The method of evaluation of results of treatment of patients with chronic osteomyelitis

 

(57) Abstract:

The invention relates to medicine, in particular to orthopedics, and can be used for the treatment of patients with chronic osteomyelitis of the Method involves the analysis of the results of biochemical, radionuclide and x-ray examinations, while in biochemical studies to determine fosfatazy index system index electrolytes and system index of glycolysis, comparing them with the degree of accumulation in the bone tissue of the radiopharmaceutical and the data of x-ray examinations and the values at the time of completion of treatment: phosphatases index over 13, system index electrolytes from 160 to 200, system index of glycolysis less than 50, the degree of accumulation of the radiopharmaceutical from 160 to 180%, the absence of the patient's residual bone cavities, phenomena osteosclerosis and/or osteoporosis judge sustained relief of osteomyelitic process, when values: phosphatases index less than 8, the system index of electrolytes over 200, system index of glycolysis over 70, the degree of accumulation of the radiopharmaceutical from 180 to 200% on the background of the phenomena of osteoporosis and/or osteosclerosis make a conclusion about the need for a Supplement which of traetow less than 160, system index of glycolysis from 50 to 70, the degree of accumulation of the radiopharmaceutical more than 220% in the face of residual bone cavities in combination with symptoms of osteoporosis and/or osteosclerosis conclude an unsatisfactory result. Effect: invention allows to obtain an objective picture of the condition of the patient after complete course of medical rehabilitation.

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with chronic osteomyelitis.

Known methods of assessment of results of treatment of patients with chronic osteomyelitis based on the analysis of x-ray data, data for biochemical research, as well as the results of radionuclide studies (1, 2). However, the evaluation results on the specified parameters are private and in each form of studies provide the opportunity to evaluate only one-sided picture of the status of individual systems of the body.

At the same time, being a systemic disease chronic osteomyelitis affects the functioning of the organism as a whole and needs when assessing treatment outcomes of a comprehensive approach.

The task is looking to obtain an objective picture of the condition of the patient after complete course of medical rehabilitation.

This task is solved in that in the method, including the analysis of the results of biochemical, radionuclide and x-ray studies, biochemical studies identify fosfatazy index system index electrolytes and system index of glycolysis, comparing them with the exponent accumulation in bone radiopharmaceutical 99 t TC pyrophosphate and the data of x-ray examinations, and when the values at the time of completion of treatment:

- phosphatase index over 13,

- system index of electrolytes from 160 to 200,

- system index of glycolysis less than 50,

- the degree of accumulation of the radiopharmaceutical from 160 to 180%,

in the absence of the patient's residual bone cavities, phenomena osteosclerosis and/or osteoporosis judge sustained relief of osteomyelitic process;

when values:

- phosphatase index less than 8,

- system index electrolytes more than 200,

- system index of glycolysis over 70,

- the degree of accumulation of the radiopharmaceutical from 180 to 200% on the background of the phenomena of osteoporosis and/or osteosclerosis make a conclusion about the need for an additional course is - system index of the electrolyte is less than 160,

- system index of glycolysis from 50 to 70,

- the degree of accumulation of the radiopharmaceutical more than 220% in the face of residual bone cavities in combination with symptoms of osteoporosis and/or osteosclerosis conclude his unsatisfactory result.

New in the proposed method is that when biochemical studies identify fosfatazy index system index electrolytes and system index of glycolysis, comparing them with the degree of accumulation in the bone tissue of the radiopharmaceutical and the data of x-ray examinations, and when the values at the time of completion of treatment:

- phosphatase index over 13,

- system index of electrolytes from 160 to 200,

- system index of glycolysis less than 50,

- the degree of accumulation of the radiopharmaceutical from 160 to 180%, in the absence of the patient's residual bone cavities, phenomena osteosclerosis and/or osteoporosis judge sustained relief of osteomyelitic process;

when values:

- phosphatase index less than 8,

- system index electrolytes more than 200,

- system index of glycolysis over 70,

- the degree of accumulation of radionuclides the additional course of conservative treatment;

but values:

- phosphatase index from 8 to 13,

- system index of the electrolyte is less than 160,

- system index of glycolysis from 50 to 70,

- the degree of accumulation of the radiopharmaceutical more than 220% in the face of residual bone cavities in combination with symptoms of osteoporosis and/or osteosclerosis conclude his unsatisfactory result. Marked allows to make a conclusion on the conformity of the proposed method the criterion of “novelty”.

