PATHOMORPHOLOGICAL FEATURES OF BONE LESIONS AND CORRELATION OF CLINICAL, LABORATORY AND MORPHOMETRIC CRITERIA IN PATIENTS WITH LATENT SCLEROSING HEMATOGENOUS OSTEOMYELITIS (GARRÉ)

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Abstract

Introduction. Sclerosing hematogenous osteomyelitis of Garré (SHO) holds a significant place among cases of latent hematogenous osteomyelitis. Pathomorphological studies of sclerosing hematogenous osteomyelitis are needed to improve differentiated diagnostics, to prognosticate morphology specifics of nidus and to choose the optimal treatment tactics.

Purpose of the study — to identify statistical differences between manifestation patterns of various disease types and correlation between clinical, laboratorial and morphometric criteria of bone lesions in patients with sclerosing hematogenous osteomyelitis.

Material and methods. The authors studied tissue fragments of affected bones of 25 patients with SHO which was diagnosed by clinical, laboratorial, visualizing and morphological methods. Gradation morphometric criteria were used to reflect condition of nidus tissues. The authors made the analysis of qualitative characters and correlation analysis of dependencies between clinical and laboratorial criteria on the one hand, and with morphometric criteria — on the other, and identified association factor.

 Results. Pathomorphological study of SHO nidus demonstrated variances of bone lesions in separate disease cases despite the overall similarity of morphological manifestation. About 2/3 of all cases correspond to fibrosing type whereby even small exudative inflammation sites are absent. In about 1/3 of all cases apart from fibrosis, osteosclerosis and remodeling, the osteomyelitis niduses contain microabscesses indicative of suppurative inflammation as well as the authors observed small sequestration. The maximum differences in patients with various types of SHO were identified in such parameters as share of stab microphages and erythrocyte sedimentation rate (ESR). In cases of long term morbidity the fibrosing disease type is prevailing, in cases of short term lesion (1–2 years) — a fibrosing type with microabscesses formation.

A series of correlation dependencies was reported between clinical and laboratorial criteria on the one hand, and with morphometric criteria — on the other hand.

Conclusion. Pathomorphological features of bone lesions in sclerosing hematogenous osteomyelitis are nonhomogeneous. Every case in the study demonstrated stereotype alterations such as substantial diffuse fibroses of marrow spaces in cancellous bone and bone regenerate, remodeling of bone tissues with gradual acceleration of osteosclerosis and persisting productive inflammation. Only in sone cases featured small sites of exudative inflammation — microabscesses with microsequestration.

About the authors

V. V. Grigorovsky

Research Institute for Traumatology and Orthopaedics of National Academy of Medical Sciences of Ukraine

Author for correspondence.
Email: val_grigorov@bigmir.net

Dr. Sci. (Med.), Professor, Principal Scientific Associate of the Department for Pathomorphology

27, Bulvarno-Kudryavskaya ul., 01054, Kiev

Ukraine

A. S. Gordy

Research Institute for Traumatology and Orthopaedics of National Academy of Medical Sciences of Ukraine

Email: fake@neicon.ru

Orthopedic Surgeon, Department for Purulent Bone Surgery

27, Bulvarno-Kudryavskaya ul., 01054, Kiev

Ukraine

O. B. Lyutko

Research Institute for Traumatology and Orthopaedics of National Academy of Medical Sciences of Ukraine

Email: fake@neicon.ru

head of the Laboratory for microbiology

27, Bulvarno-Kudryavskaya ul., 01054, Kiev

Ukraine

A. V. Grigorovskaya

Research Institute for Traumatology and Orthopaedics of National Academy of Medical Sciences of Ukraine

Email: fake@neicon.ru

pathoanatomist of the Department for pathomorphology

27, Bulvarno-Kudryavskaya ul., 01054, Kiev

Ukraine

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