Digital programming method for determining bone fracture consolidation degree

FIELD: medicine.

SUBSTANCE: method involves scanning X-ray picture with a scanner. Optical density difference is determined between fracture place and cortical layer thereof. The value being equal to 1.0-1.2, finished consolidation is concluded to be the case. The value being equal to 1.21-1.8, sufficient consolidation is concluded to be the case. The value being equal to 1.81-2.0, insufficient consolidation is concluded to be the case. The value being greater than 2.0, no consolidation is to be diagnosed.

EFFECT: high objectivity in evaluating consolidation quality.

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The invention relates to medicine and can be used for diagnosing the degree of fusion of bone fractures.

There is a method for quantitative assessment of lesion of bone formation by indirect results of computer densiometry review of radiographs (application No. 2001102225/14 from 24.01.2001,, “Method for quantitative assessment of lesion of bone formation by indirect results of computer densiometry review of radiographs”). The method is to use indirect densiometry to study mineral density of the distraction regenerate during replacement of large bone defects or the correction of limb deformities (congenital or acquired), as well as lengthening the limbs to align their length.

The closest analogue of the present invention is a method for diagnosing the severity of the reparative process during bonding of fractures of long bones, namely, that to determine bone density investigate the difference in sound conductivity bones in the dynamics and perfusion scintigraphy 99 TC (RF Patent No. 2194448 from 06.05.2000, “a method for the diagnosis of Union fractures of long bones”). The method is invasive (provides for the integrity of the skin), and is accompanied by the introduction of radiotherapeutic - 99 TC, which causes additional radial load, the LC on the patient.

Object of the invention is the study of the optical properties of bone tissue for the objectification of the consolidation process (fusion) of the fractures and the reflection of it in digital form.

The task is achieved by the fact that appreciate the difference of optical density of the fracture site (APMP) and the optical density of the cortical layer (OPCS) in the dynamics of coalescence of fracture on x-ray data.

The optical density (OD) video on radiographs depends primarily on the density of the tissue through which the x-ray beam. It is known that black-and-white image by optical density (R) is decomposed into a 255 tones, depending on the intensity of the color pixels (1 - point video). So, the point “0” corresponds to a black color. Accordingly, the point of “255” is absolutely white. Thus, in the x-ray image, after it is digitized, using histographical research, you can determine the optical density of any pixel, the selected area or the entire x-rays. It is known that than through a more dense fabric passes the x-ray beam, the brighter the image is produced on the negative and, on the contrary, the smaller the density of the tissue studied, the darker the image. Thus, the cortical layer of long tubular bones looks on the radiograph practical and white, and the image of the soft tissues of the limb - dark.

Thus, it is obvious that the optical density of the fracture site (OPMP) on the x-ray is identical to the optical density of the soft tissues. As intergrowths of fracture OPMP will be closer to the optical density of the cortical layer (OPCS). Thus, exploring the optical density of the fracture site in the dynamics, it is possible to trace the process of consolidation and Express it in digital form. However, given the different quality characteristics of the LMS, it is difficult to compare the obtained histograms and correctly interpret the results. For the objectification of the method proposed to estimate the difference of optical density (PMAS) of the fractured bone and the cortical bone layer, assuming that the dynamics in the process of consolidation OPMP approaching OPKS. Accordingly, the smaller the indicator ROP fractured bone (MP) and cortical (CC) studied the bones, the more you can talk about completed the consolidation process.

Based on the foregoing, we conducted a study of the optical density of the radiographs in 48 patients with fractures of the long bones of the limbs, which were divided into 2 groups. The 1st (n=24) included patients, which during the operation of transosseous osteosynthesis achieved the exact reposition of bone fragments, wound by the with was uneventful, healing of the fracture took place in the normal localization of the fracture time. In this group were treated 6 patients with femoral fractures, bones, tibia, humerus and forearm bones. The 2nd group (n=24) consisted of patients who during the operation of transosseous osteosynthesis was not achieved accurately reposition of bone fragments, kept various kinds of displacement of bone fragments in the range of several mm or degrees. In this regard, the healing of the fracture took place in longer terms than in group 1. It also included 6 patients with fractures of the femur, bones, tibia, humerus and forearm bones. Investigated the optical density of the fracture site (OPMP), the optical density of the cortical layer (OPCS) and the difference between APMP and OPX dynamics (PMAS).