Analysis of available information sources on the problem of assessing the results of treatment of chronic osteomyelitis shows that the proposed technical solution is not obvious and does not follow what has been achieved in this field of knowledge that allows to judge the criterion of “inventive step”.

The applicability of the method is confirmed by the fact of its successful clinical use in RISC “RTO” named after academician G. A. Ilizarov.

The method is as follows.

After the full course of rehabilitation in patients with chronic osteomyelitis perform complex studies, including determination using known is swagat evaluation of treatment results.

During the execution of biochemical studies to determine fosfatazy index system index electrolytes and system index of glycolysis.

Under fosfatnym index understand the attitude indicator thermolabile fraction of alkaline phosphatase to the acidic phosphatase; under the system index electrolytes understand the works of the concentration of the electrolytes calcium, and chlorine concentration ion phosphate; system index of glycolysis is the ratio of the product of lactate dehydrogenase activity by a factor of lactate pyruvate to the ratio of N - and M-subunits of this enzyme.

Along with the definition of biochemical parameters produce radionuclide studies, on the basis of which determine the degree of accumulation of the radiopharmaceutical in the bone tissue, and also perform standard x-rays to determine the structure of the bone tissue in the affected area and identify residual abdominal masses.

Based on the analysis of the obtained data make a conclusion about the complete relief of osteomyelitic process, if:

- fosfatazy index over 13,

- system index of electrolytes from 160 to 200,

- system index glycolysis is the residual bone cavities, phenomena osteosclerosis and/or osteoporosis.

If the values are the same:

- phosphatase index less than 8,

- system index electrolytes more than 200,

- system index of glycolysis over 70,

- the degree of accumulation of the radiopharmaceutical from 180 to 220%

on the background of the residual effects of osteoporosis and/or osteosclerosis make a conclusion about the need for additional course of conservative treatment.

But values:

- phosphatase index from 8 to 13,

- system index of the electrolyte is less than 160,

- system index of glycolysis from 50 to 70,

- the degree of accumulation of the radiopharmaceutical more than 220%

on the background of residual bone cavities in combination with symptoms of osteoporosis and/or osteosclerosis conclude unsatisfactory results of treatment.

Practical implementation of the method is illustrated by the following clinical observations.

Example 1. Patient C., 14 years old, diagnosis: chronic hematogenous osteomyelitis, right femur, active form, osteomyelitic cavity 102 cm, the excess length of the right femur five centimeters, ill nine years. By place of residence many times, the sonogram in the lower third of the right femur osteomyelitic cavity length of 10 see Isolated from purulent pathogenic Staphylococcus sensitive to cephalosporins, gentamicin and carbenicillin.

On scanogram distribution of the radiopharmaceutical (RN) was patchy, there was a focus hyperfixation of the drug in the affected area. Around him the diffuse area of increasing activity with the transition to releasea matatizo (a clear sign of the presence of inflammation). The intensity of the inflammatory lesion was 321,5%. According to the radiological survey installed a second extent of osteomyelitic process.

Made sequestrectomy right femur in healthy tissues, transverse osteotomy through the middle of the cavity. Its walls Prednisolonum access completely excised together with robovie fabrics. Thigh exposed within osteomyelitic cavity. Granulation tissue lining the cavity removed. Necrectomy the affected area of bone within healthy tissue. The ends of the fragments after the osteotomy is connected on the type of “Russian lock up tight contact. Osteosynthesis by Ilizarov. Soft tissue sutured in layers.

The period of fixation apparatus was 63 days.

