Method for treating comminuted fractures of long tubular bones

FIELD: medicine, traumatology.

SUBSTANCE: osseous defect after filling with collapan and usage of metallofixative should be covered with absorbable collagen film that provides orientation of osseous regenerate's organization.

EFFECT: higher efficiency of therapy.

2 ex

 

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for the treatment of comminuted fractures of long tubular bones.

The growing severity of injuries to bones, as well as the high incidence of post-traumatic complications associated with impaired reparative osteogenesis and nosocomial infection, encourage the search for means and methods of influence on the repair of bone tissue and the prevention of suppurative complications.

Open and closed comminuted fractures of type b and C according to the classification of AO/ASIF) are characterized by significant soft tissue injury, the presence of a large number of bone fragments and bone defects. The latter arise due to the inability to match a small bone fragments or removal of bone fragments during the primary surgical treatment for open fractures (Bialik H., Markov, S.A., Boyarshinov I. optimization of the processes of bone repair in the treatment of complex diaphyseal fractures in patients with combined and multiple trauma // materials of the city scientific and practical conference, Moscow, 2000, P.50-55).

The use of bone autoplasty in combination with metallicities can solve the problem of the osseous defect and partially the problem of stimulating bone regeneration in question is the area (Lazarev A.F., Gorokhov V.Y., Kesan GA, Urazgildeev R.Z. Use of Kalapana" in total hip arthroplasty //Sat. theses "Bioinventory on the threshold of XXI century", Moscow, 2001, P.84-85).

However, autoplastic bone grafting, along with the obvious advantages, has several disadvantages. First of all, this is a fairly quick lysis and the possibility of purulent-inflammatory complications, as well as the application of additional operating injuries to harvest autogenous bone.

Attempts to prevent interposition soft tissues in the area of the defect and to create favorable conditions for regeneration by otgorajivayas area of the defect due to the use of synthetic polymeric materials in the form of tubes and films insufficient.

There is a method of applying a polymer tube of polytetrafluoroethylene, worn to the bone fragments in the area of the defect in combination with metallicities (Nyman R, Magnusson M, Sennerby L, Nyman S, Lundgren D. Membrane-guided bone regeneration. Segmental defect radius studied in the rabbit. J / Acta Orthop. Scand. 1995 Apr; 66(2): 169-173).

The disadvantage of this method is the lack of osteoinductive properties of this material and method of implantation, leading to the formation of the switching plates on the bone fragments.

In recent years, widely used for filling bone defects and stimulation of osteogenesis complex preparations based gidroksiapatit the and. Data bioimpedance have properties that provide optimal conditions for reparative regeneration in the period of formation of the primary corn and its restructuring into a full bone.

Closest to the proposed method of treating comminuted and intra-articular fractures is a method where the bone defect before metallicities was filled with kalapana (Smolin, Avistream, Whatpulse, Vaganova. “Using kalapana in treatment of fractures of long tubular bones” // Materials of scientific conference “Modern medical technologies and prospects of development of military traumatology and orthopedics”, S.-Petersburg, 2000, pp.182).

The disadvantage of this method is the relatively long duration of treatment of fractures, because of the introduction of this drug in the region of the defect, even with careful suturing of soft tissues, in the form of the coupling, there may be migration of kalapana from the zone of the defect due to the mobility of the surrounding soft tissues.

The present invention is a method of treating comminuted fractures of long tubular bones, allowing to reduce the treatment time by stimulating the regenerative properties of bone.

The problem is solved by the method lies in the fact that additional bone defect after filling kalapana turns absorbable to Lagunova film.

The effectiveness of the proposed method was studied in experiments on animals (mongrel dogs of both sexes weighing about 20 kg).

To create experimental bone defect under intramuscular anesthesia (calypsol and rometar) in the middle third of the right femur with saws, Gigli formed a circular defect of the diaphysis length of 5 mm, then was made of plate osteosynthesis metal plate and screws. We used the drug on the basis of artificial hydroxyapatite and collagen kollapen (manufactured by the firm "Intermediate"), as well as semi-permeable collagen film.

The next stage animals were divided into 3 groups.

In the first group (10 animals) bone defect does not fill the wound had usuals tightly (control group).

In the second group (10 animals) in the bone defect was Packed granules kalapana, wound layers were usuals.

In the third group (9 animals) in the bone defect was Packed granules kalapana, defect hid absorbable collagen film, wound layers were usuals.

