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 (mlmin/100 ml tissue) in different parts of the body of the operated segment and the symmetric part of the body healthy intact segment varied within the following limits (see table).

Ratio in terms of capillary blood flow of peace (KP) of the skin of the operated segment symmetrical healthy body parts intact segment of 1.25 to 3.8. When conducting regular examinations during treatment revealed an increase capillary blood flow in a rest (KP) of the skin in the lower third of the operated tibia to 13.2 with 21.3 mlmin/100 ml tissue (average of 17.2), balanced healthy part of the body intact tibia indicators laser flowmetry was 2.5-5.5 mlmin/100 ml tissue (average of 4.0).

The calculated ratio KP: 17,2: 4,0 that was 4.3. Increase the value of the index greater than 4.0 testified about the possible development in the soft tissues of inflammatory PR and: postischemic increase blood flow amounted to 1.56, time to maximum postischemic blood flow (Tnic) 1 min 30 s, the duration of reactive hyperemia (Tpr) for more than 5 minutes (after the 5-min values of capillary blood flow exceeded the initial level of 6%). On the basis of the obtained data was diagnosed with inflammatory changes in the soft tissues.

The patient was prescribed course of anti-inflammatory and antibacterial treatment and despite treatment after 2 days appeared the clinical signs of inflammation of the soft tissues around the wound. Continued course of anti-inflammatory therapy. The definition within 2 weeks after the onset of inflammation of the capillary blood flow of the skin using laser flowmetry showed that on a background of treatment remained the ratio of capillary blood flow rest in the range of values of 4.0 to 4.5. Additionally, we performed functional 3-minute ischemic sample. Define the following indicators: postischemic increase blood flow was 2,39, time to maximum postischemic blood flow (Tnic) 1 min 45 s, the duration of reactive hyperemia (TWG) for more than 5 minutes (after the 5-min values of capillary blood flow was higher than the original level). This was confirmed, as Dan and clinical tissues with the creation of adequate drainage of the wound. Post-operative treatment decreased inflammation and complete relief of inflammation through the 7 days.

At follow-up in this period by laser flowmetry difference measurements of capillary blood flow in the skin near the wound surface during the survey was 3.5 times. According to the results of a 3-minute ischemic functional tests in the operated limb segment postischemic increase in blood flow (PEPC) was 3.8 times, time to maximum postischemic blood flow (Tnic) 30 seconds, the duration of reactive hyperemia (TWG) for 5 minutes. These values were regarded as kopiowanie inflammatory process near the wounds.

The proposed method is used in RISC "RTO". The implementation of it in any of orthopedic and trauma Department and is performed with the analyzer using laser speed superficial capillary blood flow LACC-01 for non-invasive measurements of velocity of blood flow in the capillaries and diagnosing the condition of microcirculation in the tissues and organs in various pathological processes; NITZ "DEVICE" , Moscow, ( GOS. registration 93/199-3).

The proposed method allows non-invasive in the us is th at transosseous osteosynthesis and adjust accordingly tactics of treatment.

Techniques and method used to implement the technical means are simple and accessible to a wide range of specialists involved in the treatment of orthopedic and trauma patients by the method of transosseous osteosynthesis, easy nursing staff, not limited to the frequency of the survey.

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

 

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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.

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