After dismantling the apparatus vstanovleno, what

- fosfatazy index equal to 14,

- system index electrolytes -170,

- system index of glycolysis - 45,

the degree of accumulation radiofarmpreparatov - 165%,

radiograph shows organotypic rebuilding of bone tissue with no evidence of residual cavities. The patient fully load on the operated limb, movement joints in full, wounds and fistulas no. Marked has made it possible to observe complete relief of osteomyelitic process.

Example 2. Patient D., aged 39, was admitted to the hospital Ilizarov scientific centre with a diagnosis of chronic post-traumatic osteomyelitis of the left femur, active form; osteomyelitic cavity 33,5 cm; malunion, vkusno-rotational deformity 150, rotary offset 40; shortening 6 see

For the elimination of osteomyelitis focus, recovery length and axis of the limb, the patient underwent an operation: sequestrectomy, osteotomy of the left thigh through osteomyelitic cavity; osteosynthesis by Ilizarov.

Distraction 79 days, the fixation of 93 days.

Operating the wound healed by first intention, the fistula was closed after the operation. Additional impanema research which has the following values of desired parameters:

- phosphatase index - 7,

- system index electrolytes - 210,

- system index of glycolysis - 80,

- the degree of accumulation of the radiopharmaceutical - 210%,

when radiographically severe osteoporosis of the hip throughout. The results obtained allowed to recommend to the patient an additional therapeutic course of treatment for relief of symptoms of osteoporosis.

Example 3. Patient Z., 40 years old, was admitted with a diagnosis of chronic hematogenous osteomyelitis, right thigh, which suffers from the age of seven. Unsuccessful sequestrectomy before entering the RISC "RTO" was performed 16 times. At the time of treatment revealed osteomyelitic cavity in the upper third of the right thigh 122,0 cm, and on the border of middle and lower third of the second cavity size 2,51,8 see

Osteomyelitic cavity in the upper third of the thigh was replaced by bone grafting, performed sequestrectomy second, distal cavity. At the end of treatment parameters:

- phosphatase index 11,

- system index of the electrolyte 120,

geologicheskiy defined residual bone cavity size 2,51,8 cm in the lower third of the thigh with the phenomena expressed osteosclerosis all over. These data allowed us to conclude that poor treatment outcome. Patient recommended surgery to perform osteosynthesis by Ilizarov.

The execute method allows you to objectively evaluate the results of treatment of patients with chronic osteomyelitis.

Sources of information

1. X-ray radionuclide diagnosis of reparative bone formation during the treatment by Ilizarov patients with incorrectly fused bone fractures of the lower extremities in chronic osteomyelitis. A. A. Sveshnikov, A. M. Aranovich, L. A. Smotrova, S. C. Salnikova//Method.REC. - Barrow, 1994. - 11 S.

2. Y. P. Baldin, K. C. Desatnick. Evaluation of the activity of reparative osteogenesis.//Method.REC. - Barrow, 1991. - 22 S.

The method of evaluation of results of treatment of patients with chronic osteomyelitis, including the analysis of the results of biochemical and radionuclide and x-ray examinations, characterized in that when biochemical studies identify fosfatazy index system index electrolytes and system index of glycolysis, comparing them with the degree of accumulation in the bone tissue of the radiopharmaceutical and data Ren is 13, system index electrolytes from 160 to 200, system index of glycolysis less than 50, the degree of accumulation of the radiopharmaceutical from 160 to 180%, the absence of the patient's residual bone cavities, phenomena osteosclerosis and/or osteoporosis judge sustained relief of osteomyelitic process, when values: phosphatases index less than 8, the system index of electrolytes over 200, system index of glycolysis over 70, the degree of accumulation of the radiopharmaceutical from 180 to 200% on the background of the phenomena of osteoporosis and/or osteosclerosis make a conclusion about the need for additional course of conservative treatment, while values: phosphatases index from 8 to 13, system index of the electrolyte is less than 160, the system index of glycolysis from 50 to 70, the degree of accumulation of the radiopharmaceutical more than 220%, while the residual bone cavities in combination with symptoms of osteoporosis and/or osteosclerosis conclude an unsatisfactory result.

 

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