A method for the treatment of chronic recurrent osteomyelitis of long bones using kalapana

 

(57) Abstract:

The invention relates to medicine, in particular, to orthopedics and traumatology, and can be used for the treatment of chronic osteomyelitis. Perform surgical treatment of pathological lesion and subsequent filling of the bone defect with an implant. In the treatment in the acute stage are sequestrectomy, washing with antiseptics, vacuum. Then fill the bone defect granules kalapana. When forming after sequestrectomy cavity filling granules kalapana produce without compaction to bounding the cavity of level edges. In the case of formation of extensive bone defects in the form of cavity filling granules kalapana complement of muscle plasticity. When resection sequestrectomy granules kalapana placed between the bone fragments and produce osteosynthesis compression-distraction apparatus. In the treatment in remission are channelization area of pathologically altered bone. Then fill the channels formed by kalapana in the form of a gel through the catheter under pressure. The method allows the filling of bone defects with the stimulation osteocyte to medicine and can be used in traumatology and orthopedics for the treatment of chronic osteomyelitis.

Treatment of chronic recurrent osteomyelitis of long bones, or inflammation of the bone marrow, usually covering compact and cancellous bone and the periosteum regardless of etiology and clinical course has the General principles. These are the opening purulent foci, sequestrectomy, washing hearth antiseptic solutions, filling the formed bone defects, antibacterial therapy. The mechanism of recurrence is often associated with the presence of not sanitized infectious lesion and the residual cavity.

Currently, there are many ways to fill the resulting extensive bone defect after sequestrectomy. This plastic bone cavities as auto-and allogenic and xenogenic tissues and implants.

One way to fill the muscle is plastic, which carries a number of important functions: substitution, hemostatic, drainage, restoration. However, this method cannot fully provide one of the most important functions - antibacterial.

The present invention is to create a simple way to treat chronic retidivirovanii antibacterial environment and stimulate the regeneration of bone properties in 96% of cases. None of the existing methods can not achieve this effect.

The use of broad-spectrum antibiotics requires multiple injections. Plastic known materials or do not create antibacterial effect, or it is significantly less than the required and is only a few days [1].

As a prototype of the invention, the selected method of treatment of chronic recurrent osteomyelitis, including surgical resection sequestrectomy, washing the bone cavity with antiseptic solutions, filling the defect with a graft in the form of ground formalising cartilage and wound closure (see ed. St. N 700115 1979, class A 61 B 17100). [2].

The disadvantages of this method include: the presence of complications due to transplant rejection, lysis, samkovaya, which ultimately leads to relapse. The number of relapses can reach 10% and above.

The task of the invention was the creation of such a method for the treatment of chronic recurrent osteomyelitis of long bones, in which the number of relapses do not exceed 3-4%. Moreover, the method should be simpler, not requiring isyst the healing process must also be reduced. When this bone repair processes should be observed on the 2-3rd of the month.

The problem is solved as follows.

In the treatment of chronic recurrent osteomyelitis of the long bones in the acute stage as surgical treatment are sequestrectomy and in the formation after sequestrectomy cavity, after washing with antiseptics that cavity additionally vaccum, and Callahan used in the form of granules, which are placed without compaction to the level of the edges bounding the cavity. During the formation of extensive bone defects in the form of a cavity in addition to filling the pellets muscle plasticity.

In the treatment of chronic recurrent osteomyelitis of the long bones in the acute stage in the formation after sequestrectomy bone defects during the granules kalapana placed in the defect between the bone fragments and spend osteosynthesis compression-distraction apparatus.

In the treatment of chronic recurrent osteomyelitis of long bones in remission as surgical intervention are channelization area of pathologically altered bone and fill posnania for executing various techniques.

Drug kollapen developed and implemented the firm Intermediates together with IHL "C" MNT "eye Microsurgery" in 1996

In the Protocol No. 1 of the Committee on new medical technology MZ and MP of the Russian Federation indicated that Callahan is a complex of hydroxyapatite, collagen, and medicine. We use various modifications of the medication with antibiotics, in particular with lincomycin and gentamicin. These drugs are recommended for use in maxillofacial surgery in the treatment of periodontal disease.

