The way to accelerate the consolidation of diaphyseal fractures of the tibia

 

(57) Abstract:

The invention relates to medicine, more specifically to trauma, and can be used to accelerate the consolidation of diaphyseal fractures of the tibia after a stable immobilization of the fragments. To do this, starting from the first day the patient is administered an intramuscular injection of heparin 5000 IU 4 times a day for 5-7 days, at the same time introducing Venelin scheme: 0.03 g 3 times a day for 3 days, 2 times a day 0.03 g in 2 days and to 0,015 g, 2 times a day for 3 days, also administered aspirin, 0.5 g 3 times a day for 5 days, and 0.5 g 2 times a day for 5 days, then within 7-10 days on the fracture affected by electrophoresis with heparin and aminophylline. The method allows to prevent delayed Union or nonunion, and accelerate the consolidation of the bones.

The invention relates to medicine, in particular for orthopedics and traumatology.

It is known that diaphyseal fractures of leg bones give the highest percentage of cases of delayed Union or necromania fragments with subsequent development of a false joint (A. C. Kaplan; S., Yumashev; A. F. Krasnov and others). The cause of these complications, in addition to known factors, is also increasing about iznih vessels and gaverova channels on the site of the fracture, violate regional hemodynamics (C. I. Fishkin and co-authors).

The PROTOTYPE.

The way to accelerate the consolidation of diaphyseal fractures of the tibia. A. F. Krasnov, B. M. Arshin, M. D. Zeitlin Reference traumatology. M.: Medicine, 1984

Its distinctive features:

- open reposition of fragments of the Shin bone;

- fixation of the tibia tibia intramedullary pin;

- take autograft from the tibia and laying his interquartile between fragments;

the implementation of this method stimulates intermediaries bone formation due to automakers transplant.

The disadvantages of this method include:

the invasiveness of the surgery;

- the possibility of infection of the wound and the subsequent development of osteomyelitis;

violation medalernogo and periosteal blood flow.

The purpose of the invention is the creation of optimal conditions for reparative regeneration in the fracture area, prevention of delayed Union and necromania fractures of the tibia.

This goal is achieved as follows. After closed or open fracture of tibia and stable therapeutic is) from the first day of assigned complex anticoagulant therapy: intramuscularly injected heparin 5000 IU 4 times a day for 5-7 days. At the same time applies the indirect anticoagulant action - phenylin: 3 days to 0.03 g 3 times, 2 days at 0.03 2 times and 3 days to 0.015 2 times. You also use aspirin as an anti-platelet agent platelets, 0.5 to 3 times 5 days and 0.5 to 2 times 5 days. So, for 7-10 days (the period of increased risk of thrombosis) blood clotting time is prolonged in 2 times, and prothrombin index is kept low in the range of 30-50%.

The next 7-10 days on the fracture assigned electrophoresis with heparin and aminophylline.

Thus, in the complex of anticoagulant therapy in the body is created hypocoagulation the background of the blood, which prevents the formation of trombicula and regional DIC, improves microcirculation and blood flow in the damage zone; create favorable conditions for reparative regeneration, accelerated consolidation of fragments and, consequently, reduces the treatment time.

A similar treatment was used in 26 patients aged 23 to 60 years. Men there were 19 women and 7. All fractures were localized in the lower and middle third of the leg. The 4 was a transverse fracture, which produced simultaneously closed reposition of bone fragments and imposed Langata, then circular gig it in about 4 weeks. Then these patients superimposed circular plaster bandage. In 6 patients was comminuted fracture. They also imposed skeletal traction, in a subsequent cast. Surgical treatment is conducted in 5 patients, 3 of them made extramedullary osteosynthesis, 2-m - imposed Ilizarov.

On average, the immobilization of the limb lasted 3 months. After 2-2 .5 months were allowed metered load. In all patients the fracture was healed without any complications and returned to work after 4-4 .5 months. Was not observed complications associated with the use of anticoagulant therapy. Served as control urine analysis, clotting time according to the Mass-Magro and prothrombin index on the Quick.

A specific example of the method (extract from history):

Sick,, 38 years of age, was treated with a diagnosis of open comminuted fracture of both bones of the right leg in n/3 tibia with displacement of fragments. Injury road. Upon receipt produced primary debridement of open fracture of tibia and imposed skeletal traction for the heel bone. From the first day was prescribed a comprehensive anticoagulation: intramuscularly wadia - fenilin: 3 days 0.03 3 times, 2 days at 0.03 2 times and 3 days to 0.015 2 times. You also use aspirin as an anti-platelet agent platelets, 0.5 to 3 times 5 days and 0.5 to 2 times 5 days. The next 7-10 days on the fracture was administered electrophoresis with heparin and aminophylline. Wound healing by primary intention. After 4 weeks of superimposed circular plaster bandage. After 3.5 months on the control radiographs were determined distinct callus at the site of fracture. Plaster bandage is removed. Viewed through the year, goes without additional support, not lame.

Results of treatment of patients using anticoagulant therapy were compared with the results of treatment of 23 patients without anticoagulant therapy (control group) of approximately the same age and gender, the location and nature of the fracture and trauma treatment.

In connection with delayed Union after 4-6 weeks, 5 patients in the control group was placed in the Ilizarov frame, 4-m - made open reposition of bone fragments and extramedullary osteosynthesis. The remaining 14 patients (9 with skeletal traction, 3 - osteosynthesis and 2nd neoceram osteosynthesis) fracture of tibia coalesced way,

- easy way to perform,

- improve blood circulation zone of fracture,

- the efficiency of the method.

The results of the treatment of diaphyseal fractures of the tibia using a comprehensive anticoagulation therapy allow us to recommend this method, as a warning delayed Union or nonunion, and accelerating the consolidation of fragments.

The way to accelerate the consolidation of diaphyseal fractures of the tibia, consisting in the use of conservative and surgical methods of treatment, characterized in that the patients entering from the first day, intramuscularly heparin 5000 IU 4 times a day for 5-7 days, at the same time introducing Venelin scheme: 0.03 g 3 times a day for 3 days, 2 times a day 0.03 g in 2 days and to 0,015 g, 2 times a day for 3 days, also enter aspirin, 0.5 g 3 times a day for 5 days, and 0.5 g 2 times a day for 5 days, then the fracture is affected by electrophoresis with heparin and aminophylline within 7-10 days.

 

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