. The most sites of infection were tibia (45%) and femor (25%) respectively. 15% of cases had diabetes mellitus and 40% were smokers. Anemia was seen in 72.5% of cases and Erythrocyte sedimentation rate (ESR) was found to be greater than 20mm in the first hour in 50% of patients.In addition, No significant difference was found between ESR pre-treatment and the result of culture (p Value = 0.24).67.5% of patients had positive culture of which 51.9% were Staphylococcus aureus and E.coli (33.3%), Pseudomonas aeruginosa (7.4%) and klebsiella spp (7.4%) were the next prevalent organisms. Conclusion. Regarding to the recent results, the most prevalent clinical sign of chronic osteomyelitis was Discharge especially in large bones. Anemia was found as a prevalent complication in these patients. In this study, The most common grown organisms were staphylococcus aureus and E.coli. Based on the results of this study, one can determine the best antibiotical coverage in empiric therapy.