Method for treating juvenile dystrophic osseous cysts in children

FIELD: medicine.

SUBSTANCE: through puncture opening in proximal and distal directions one should perform osseous tunnels being coaxial to osseous log to connect, thus, the cavity of osseous cyst with medullary canal. Through the parts of healthy bone at the distance of 1-2 cm against cyst's edge in oblique direction one should implant rigid electrodes at the angle of 45 deg. against its center by applying beck's needles with dielectric covering. Subcutaneously one should implant elastic electrodes in projection of lesion focus and connect an electrostimulating unit to cutaneous ends of electrodes. Onto intraosseous electrodes one should supply impulse current of negative polarity, and onto elastic ones - of positive polarity at 10-20 mcA power and frequency of 0.5 Hz, of total duration and front of rectangular impulses cut being 200 mcsec, not more.. One should affect with impulse electric currents on the 24-h basis till complete covering the osseous defect observed.

EFFECT: higher efficiency of therapy.

2 ex

The invention relates to medicine, in particular to surgery, and can be used for the treatment of juvenile degenerative bone cysts in children.

There is a method of treatment of youth degenerative bone cysts (Waikerie “Treatment of degenerative bone cysts in children. PhD thesis, 1998, Moscow, S. 46-49), including an introduction to pathological focus, with the goal of decompression kanilirovannaya screws. After 2-3 weeks in the cyst cavity is injected injected allograft in the form of mist demineralized bone chips, which gradually resolves within 6-12 months and replaced by native bone tissue.

The disadvantage of this method is a lot of stages of surgical intervention. The terms of the restoration of bone structure are long. Often after treatment remain a bone cavity, which requires repeated interventions.

As the closest analogue is adopted a method of treating degenerative juvenile bone cysts in children by the method of microwave-destruction (“Pathogenetic aspects of treatment of degenerative bone cysts in children by the method of microwave-destruction”. Vybornov DO, Shafranov CENTURIES, Morgunova E.N., Koroteev V.V., Petrov, M.A. Materials XXYI scientific-practical conference of pediatric orthopedists-traumatologists. Moscow, 2003, pp.28-29). The method consists in the fact that the implementation of Aut puncture degenerative bone cyst, then using the trocar in its cavity probe is introduced with a fixed microwave emitter. Mode osteodistraction make processing of the inner walls of bone cyst in order to achieve a shallow cell necrosis. This preserves the fibroarchitectonics bone frame, which further serves as a material for bone regeneration in a period of 6 months to 1 year depending on the size of bone cyst.

However, the known method has a number of disadvantages. Restoration of bone structure passes through the stage of avascular necrosis, and therefore the filling of bone cyst is within 6-12 months, and the bone cavity remains isolated from normally developed vascular network that can lead to relapse.

The objective of the invention is to provide a method of treatment of youth degenerative bone cysts in children, allowing you to accelerate the closure of bone defects, to reduce the treatment time and to prevent the development of disease recurrence.

The invention consists in that in the method of treatment of youth degenerative bone cysts in children, including puncture of the cyst through the puncture hole in the proximal and distal direction perform coaxially with clinicom bone bone tunnels, giving thus a bone cyst cavity with bone-marrow channel, then black is C areas of healthy bone at a distance of 1-2 cm from the edge of the cyst in an oblique direction at an angle of 45° her heart hard implanted electrodes, which use needles Beck with a dielectric coating, and then subcutaneously implanted elastic electrodes in the projection of the lesion, cutaneous ends of the electrodes connect the pacemaker, intraosseous electrodes serves pulse current of negative polarity, and the elastic electrode positive polarity power from 10 to 20 µa with a frequency of 0.5 Hz, the total length and the front cut rectangular pulses is not more than 200 µs and carry out impact of pulsed electric currents around the clock to complete closure of bone defects.

The use of the invention allows to obtain the following technical result.

There is much less trauma to the soft tissues due to the fact that manipulation of the trocar and the electrodes is performed through punctures in the skin. During the electrode does not violate the anatomical integrity of the bones as the body, because the electrodes are implanted under the control of fluoroscopy. This method allows the first day of treatment to stimulate natural osteoreparative processes in bone, does not require additional expenses for allografts, as for bone regeneration are natural plastic resources of the organism.

The method enables the norm is Ino developed vessels bone marrow channel and angosto to proliferate in the cavity degenerative bone cysts by creating a tunnel messages between polotu bone cysts and bone marrow channel. Perform trephination bone cyst of the trocar has a decompression effect on nutricote pressure.

The method involves the installation of metal electrodes at an angle of 45 degrees to the axis of the bone in the cavity degenerative bone cyst in the immediate vicinity formed between the bone cavity and the bone-marrow channel of the tunnels that allows you to stimulate osteogenesis by pulsed electric currents in terms of improved blood circulation. If necessary, the end of the treatment by the method of electrical stimulation may simultaneously remove electrodes without the use of anaesthesia and analgesia.

The duration of treatment is reduced in 2 times in comparison with accepted methods and are on average 1-2 months by accelerating the rate of recovery of normal bone structure in the affected area of the bone. The method allows to avoid recurrence of the disease, due to the stimulation of natural bone formation.

Furthermore, the method does not require high material costs and can be applied in the outpatient setting.

The technical result is achieved due to the proposed by the authors of the new technologies of treatment of youth degenerative bone cyst. Running coaxially with clinicom bone tunnels, telling cavity bone cyst with medullar channel is m, normalizes blood circulation in the bone marrow cavity and creates conditions for proliferation of normally developed vessels in the bone cavity of the cyst, which in turn promotes normal oxygenation of osteogenic tissue in conditions of stimulation of growth of pulsed electric currents.