Produced x-rays immediately after the operation, after 30 days, 2 and 3 months. In the same period, the animals were sacrificed experience and material from the area of bone defect was going on histological examination.

In the series conducted by OPITO the identified high biocompatibility of kalapana and collagen films with animal tissues. In none of the series was not observed suppuration of postoperative wounds and soft tissue around the implants. Around implanted materials of both early and late study histologically detected very weak cellular response.

In a series of experiments, where the bone defect was introduced Callahan and not hid collagen film, the implant purely mechanically by movement of the adjacent muscles migrated beyond the defect, the greater part of it was loose in the muscle pattern. This did not happen, if the bone defect optional hid collagen film.

According to x-ray, compared with the control indicated a more pronounced bone formation in a series of experiments using kalapana and, especially, by complex kalapana and collagen film. Already in the early stages (30 days) in 2 and especially 3 series of experiments revealed a "veil" primary corn in the area of bone defect. Periosteal reaction in the coverage area of the collagen film is not observed. 3 months after surgery in all 9 (100%) animals of the third (core) group, the bone defect was filled full bone regenerate, which was not observed none of the animals in the control (group 1) group, and was less pronounced in experiments using kalapana without collagen to generate the new film the development of callus was observed in 60% of cases (6 animals). Histological study showed that the most active processes of osteogenesis was in the 3rd group of animals, with newly formed bone was formed directly on the surface of the granules kalapana.

In the same group remodeling of bone trabeculae and recovery of cortical bone also are the most active.

The use of absorbable collagen film prevented the migration of kalapana from the area of the defect, thereby prolonging its action. Long-term (up to 1 month) biodegradation of the collagen film causes the optimal conditions for the development of primary bone spur and subsequent rebuilding and restoration of normal structure and function of long tubular bones.

Based on the positive results of experimental studies of the proposed method of treatment used in clinical practice in 3 patients. We all came a consolidation of fractures. Pyo-inflammatory complications were not observed.

Clinical example 1

Patient S., age 28, transferred in tsito of CRH, Mytishchi on the second day after receiving autotray, with a diagnosis of closed comminuted fracture of the middle third of the right tibia. On the second day after admission, the patient was prooperiruem is N. During the operation detected: large hematoma, soft tissue swelling, abrasion, fracture of the many small, loose fragments, interposition of soft tissue. After removing the loose small bone fragments and reposition the field of fracture formed bone defects, which were filled with kalapana. To provide directional regeneration of the fracture is covered (wrapped in the form of a clutch) collagen film, recorded by the ligature. Then was made of plate osteosynthesis metal plate. Despite the severity of the fracture and extensive soft tissue bruises, no complications were observed. Consolidation of the fracture occurred after 8 weeks on the type of the primary seam, without showing signs of periosteal corn. Work capacity is restored.

Clinical example 2

Patient D., aged 45, is delivered to the receiving Department cyto 3 hours after injury (fall from a height of 6 meters at the construction site) with a diagnosis of open comminuted fracture of the lower third of the left femur. Upon receipt detected: shock II degree, on the border of the middle and lower third of the left thigh on the front surface of the ragged wound size 4 by 3 cm with bloody discharge. In the wound are bone fragments. Upon receipt immediately made the initial surgical treatment of RA is s with excision of nonviable tissue, removed the loose in the wound tract fragments and resected bone fragments protruding from the wound channel. The bone defect, loosely filled with kalapana after reposition of fragments spacestationsim apparatus mounted on the base of the Ilizarov apparatus. The fracture shrouded collagen film, recorded by the ligature. Due to the large defect sutures on the skin do not overlap. The postoperative period was uneventful. The wound healed by active epithelialization on the 20th day, skin plasty was not required. Any complications were observed. The patient was discharged on the 25th day after the operation. During follow-up revealed active reparative regeneration of bone tissue in the area of the fracture. The fracture fracture occurred after 11 weeks, the device was removed, she recovered, the recovered completely disabled.

Thus, a semi-permeable collagen film, which was closed place implantation kalapana in the field of fracture, promotes localization of kalapana and prevents its migration, thereby enhancing and prolonging the effect of kalapana.

A method for the treatment of comminuted fractures of the long bones, including the use of kalapana and metallicity, characterized in that it further bone defect after fill number is Apana wrap absorbable collagen film.



 

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22 ex, 1 tbl

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13 cl, 16 ex, 4 tbl

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1 cl, 3 dwg, 1 ex

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