| disease | Sclerosing Osteomyelitis |
Sclerosing osteomyelitis, also known as Garre's disease, idiopathic cortical sclerosis, and dry osteomyelitis, is a rare condition. The cause of the disease is unknown, and pathogenic bacteria are difficult to identify. It may sometimes be related to injury. Injury leads to subperiosteal hematoma, which calcifies. This disease mostly occurs in young adults, with males more affected than females, and patients are often physically robust, such as athletes. Long bones are frequently involved, with the tibia being the most common site in the lower limbs.
bubble_chart Etiology
This disease is a progressive, extensive, and sclerosing inflammation of the bone. The inflammatory reaction leads to widespread fibrosis within the bone marrow cavity, causing circulatory disturbances and a decrease in oxygen tension within the bone. This promotes the proliferation, deposition, and calcification of osteoid tissue beneath the bone membrane, along with the obstruction of Haversian canals, resulting in reactive thickening of the bone membrane. The bone cortex undergoes spindle-shaped hyperplasia, leading to a series of pathological changes. These changes are relatively localized and mild. Unlike typical suppurative osteomyelitis, it does not produce abscesses, sequestra, or fistulas. In a few cases, some wounds may exhibit pus and granulation tissue, and cultures may reveal the growth of Staphylococcus aureus.
General symptoms are not obvious, and local symptoms may sometimes be absent or include inflammatory reactions such as swelling and pain. Tenderness and distending pain are often more severe at night than during the day. The disease progresses slowly and may be aggravated by trauma or other conditions, but the joints are mostly unaffected.
X-ray examination: In the initial stage (first month), no abnormalities are observed. Over time, diffuse thickening and sclerosis of the cortical bone may be seen, with no clear boundary from normal bone. The medullary cavity becomes narrower or obliterated, indicating hyperplasia of the intramedullary membrane and new bone formation.
(1) Sclerotic osteosarcoma occurs in adolescents, typically in the metaphysis rather than the diaphysis, with radial proliferation and the presence of a periosteal triangle. Delayed treatment may lead to lung metastasis.
(2) Ewing's sarcoma affects younger patients, progresses rapidly, and resembles acute suppurative osteomyelitis. Symptoms include high fever, chills, severe pain, and elevated serum AKP levels. X-rays show an onion-skin appearance of the cortical bone, with destruction and expansion of the medullary cavity.(3) Osteoid osteoma presents as cortical hyperplasia on one side of the upper diaphysis, with a small translucent area in the center, resembling a nest.
(4) Syphilitic osteitis is characterized by a positive Wassermann test, painless multiple bone hyperplasia, and bilateral symmetry.
(5) Paget's disease, also known as osteitis deformans, commonly affects the elderly, is multifocal, and involves the lower limbs, causing bone thickening and curvature. The disease progresses slowly, with mild pain and possible local low-grade fever. X-rays show thickened cortical bone, an enlarged medullary cavity, and irregular trabecular patterns. Compensatory thickening occurs on the convex side, with elevated serum AKP levels and normal blood calcium.
bubble_chart Treatment Measures
(1) Non-surgical treatment: The efficacy is extremely poor. Antibiotics, physical therapy, and Chinese medicinals for {|clearing heat and removing toxin, invigorating blood and resolving stasis|} can be used.
(2) Decompression surgery: Drilling for drainage or grooving, removing inflammatory granulation tissue in the medullary cavity, placing antibiotics, and the wound can heal at the {|initial stage [first stage]|}.