Stable fixation of the metal electrodes by conducting them through areas of healthy bone at a distance of 1-2 cm from bone cyst in an oblique direction at an angle of 45 degrees to the center of the cyst allows to achieve the optimal location of the working end of the electrode relative to the formed between the bone cyst bone marrow and the channel tunnel and prevents the development of inflammatory complications in the place of installation of the electrode.

The subcutaneous implantation of elastic electrodes in the projection of the lesion allows subsequent to optimally concentrate the energy of the electric fields in bone cyst in the conduction of electrical stimulation weak pulse currents.

The course of stimulation of osteogenesis weak pulse currents in the regime of 10 to 20 µa with a frequency of 0.5 Hz, a voltage of 8.8 V with the total length of the front and cut rectangular pulses of 200 µs clock allows you to optimally achieve the formation of actively regenerating osteogenic tissue in the cavity to the local cysts.

The method is as follows. The patient under General anesthesia and under the control of the x-ray screen in aseptic conditions perform puncture bone cyst using a standard trocar. In proximal and distal direction by means of a curved medical sewing needle through the hole in the thinned cortical bone cysts perform coaxially with clinicom bone bone tunnels, giving thus a bone cyst cavity with bone-marrow channel. Then, in the cavity of bone cyst implanted two are rigid electrode, which is inserted through the areas of healthy bone at a distance of 1-2 cm from the edge of bone cyst in an oblique direction at an angle of 45° to its center. As intraosseous electrodes used needles Beck with a dielectric coating made by the method of plasma spraying of ceramics or ultrapure silicon. Electrical insulation of the wires is carried out in such a way that their ends remained conductive surface, free from dielectric at a distance of 1 cm (the working surface of the electrode). Then to create an electric field through the trocar subcutaneously in the projection cysts implanted elastic electrode PEOU-1 (length 600 mm) or PEOU-2 (length 900 mm). To skin the ends of the electrodes connected to the stimulator EOS-20-01 “Osteochon-2”. On vnutrirossijskie the electrodes pulse current of negative polarity, and subcutaneous elastic electrode positive polarity power from 10 to 20 µa with a frequency of 0.5 Hz, the total duration and front cut rectangular pulses of 200 μs. Impact of pulsed electric currents carry out round-the-clock within 28-60 days to complete closure of bone defects. The method allows to accelerate the formation of bone regeneration and to prevent the development of disease recurrence.

The method has been clinically tested at the Tushino children's hospital on 20 patients aged from 7 to 14 years with a diagnosis of degenerative bone cyst (any bones and it Department); pathological fracture on the background of degenerative bone cyst (any bones and it Department). In the treatment and monitoring of sick children relapses of the disease is not observed. The maximum period of sick children after treatment 3 years.

Example 1. Child S., age 7 was treated with a diagnosis of extensive youth degenerative bone cyst in the lower third of the left bedernau bones. Under General anesthesia and under the control of the x-ray screen is made to puncture bone cyst. The trocar is formed tunnel, indicating bone cyst with bone-marrow channel. In the cavity of bone cyst implanted 2 rigid electrode (spokes Beck with a dielectric coating). The electrodes are oriented is ovale in the cavity so that to the conductive surface located in the vicinity of the center of the bone cyst. Two subcutaneous electrode PEOU-1 introduced subcutaneously using a trocar just above the site of lesion of bone and fixed to the skin with interrupted sutures. The immobilization of the limb exercises on skeletal traction. Cutaneous ends of the electrodes connected to the generator weak pulse currents EOS-20-01 “Osteochon-2”. The clock was applied pulse current with a frequency of 0.5 Hz, the power of 10 µa and the total length of the front and cut a rectangular pulse is not more than 200 µs. For intraosseous electrodes was applied currents of negative polarity, subcutaneous positive polarity (cathode mode). On the 28th day of the electrodes removed. On radiographs was determined by the formation of bone regenerate throughout the volume of bone cysts. The allowable load on the affected limb. During the time of observation during the year relapse was not observed.

Example 2. Child S., 14 years old, was admitted to hospital with a diagnosis of a pathological fracture of the upper third of the right femur amid youthful degenerative bone cyst. For stabilization of the fracture imposed skeletal traction. After the consolidation of the fracture through month of treatment in the absence of dynamics in the closing of the bone defect, under the General obisbo ywaniem made puncture and channelizate bone cyst forming messages cavity and the bone-marrow channel of the femur. In the cavity of the cyst implanted 2 metal electrode. Subcutaneously implanted electrode 2, PEOU-2. Within 60 days produced stimulation of osteogenesis weak pulse currents in the cathode mode with a frequency of 0.5 Hz and a power of 20 μa, with a total length of the front and cut a rectangular pulse is not more than 200 µs. At the end of stimulation on radiographs determine the complete filling of the cavity of the cyst osteogenic tissue. The child is allowed full weight-bearing on the affected leg. Monitor patients during the year revealed no recurrence of the disease.

Method of treatment of youth degenerative bone cysts in children, including puncture bone cyst, characterized in that the needle through the hole in the proximal and distal direction perform coaxially with clinicom bone bone tunnels, giving thus a bone cyst cavity with bone marrow channel, then through the areas of healthy bone at a distance of 1-2 cm from the edge of the cyst in an oblique direction at an angle of 45° its center hard implanted electrodes, which use needles Beck with a dielectric coating, and then subcutaneously implanted elastic electrodes in the projection of the lesion, cutaneous ends of the electrodes connect the pacemaker, intraosseous electrodes serves pulse current of negative polarity and the elastic electrode positive polarity power from 10 to 20 µa with a frequency of 0.5 Hz, the total length and the front cut rectangular pulses is not more than 200 µs and carry out impact of pulsed electric currents around the clock to complete closure of bone defects.