Removing parameters from x-ray was performed three times: at 1 and 30 days. after injury and at the time of dismantling of Ilizarov (PL. 1).

Table 1

The difference of optical density region of the fracture and the cortical layer of the bone
 group 1*group 2**
day.

The limb segment
130disassembly of the device130demont the W of the device
Thigh3,19±0,751,55±0,331,04±0,173,10±0,732,55±0,421,60±0,34
Shin bones3,62±0,811,69±0,361,03±0,154,65±0,902,75±0,471,81±0,41
Humerus4,73±0,921,43±0,301,08±0,223,69±0,831,92±0,551,55±0,39
The bones of the forearm5,66±0,991,35±0,271,06±0,205,26±0,952,19±0,411,80±0,40
Average4,30±0,851,51±0,321,05± 0,194,21±0,822,35±0,411,70±0,36
(p≤0.5)

*the period of dismantling apparatus - 66,5±10,8 day; ** deadline Dismounting apparatus - 111,8±17,5 day.

At the time of injury (1 day) PMAS fractured bone and the cortical layer were practically identical and were within 4,21±0,82 -4,30±0,85 in both groups. However, after 30 days. the value of PMAS in the studied groups revealed significant differences. Thus, in group 1, it is part of the Yala 1,51± 0,32; whereas in group 2 to 2.35±0,41. Thus, after 30 days PMAS in group 1 was lower than in group 2, 1.56 times.

When dismantling the device, and, in group 1, he ran to 66,5±10,8 d, while in group 2 to 111,8±17,5 d, The rope was in group 1 1,05±0,19, whereas in group 2 -1,70±0,36. Thus, the period of consolidation of the fracture diagnosed on clinical, radiological and functional criteria, OPMP in group 1 was not significantly different from APCS, whereas in group 2, this figure was higher than in group 1, of 1.62 times. On the way to study the optical density of the bone tissue is submitted for the invention.

Clinical example 1. IB 152, 19.12.93 (group 2). Fragments of comminuted fracture of the femur in the middle third with displacement of bone fragments (figure 1).

From the above analysis of the histograms in figure 1 it follows that 1 day. after injury OPN was lower than OPKS, 3,15 times. At 30 days. indicator ROP decreased only up to 3,05. And only 150 m day (at the time of Dismounting apparatus Gailizarov) ROP decreased to 1.77. The reason for this was insufficient reposition of bone fragments in the apparatus and delayed Union of fracture, which is visible on reginorum 1.

Clinical example 2. IB No. 3503, 20.08.01 (group 1). Fracture of the femur in the lower third with displacement of bone fragments (figure 2).

On 1 day. after injury OPM who was below, than OPKS, 1,87 time. At 30 days. indicator ROP decreased to 1.56. At the time of Dismounting apparatus Gailizarov (60 days) The rope fell to 1.03. Thus, by the deadline OPMP and OPCS was not significantly different. Based on the above optical properties of bone tissue, in particular OPMP, OPX and PMAS, and comparing them with clinical, radiological and functional criteria of consolidation of fractures, we propose a classification of the degree of consolidation of bone fractures (table 2).

Table 2

The classification of the degree of consolidation of fractures of the extremities
The degree of consolidationThe difference of optical density (PMAS) of the cortical layer (COP) and the fracture site (MP)
1. Completed consolidation1,0-1,20
2. Sufficient consolidation1,21-1,80
3. Insufficient consolidation1,81-2,00
4. The lack of consolidationMore than 2,00

Thus, the study of the optical density of bone tissue in the dynamics of accretion of fracture according to the digitized x-ray analysis of the histograms of the area of the fracture and the area of the cortical layer allows you to objectify the quality to which solidly fracture on quantitative (numerical) level. The method is objective, non-invasive and, aside from having a personal computer and scanner that allows you to scan x-rays, does not require additional material costs.

The method of determining the degree of fusion of the fracture, including scanning x-rays using a scanner and determining the difference of optical density (PMAS) of the fractured bone and the cortical layer of the fracture site and at values of 1.0 to 1.2 identify completed consolidation, 1,21-1,8 - sufficient consolidation of 1.81-2.00 in insufficient consolidation, and a value of more than 2.0 is the lack of consolidation.



 

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