Our research has shown

1) Callahan complex preparation, the structure is close to the bone

2) as part of kalapana includes collagen and hydroxyapatite, stimulating osteogenesis,

3) the presence of the antibiotic, locally provides long-lasting antibacterial environment,

4) ability to choose an antibiotic based on the sensitivity selected from osteomyelitis focus microflora.

Filling of the bone defect.

After conducting resection sequestrectomy about osteomyelitis and readjustment of the operating cavity, including irrigation with antiseptics, ultrasound, vacuum, the space between the bone fragments: size is In the postoperative period of continuous irrigation with antiseptics is not required. If necessary compression in the area of the defect in the postoperative period existing between fragments of calapan does not prevent the convergence of the fragments, and reparative and anti-bacterial properties are preserved.

Arthrodesis of the ankle joint after resection sequestrectomy bones comprising the joint.

To date, the achievement of adequate arthrodesis of the ankle joint when osteomyelitis of the articular surfaces of the tibia and the talus bone remains difficult. On the one hand it is not always possible to perfectly adapt the resected surface of the tibia and talus bones because of the irregularities and the presence of bone cavities of various sizes, on the other, there is always the risk of relapse suppurative process. All this is reflected in the results of treatment is longer term and worsens the outcome. Given the above, we propose the following.

After conducting resection sequestrectomy osteomyelitis modified articular surfaces of the tibia and talus bones and readjustment of the operating cavity, including irrigation with antiseptics, ultrasound, vacuum and layout elements of the apparatus Iuda granules kalapana. Left drainage for the evacuation of traumatic content. The wound is sutured closed. In the postoperative period of continuous irrigation with antiseptics is not required. If necessary compression in the area of the defect in the postoperative period existing between the fragments Callahan does not prevent the convergence of fragments, fills the formed bumps and cavities between fragments, creating a depot of antibiotic and stimulating osteogenesis, helps prevent the development of recurrent suppurative process and accelerate the achievement of fusion.

Advantages over the known method is:

1) Callahan complex preparation, the structure is close to the bone

2) the drug stimulates osteogenesis,

3) the presence of antibiotic locally provides long-lasting antibacterial environment,

4) due to the possibility of introducing a composition of any of the antibiotic medication you can find specifically for each patient taking into account the selected microflora and its sensitivity to antibiotics,

5) ease of implantation does not complicate surgical intervention when combining it with kalapana.

Treatment of chronic recurrent osteomyelitis of long bones in remission.

brilliant osteomyelitis, we propose to use kollapen in the form of a gel, for introduction into a false joint area, followed by osteosynthesis by Ilizarov.

Advantages over known methods:

1. The drug is a biological material, which is similar in composition to bone.

2. The drug stimulates osteogenesis.

3. Due to the presence of the antibiotic, has anti-bacterial property.

4. The proposed technique is less traumatic to prevent venous disorders.

5. This technique can be applied before or after osteosynthesis by Ilizarov.

Description of methods of treatment of chronic recurrent osteomyelitis of long bones in remission.

In the projection zone of the false joint or unjoining fracture is a small skin incision. Enter the Elevator, pushing the soft tissue that will prevent them from trauma. Using a drill to produce the fan-shaped channelization region of false joint. Then add a catheter connected to a syringe containing gel kalapana. Under the pressure of the medium formed channels gel. Wound tightly sewn. Produce osteosynthesis by Ilizarov. Also, this method of Patient D. 50. and/309 b was treated at the Central scientific research Institute of traumatology and orthopedics named. N. N. Priorov, in the clinic of purulent complications and consequences of injuries to the musculoskeletal diagnosed with Chronic post-traumatic osteomyelitis of the bones of the right ankle joint, active form.

Medical history: Trauma 4 April 1997, was hit by a motorcycle, this was an outdoor perelomova bones of the right ankle joint. After injury was taken to the casualty Department of the city hospital at the place of residence, where admission made PHO wounds, manual reduction with fixation transarticular spokes. Further immobilization was carried out plaster Longuet. For injury was complicated by suppuration with outcomes in osteomyelitis, the needles are removed, the patient had a fistula opening on the anterior surface of the right ankle, held antibacterial therapy and conservative treatment without effect, the patient is suggested amputation. Consulted in tsito, in January 1998 hospitalized purulent complications and injuries of musculoskeletal system for the planning of surgical treatment.

noanim detachable.

