Method for treating the cases of linear cerebral bone vault fractures

FIELD: medicine.

SUBSTANCE: method involves introducing sharp tip of hollow needle into bone cortical layer crack. The crack is filled through needle lumen by introducing Collapan gel mixed with radiopaque substance in minimum concentration providing radio contrast range excess above injured bone contrast. Soft tissues are pierced with the needle in the vicinity of crack filling area center. Needle bevel plane is set in crack plane projection and introduced into the crack. Then, needle tube is rotated with its bevel plane directed into crack space. The cerebral covering soft tissues are pressed to bone along the crack path above positioned needle tip projection and the mixture is introduced in the amount equal to crack cavity region under pressed sift tissue. The needle end is pulled and directed towards the opposite crack region without removing it from the soft tissues and the region is also filled. Collapan introduction into crack fissure is carried out under X-ray optoelectronic transducer control.

EFFECT: enhanced effectiveness of treatment; reduced risk of postoperative complications.

3 cl

 

The invention relates to medicine, in particular to neurosurgery, namely for the treatment of patients with linear fractures of the skull vault bones.

In traumatic brain injury allocate linear (make up 61% of all fractures of the skull, depressed and comminuted fractures of the bones of the human cerebral cranium. In 12% of patients with fractures of the skull vault combined with fractures of the base (Old B.C., Chuprov A.G., Shubin LI, Ginzburg ER, A.V. Ushakov. To the problem of diagnosing fractures of the skull vault. VII Congress of traumatologists and orthopedists Russia, 18-20 September 2002, Abstracts. Novosibirsk, 2002. Vol.2. C. 132-133). It is known that the bones of the calvarium and skull base fractures have a negligible tendency to fusion (Ushmanova-Stroganov, Dgoogle. Bones and joints in the x-ray image. Vol. 1. Head. - S. 322. - M.: Medgiz, 1955). The line of fracture of the skull radiographically detected through many years, and it tends to further bone resorption (Fahrenberg. X-ray diagnosis of diseases of bones and joints. - M.: Medicine, 1964, 4th edition, p.91). Linear fractures, not prone to bone regeneration, impair the function of the skull that protects the brain from mechanical damage. It is known that traumatic brain injuries with linear fractures of the skull vault bones diagnose brain injury and treatment b is a high carry over damaged brain including the creation of peace to the patient without the use of tools, aimed at the pathology of the cerebral cranium bones. In the textbook for students of medical institutes reported: "the Treatment of fractures of the skull base is basically the same as medium, and severe concussion and brain injury, and indications for surgery for fractures of the skull vault arise in the implementation of an internal bone plates of the cranial cavity 1 cm (Imilar. Neurosurgery. M: Medicine. 1982, s, 232). There is no doubt that this tutorial is about the surgical treatment of non-linear fracture, and the introduction of bone in the skull cavity. Therefore, in this tutorial recommendations do not provide techniques for targeted treatment of linear skull fracture. These data show that unresolved problems and encourage to search and develop targeted treatments for patients with linear fractures of the skull vault bones.

There is a method of treatment in a linear fractures of the skull vault, including cold on the head, inside calcium chloride 10% solution, intravenous glucose and 40% of urotropine, and antibiotics (Vaaranam. In the book "Surgery. Lesions of the nervous system". A practical guide edited by Prof. Vnemiw. Medgiz. Len. the CTD. 1959, S. 58).

The disadvantage of this therapy is the lack of the s in her techniques, aimed at improving the quality of healing of bone fractures of the cranial vault by accelerating and improving the quality of bone regeneration in the line of fracture.

There is a method of treatment for comminuted and depressed fractures of the skull vault by reposition of large fragments and placing a bone graft in place, i.e. the transformation depressed comminuted fracture in without the introduction of fragments of bones in the skull cavity. Moreover, small fractures around the first depressions cut a large bone flap, then map fragments and then put the bone flap back in place (Bed and Lubriderm, 1987). Thus, before laying the bone fragments fasten cyanocrylate glue (Lyalevich et al., 1995).

The disadvantage of this method is lack of signs aimed at improving the quality of healing of linear fractures of the skull vault bones by improving and accelerating bone regeneration along the line of fracture.

