Method for the diagnosis of suppurative inflammation of the soft tissues in the treatment apparatus of external fixation external fixation
The invention relates to medicine, namely to traumatology and is intended for the diagnosis of suppurative inflammation of the soft tissues in the treatment apparatus of external fixation external fixation. Using laser flowmetry register capillary blood flow in a rest (KP) of the skin at the site of the proposed inflammation and balanced healthy body. On both limbs spend ischemic samples. Record the maximum postischemic capillary blood flow (MPIC), time to maximum postischemic blood flow, the duration of reactive hyperemia. Expect the postischemic increase in blood flow as the ratio of CP to MPIC. When the ratio KP patient healthy and balanced body is more than 4.0, the reduction of postischemic flow increase of more than 3 times, the increase in time to maximum postischemic blood flow more than 1 min and the increase in the duration of reactive hyperemia more than 5 min diagnose the presence of purulent inflammation of the tissues. The method is simple to perform, non-invasive and allows early diagnosis of purulent-inflammatory complications of transosseous osteosynthesis. 1 Il., table 1. There is a method of diagnosis using the methods of functional diagnostics, purulent-inflammatory processes in soft tissues, providing for the determination of the electrical resistance of the tissue in the wound and the area located outside the area of inflammation using needle electrodes connected to a recording device. The development of the inflammatory process in a known manner is diagnosed with increasing the electrical resistance of the wound compared to the resistance of the intact area of the same segment (Khachatryan A. P. , Myc B. C. Impedancometry as a method of rapid diagnosis and prognosis of wound purulent-inflammatory processes of the soft tissues. The invention and rationalization in medicine. Republican scientific papers. Ed. by C. N. Yarygin. M: 2nd magmi them. N. And. Pirogov, 1987, S. 154-156).However, the known method provides a diagnosis of the inflammatory process, using an invasive technique involving the introduction of needle electrodes and only in the case of large violations of the integrity of the soft tissue of leg bones during treatment by Ilizarov method using laser flowmetry, reflecting the dynamics of capillary blood flow during treatment of patients with open fractures of the tibia apparatus Ilizarova (Dolganov T. I., Martel, I. I., Dolganov D. C. assessment of the microcirculation in patients with open fractures of the tibia in the process of treatment by Ilizarov //Genius, 1999. - 4. -S. 53-56).A known method for the diagnosis of purulent inflammation of the tissues, using data from the laser flowmetry. The development of the inflammatory process in a known manner is diagnosed when comparing the parameters of the laser flowmetry alone in place of the proposed inflammation and simmetrichnogo healthy plot (patent 2140201, RF MKI6AND 61 IN 8/06. Method for the diagnosis of suppurative inflammation /Chekmarev C. M. , Crivain C. T., Martino, A. A., P. Thick And. - Declared 26.09.1997. Publ. 27.06.1999).However, the known method provides a diagnosis of the inflammatory process of the soft tissues in conditions not involving the treatment of patients with apparatus external transosseous fixation, as in the conditions of transosseous osteosynthesis excess skin capillary blood flow, determined by laser flowmetry, on the operated limb segment is greater than 1.6 times not considered a pathology that does not allow islamologiques patients apparatus external transosseous fixation.As a result of violations of the stability of the fixation of bone fragments or infection of the soft tissues in the course of elements of the apparatus transosseous fixation, penetrating through the skin and bone, inflammation can develop in the deep tissues. Naturally, early diagnosis of this complication in the treatment of external transosseous fixation methods of functional diagnostics used to monitor the status of the soft tissues is of great importance.The objective of the invention is to develop a method that provides early diagnosis of infectious complications arising during treatment apparatus external transosseous fixation on the basis of functional studies.This task is solved in that in the method for the diagnosis of purulent inflammation of the tissues in the treatment of external transosseous fixation, including the use of laser flowmetry, which register the capillary blood flow of peace (KP) of the skin at the site of the proposed inflammation and symmetrical healthy part of the body, additionally, on both limbs, a 3-minute ischemic sample register maximum postischemic capillary blood flow (what registracii maximum postischemic blood flow (Tnic) in minutes and the duration of reactive hyperemia (TWG) in minutes the obtained map data, diagnosing the presence of purulent inflammation of the tissues in the treatment of external transosseous fixation when the ratio of rates of flow of peace (CP) patients and healthy symmetric part of the body more than 4.0, and when conducting a 3-minute ischemic functional tests determine the reduction of postischemic flow increase of more than 3 times increase in time to maximum postischemic blood flow more than 1.0 minutes, increasing the duration of reactive hyperemia more than 5 minutes.Patenting an invention to explain a detailed description of his method, clinical example and diagram 3-minute ischemic breakdown, which presents dynamics of laser flowmetry skin near the wound during the 3-minute ischemic samples.The method is as follows.In the supine position the patient, which made the osteosynthesis device for external transosseous fixation, conduct measurement: capillary blood flow of peace (KP) of the skin of the operated segment of the limb in place of the proposed inflammation and symmetrical healthy part of the body; 3-minute ischemic sample, record the maximum Postica to MPIC, record the time to the maximum postischemic blood flow (Tnic) in minutes and the duration of reactive hyperemia (TWG) in minutes. Then the received data on the patient and intact limbs map. The presence of purulent inflammation in the tissues of the operated segment in the treatment of external transosseous fixation diagnosed with a ratio in the range of parameters: capillary blood flow of peace (KP) of the skin of the operated segment symmetrical healthy part of the body intact segment greater than 4.0, the results of 3-minute ischemic functional tests determine the reduction in the operated limb segment postischemic increase in blood flow (PIPC) more than 3 times increase in time to maximum postischemic blood flow (Tnic) more than 1.0 minutes, increasing the duration of reactive hyperemia (TWG) for more than 5 minutes (Fig.1).An example of performing the method.Patient T., 28 years. In the clinic RISC "RTO" was treated about open V type (A. C. Kaplan-O. N. Markova) comminuted, with a bone fracture of the tibia and fibula fracture in h/h of left tibia. Upon receipt produced primary chirurgical after the operation was carried out regular examination of the patient by laser flowmetry, we determined the rate of capillary blood flow of peace (KP) of the skin on various parts of the body of the operated segment and the symmetric part of the body of the contralateral leg.The obtained values of capillary blood flow of peace (KP) skin (ml



Claims
Method for the diagnosis of purulent inflammation of the tissues in the treatment apparatus of external fixation, including the use of laser flowmetry, which register the capillary blood flow of peace (KP) of the skin at the site of the proposed inflammation and symmetrical healthy part of the body, characterized in that additionally at both extremities, a 3-minute ischemic sample register maximum postischemic capillary blood flow (MPIC) and expect the postischemic increase in blood flow (PIPC), as the ratio of CP to MPIC, registering time to register maximum postischemic blood flow (Tnic) in minutes and the duration of reactive hyperemia (TWG) in minutes the obtained map data, diagnosing the presence of purulent inflammation of the tissues in the treatment of external transosseous fixa, and when conducting a 3-minute ischemic functional tests determine the reduction of postischemic flow increase of more than 3 times increase in time to maximum postischemic blood flow more than 1.0 min, increasing the duration of reactive hyperemia more than 5 minutes
FIELD: medicine.
SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.
EFFECT: high accuracy of diagnosis.