Local status: the Patient walks with a stick, limping on the right lower limb. Upon examination there is marked swelling, redness of the right ankle and foot. On the anterior surface of the right ankle joint there are the fistula size 0.5 cm with moderate purulent discharge. Movement in the joint is limited due to pain. The pulse on peripheral arteries of the right lower extremity distinct. Neurological disorders are not detected.

Conducted a comprehensive clinical and radiographic examination. On radiographs, there is destruction of the bones forming the right ankle, fistulogram leaking of contrast in sustavnoi space of the tibia and talus bones. Also defined soft tissue cavity. Microbiological examination separated fistula showed the presence of Pseudomonas aeroginosa 104sensitive to gentamicin, amikacin, tobramycin, polymyxin, ciprofloxacin and resistant to penicillin, tetracycline, levomycetin and lincomycin.

The description of the operation.

Under General anesthesia after processing operating margins in the fistula entered the solution of brilliant green. Made a skin incision on the front is Strim by accessed distal metapelite of the tibia. Using a spoon Volkmann removed necrotic tissue and curtailment, with further revision revealed that the cartilage of the tibia and talus bones debonded and exposed necrotic processes. Using the bit resected articular surface of the tibia and talus bones. The wound is copiously washed with antiseptic solution and treated with ultrasound. A defect introduced granules kalapana. The wound is sutured in layers tightly, wound put two rubber graduate for the evacuation of traumatic content. With the help of Ilizarov frame in the layout 2 rings and 2 half rings produced by fusion in the right ankle joint.

The patient is re-examined after 6 months the fusion took place, osteomyelitic process is eliminated. Demounting of Ilizarov. The patient is examined in two months, going with a full load on the operated limb.

Drug Callahan was used in 104 patients (23 female and 81 male) for the plastic bone defects after surgical treatment of chronic osteomyelitis. Localization of the lesions was as follows: femur - 37 (35,58%) cases, Shin bones - 31 (29,81%), humerus- 10 (9,62%), (1,92%), rib, clavicle, pelvis and elbow - 1 (0,96%) occasion.

Results.

The results of the application of kalapana were as follows: 88 patients operational wounds healed by primary intention, the 16 - secondary. After 6-7 months after surgery radiographically, there was a gradual filling of the osteomyelitic cavities, bone tissue (longest follow - up period of 3 years). Of the 104 patients 100 (96%) received a positive result. The observation period up to 3 years. 4 patients underwent surgery again due to the development of recurrence of osteomyelitis. Histological examination of bioptic material (6-8 months after surgery) in the area of the former osteomyelitic cavity detected newly formed bone trabeculae, which contains inclusions of resorbable kalapana.

Thus, the use of kalapana in complex treatment of chronic recurrent osteomyelitis of long bones for filling bone cavities and segmental defects resulting from radical sequestrectomy, can be considered effective and promising.

References

1. Moussa M Plastic osteomyelitic cavities some biological and synthetic Mat is ical gunshot osteomyelitis in the later period. Kida. dis. M., 1975

1. A method for the treatment of chronic recurrent osteomyelitis of long bones, including surgical treatment of pathological lesion and subsequent filling of the bone defect implant, characterized in that the treatment in the acute stage are sequestrectomy, washing with antiseptics, evacuation and filling of the bone defect granules kalapana, the treatment in remission are channelization area of pathologically altered bone and fill the channels formed by kalapana in the form of a gel through the catheter under pressure.

2. The method according to p. 1, characterized in that the treatment in the acute stage formed after sequestrectomy cavity is filled with granules of kalapana without compaction to bounding the cavity of level edges.

3. The method according to p. 1, characterized in that the treatment in the acute stage when the formation of extensive bone defects in the form of a cavity in addition to filling granules kalapana hold muscle plasticity.

4. The method according to p. 1, characterized in that the treatment in the acute stage at resection sequestrectomy granules kalapana placed between the bone fragments

 

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