There is a method of treating bone defects of the skull vault under the patent of the Russian Federation No. 2199287 (Authors Westrich and Arrisburg), including refreshment in the bone defect edges, blurring the edges of the bone in the defect gel kalapana containing the antibiotic gentamicin. Then, the bone defect is filled with granules of kalapana, covered it with gel, and cover plate.

The disadvantage of this with the person is the lack of signs, aimed at improving the quality of healing of linear fractures of the skull vault bones by improving and accelerating bone regeneration along the line of fracture.

The closest in technical essence to the proposed method is the method according to the patent of Russian Federation №2199287, which we take as a prototype, and the drawbacks set forth above.

The technical result of the invention is to improve the quality of healing of linear fractures of the skull vault bones by improving and accelerating bone regeneration along the line of fracture.

The technical result is achieved in that a method of treatment of linear fractures of the skull vault includes creating calm the patient and treatment of brain injuries. In the crack of the cortical layer of the bone enter the sharp end of the hollow needle and through the lumen of the needle sealed the crack with the introduction of gel kalapana in a mixture with a minimum concentration of radiopaque substances, providing the excess of rentgencontrastnoe mixture over that of the damaged bone.

In a preferred embodiment of the method of soft tissue puncture needle in the middle of the proposed site filling cracks, the plane of the bevel end of the needle set in the projection plane of the crack and injected into the crack, then turn the tube of the needle plane of the bevel into the lumen of the cracks, then press the m is gcie fabric covers of the skull to the bones along the cracks over the projection of the fixed end of the needle and injected the mixture into the volume of the cavity section of the cracks under pressed a soft cloth after the end of the needle to tighten the puncture site and, without removing the needle from the soft tissues, direct the end of the needle in the opposite area of the cracks, also plomberie it.

In another preferred embodiment of the method of doing kalapana in the fracture gap is realized under control of the x-ray electron-optical Converter.

A specific example of the method. Hair on the head of the patient vypivaut, and the skin in the area of the surgical field is treated with antiseptic. Along the line of fracture is produced by local infiltration anesthesia of the skin, subcutaneous tissue and periosteum 2% lidocaine solution. In a syringe with needle, diameter not less than 1 mm and cut the pointed end oriented to the layout of the divisions of the syringe, trying to enter the liquid Callahan and water-soluble radiopaque material, for example, "Ultravist 240 in the ratio 1:10. The x-ray beam electron-optical Converter (EOC) is directed along the line of fracture. Under the control of the Tube at the level of the middle of the proposed site filling cracks, some distance from the line of fracture 1.5-2 cm, after the anesthesia through the soft tissue injected hollow needle all the way into the bone. The plane of the bevel end of the needle set in the projection plane of the crack, and the end of the needle is injected into the lumen of the cracks of the cortical layer of the bone to a depth of 1-5 mm (zavisimost and the thickness of the bone at the injection needles). Then cut the needle turn the bevel in the direction of the depth of the lumen of the bone cracks. Press the soft tissue of the skin of the skull to the bones along the cracks over the projection of the fixed end of the needle and injected the mixture into the volume of the cavity section of the cracks under pressed a soft cloth that is defined by the width, depth and length of bone fractures. Sealed the crack with the introduction of gel kalapana in a mixture with a minimum concentration of radiopaque substances, providing the excess of rentgencontrastnoe mixture over that of the damaged bone. Then the end of the needle and tighten, but do not remove it from the soft tissues, is directed in the opposite area of the cracks and sealed it. On the screen of the Tube watching the spread mixture on cracks fracture. Depending on the length distribution of the mixture in the lumen of the cracks, if necessary, sequential movement of the needle tip along cracks or conducting multiple needle injections fill with a mixture of all the fracture gap. Then remove the needle, the puncture site impose a sterile hemostatic cloth and fix it a pressure bandage.

