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Efeito da oxigenoterapia hiperbárica na osteomielite crónica
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Resumo(s)
A osteomielite é uma inflamação do osso geralmente causada por infeção. No adulto não acamado, a etiologia mais frequente é osteomielite por contiguidade de etiologia pós-traumática, com fratura, exposição óssea e contaminação. O tratamento baseia-se em antibioterapia endovenosa dirigida prolongada e intervenções cirúrgicas para remover o foco infecioso, tecido necrótico, estabilização de fraturas e cobertura óssea.
No entanto, existem fatores locais e/ou sistémicos que podem levar a isquémia e hipóxia crónica no tecido afetado, o que leva à falência do tratamento em uma percentagem significativa dos casos.
O oxigénio hiperbárico corrige esta hipóxia local e, através da sua ação anti-inflamatória, anti-infeciosa, neo-angiogénica e pró-cicatrizante, provou aumentar a taxa de sucesso do tratamento cirúrgico e antimicrobiano adequado em casos de insucesso prévio.
Este estudo foi elaborado para avaliar a melhoria clínica e sintomatológica observada nos doentes com osteomielite do membro inferior que realizaram Oxigenoterapia Hiperbárica no Centro de Medicina Subaquática e Hiperbárica da Marinha Portuguesa, e correlacioná-los com um conjunto de variáveis individuais e terapêuticas. Verificámos uma redução de dor e sinais inflamatórios em 30 doentes, melhoria de cicatrização em 25 dos 32 casos de úlcera, diminuição da drenagem de trajetos fistulosos em 25 casos e encerramento em 8 de 34.
A análise dos dados disponíveis não demonstrou qualquer correlação estatisticamente significativa entre o grau de resposta terapêutica e variáveis que considerámos.
A principal conclusão deste trabalho é a necessidade de caracterização pormenorizada, uniformizada e documentação laboratorial e fotográfica das lesões, que permita aferir com rigor a evolução clínica durante os tratamentos.
A variabilidade dos registos que encontrámos, englobando um período de 10 anos, feitos por clínicos diferentes, com métodos diferentes, veio reforçar esta necessidade.
Osteomyelitis is an inflamation of the bone generally caused by infeccion. In the non-bedriden adult, the most frequent etiology is infection by contiguous focus after trauma, with bone damage, exposure and contamination. Treatment is based on sistemic prolonged intra-venous organism-specific antibiotics and surgery for removal of infectious foci and dead tissue, fracture stabilization and bone coverage with soft tissue. However, there are local and host factors which may lead do ischemia and chronic hipoxia in the infected bone, resulting in failure of adequate treatment in a significant percentage of cases. Hyperbaric oxygen has proven to correct tissue hipoxia and, through its anti-inflamatory, anti-infeccious, neo-angiogenic e wound healing mechanism, has increased the success rate of surgical and pharmacological management in cases where treatment had previously failed. This study was made with the purpose to measure the clinical and symptomatic improvement in patients with osteomyelitis of the lower limb treated with Hyperbaric Oxygen Therapy at the Underwater and Hyperbaric Medicine Centre of the Portuguese Navy, and to find correlations between the results and several individual and therapeutical aspects. At some point during treatment, we observed a reduction in pain and inflamation signs in thirty patients, improved healing in 25 and full closure in 15 out of 32 wounds, and a dicrease in sinus tract drainage in 25 and closure in 8 of 34 sinus tracts. Data analysis did not reveal any statistically significant correlations between the degree of therapeutic response to HBOT and the other variables we considered. The main conclusion of this study the need for a more detailed, standardized description of the disease, including biochemical evaluations and photographic documentation, that allows the objective assessment of the clinical progresso during the treatments. The variability of the clinical records that we consulted along a period a decade, made by different physicians with different methods supports this need.
Osteomyelitis is an inflamation of the bone generally caused by infeccion. In the non-bedriden adult, the most frequent etiology is infection by contiguous focus after trauma, with bone damage, exposure and contamination. Treatment is based on sistemic prolonged intra-venous organism-specific antibiotics and surgery for removal of infectious foci and dead tissue, fracture stabilization and bone coverage with soft tissue. However, there are local and host factors which may lead do ischemia and chronic hipoxia in the infected bone, resulting in failure of adequate treatment in a significant percentage of cases. Hyperbaric oxygen has proven to correct tissue hipoxia and, through its anti-inflamatory, anti-infeccious, neo-angiogenic e wound healing mechanism, has increased the success rate of surgical and pharmacological management in cases where treatment had previously failed. This study was made with the purpose to measure the clinical and symptomatic improvement in patients with osteomyelitis of the lower limb treated with Hyperbaric Oxygen Therapy at the Underwater and Hyperbaric Medicine Centre of the Portuguese Navy, and to find correlations between the results and several individual and therapeutical aspects. At some point during treatment, we observed a reduction in pain and inflamation signs in thirty patients, improved healing in 25 and full closure in 15 out of 32 wounds, and a dicrease in sinus tract drainage in 25 and closure in 8 of 34 sinus tracts. Data analysis did not reveal any statistically significant correlations between the degree of therapeutic response to HBOT and the other variables we considered. The main conclusion of this study the need for a more detailed, standardized description of the disease, including biochemical evaluations and photographic documentation, that allows the objective assessment of the clinical progresso during the treatments. The variability of the clinical records that we consulted along a period a decade, made by different physicians with different methods supports this need.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Osteomielite Hipoxia crónica Refratária Oxigénio hiperbárico