The significance of differences between the claimed process from the chosen prototype is the following. Kollapen, produced by the domestic firm "Intermediate", - bioactive osteoplastic material is and the basis of homogeneous composition especially pure hydroxyapatite, collagen special treatment and antibiotics. Thus Callahan-L contains lincomycin hydrochloride and Callahan-G - gentamicin sulfate. Since the base material is high-purity hydroxyapatite and collagen, which structure is most similar to biological tissues, this leads to a high biocompatibility of the material, the absence of a allergic reactions and rejection (Uwimana, 1996; Weggemans. 1999). Kollapen, because of the incoming of him hydroxyapatite, osteoinductive and matrix properties for the newly formed young bone tissue, improving the reparative processes in the contact of the bone (Vinburnine; Gagasan,1997; Weerakoon, 1997; Gambescia, 1993). The formation of bone beams almost always occurs on the surface of kalapana, and between it and the bone is not formed connective tissue layer (Omochi, 1999). This material is almost identical to human bone, able to firmly contact with the bone structures in the implantation site and, over time, to replace bone defects, bone tissue. Callahan has the ability to biological degradation, over time, undergoing biodegradation. Kollapen, including collagen, is an active medium, the protector and the prolongator of medicines, in particular antibiotics. To llagen is also a stimulant of reparative processes (Gnereic, 1997). Antimicrobial activity of kalapana saved 16-20 days (Omochi. 1999). Kollapen non-toxic, has no Carcinogenicity and forms strong complexes with antibiotics (Bel, Sambarino, Gnereic, 1992). Kollapen release in the form of a 2% gel in granular form or in the form of plates. According to the claimed method introduction in the crack of the cortical layer of the bone sharp end of the hollow needle and through the lumen of the bone filling cracks with the introduction of gel kalapana mixed with radiopaque substance improves the accuracy of introducing a therapeutic agent into the lumen of the linear fracture, the possibility x-ray control over the distribution of its lumen cracks. Use the minimum concentration of the radiopaque substance in the mixture, providing the excess of rentgencontrastnoe mixture over any damaged bones, improves tissue differentiation bone and the mixture, which improves control over the distribution of the mixture in the tissues. Puncturing the soft tissues of the needle at the middle of the proposed site cracks for sealing provides the opportunity through a single puncture of the skin to enter the needle in different directions along the cracks, which reduces the trauma to the soft tissue of the skull. Placing the plane of the bevel of the needle tip in the projection plane cracks facilitates the penetration and the introduction of the con is and needle into the crack and reduces trauma to the periosteum. Then rotate the needle tube plane the bevel facing the lumen of cracks, allows for more accurate input into the crack therapeutic agent. Thrust to the soft tissues of the skin of the skull to the bones along the cracks over the projection of the fixed end of the needle and the introduction of the mixture in the volume of the cavity section of the crack reduces the probability of the input mixture beyond the cracks on the bone under pressed a soft cloth, improving the quality of the injection. Bringing up the end of the needle, without removing it from the skin, and its direction to the opposite site of the cracks with the same filling do not require additional puncture soft tissue and reduce the damage to them. Introduction rentgencontrastnoe mixture kalapana in bone gap under the control of the x-ray electron-optical Converter improves the accuracy of the direction of introduction of the mixture into the lumen of the cracks and precision. Thus, the claimed method in all of its signs expands the choice of method of treatment and promotes subsequent regeneration of the bone tissue of the skull, which increases the quality of treatment and improves long-term outcomes, leading to economic benefits.

The application of the invention is possible in children and military surgery, as well as in veterinary medicine.

1. The method of treatment of linear fractures of the skull vault, including BB is engaged in the bone defect of kalapana in the form of a gel, wherein the percutaneous enter the sharp end of the hollow needle into the crack of the cortical layer of the bone and through the lumen of the needle sealed the crack with the introduction of gel kalapana in a mixture with a minimum concentration of radiopaque substances, providing the excess of rentgencontrastnoe put the mixture over the use of rotary instruments damaged bones.

2. The method according to claim 1, characterized in that the soft tissue of the puncture needle in the middle of the proposed site filling cracks, the plane of the bevel end of the needle set in the projection plane of the crack and injected into the crack, then turn the tube of the needle plane of the bevel into the lumen of the cracks, then press the soft tissue of the skin of the skull to the bones along the cracks over the projection of the fixed end of the needle and injected the mixture into the volume of the cavity section of the cracks under pressed a soft cloth, after which the end of the needle and tighten, but do not remove it from the soft tissues, is directed in the opposite area of the cracks and sealed it.

3. The method according to claim 1, characterized in that the introduction of kalapana in the fracture gap is realized under control of the x-ray electron-optical Converter.



 

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