Method for treating children for juvenile femur head epiphyseolysis

FIELD: medicine.

SUBSTANCE: method involves applying fractured bone fragments reposition at the first stage and implanting metal electrodes at the second stage into the osteolysis zone. Beck wires with dielectric coating are used as the electrodes. The wires are introduced transcutaneously in parallel to femur neck axis and mounted on epiphyseal germination zone with their working ends penetrating not less than 3 mm deep. Then, flexible electrodes are subcutaneously implanted in hip joint projection zone. Electric stimulator is connected to the skin ends of the electrodes. Pulsating current of negative polarity is supplied to intraosseous electrodes, whereas the flexible electrodes receive current of negative polarity from 5 to 10 mcA, frequency of 1 Hz and voltage of 8.8 V. Total duration and cross-section of rectangular pulses is not longer than 200 mcs. Pulsating electric current acts the whole day to achieve full closure of the germination zone.

EFFECT: enhanced effectiveness of treatment; prevented adverse side effects.

 

The invention relates to medicine, in particular to surgery, and can be used for the treatment of youth epiphysiolysis of the femoral head in childhood and early adolescence.

There is a method of treatment of youth of epiphysiolysis of the femoral head in children [Kuznetsian H.E., Ulrich EV Surgical treatment of children with diseases and deformations of the musculoskeletal system" - M.: Medicine, 2004. ISBN 5-225-04774-2; s-374]. The method consists in the fact that you are doing the open exposure of the upper third of the femur and the neck of the femur. Make possible the reposition of bone fragments. The capsule of the joint, visually determine the angle of deformation of the head and the femoral neck and intertrochanteric region to form a tunnel into which is injected cortical auto - or allograft bone tissue in the form of a pointed rod. Thus carry out the stabilization of the proximal epiphysis of the femur and induce osteoreparative processes in the lesion transplanted fragment of bone tissue. Limb fix Kokshetau plaster cast for 8-12 weeks. The rebuilding of bone tissue and closure of the germ band occurs in the period from 8 months to 1 year.

The disadvantage of this method is that the restoration of bone structure goes uncontrollably from the doctor and animalcruelty period of time. The intervention has an open nature traumatic for a child and is associated with blood loss. The hip joint and allied remain motionless for a long time that, in the future, entails a long rehabilitation and complications associated with physical inactivity. The result of treatment due to residual strain is not always functionally satisfactory.

As the closest analogue accepted method of treatment of youth epitheorisi of the femoral head in children [Hofgaard "the Treatment of children and adolescents with orthopaedic diseases of the lower extremities", Kazan Tatar kN. publishing house, 1995. ISBN 5-289-00526-8; s-256], including instantaneous or gradual reposition of bone fragments of the head and neck of the femur skeletal traction and percutaneous transcervical introduction in the neck and a femoral head beam spokes Beck with medical drills to stabilize the femoral head and stop its further displacement. When the limb is fixed plaster Kokshetau bandage for up to 6 months.

However, the known method is ineffective. Treatment is mainly aimed at the suspension of further slippage of the epiphysis and has no effect on the repair processes in bone. The patient had a long time to be in immobilsarda plaster bandage. While the closure of the growth plates occur in 6-12 months. The stiffness of the hip joint for such a long period of time, and lack of exercise lead to complications and long-term rehabilitation. The use of the method may lead to avascular necrosis of the femoral head, osteolysis or osteoarthritis.

The objective of the invention is to provide a highly effective method of treatment for youth epiphysiolysis of the femoral head in children, allowing to obtain a pronounced clinical outcome, reducing the duration of treatment and subsequent rehabilitation of the patient, to reduce the number of possible complications.

The essence of the invention is that a method of treating youth epiphysiolysis of the femoral head in children is characterized by the fact that the treatment is carried out in two stages, the first stage is conducted reposition kostich fragments, at the second stage in the area of osteolysis hard implanted electrodes, which use needles Beck with a dielectric coating, while their conduct percutaneous parallel to the axis of the femoral neck and set the working ends in pisarei plate to a depth of not less than 3 mm, and then subcutaneously implanted elastic electrodes in the projection of the hip joint, cutaneous ends of the electrodes connect the pacemaker, intraosseous electrodes serves pulse current negative is Olanesti, and the elastic electrode - positive polarity power from 5 to 10 μa with a frequency of 1 Hz, a voltage of 8.8 V, the total length of the front and cut a rectangular pulse is not more than 200 µs and carry out impact of pulsed electric currents around the clock to complete the circuit germ band.

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

The method is highly effective. It allows you to get a pronounced clinical effect. Allows from the first days to manage the processes of osteoreparative in the head and neck of the femur, to prevent unwanted side effects treatment of aseptic necrosis of the femoral head.

This is achieved by reducing the trauma of soft tissues due to manipulations with knitting needles and electrodes by closed method, percutaneous. During the electrode is not disturbed anatomical integrity of the bones as the body, because the electrodes are implanted under fluoroscopic control screen.

No additional costs allografts for bone regeneration are natural plastic resources of the organism.

The treatment time is reduced by 3-4 times compared with accepted methods and are on average 1-2 months.

The recovery time is reduced to 4-6 m the months.

The method allows to avoid recurrence of the disease by stimulating the natural bone formation and closure of the germinative zone of the proximal femur.

The technical result is achieved due to the proposed by the authors of the new technologies of treatment youth epiphyseolysis. Traction with the gradual abduction and internal rotation of the hips allows you to maximize the correct the displacement of bone fragments and bring them into the correct position without disturbing the blood flow.

Use as a hard metal electrodes spokes Beck with a dielectric coating simultaneously with the stabilization of the femoral head to stimulation of osteogenesis, which gives rapid and pronounced clinical effect.

Stable fixation of rigid electrodes by holding them parallel to the axis of the neck of the femur and the establishment of working ends in pisarei plate at the optimum depth sufficient to obtain a therapeutic effect (not less than 3 mm), allows to achieve the optimal location of the working surface of the electrodes in relation to the affected area and prevents the development of inflammatory complications in the installation locations of the electrodes.

Implantation of the working surface of the electrodes directly in the epiphyseal growth zone of proximal company code is adopted bones allows for isolated influence of electric field on the affected Psarou plate, without affecting the healthy sections of bone.

The subcutaneous implantation of elastic electrodes in the projection of the lesion allows to concentrate the energy of the electric field in the head and neck of the femur when performing electrical stimulation weak pulse currents.

The course of stimulation of osteogenesis weak pulse currents in mode 5 to 10 μa with a frequency of 1 Hz, a voltage of 8.8 V with the total length of the front and cut rectangular pulses of 200 µs clock allows in a short time to achieve the formation of actively regenerating osteogenic tissue in pisarna Department of the femoral neck and the closure of the germinative zone of the proximal femur.

The modes of action of pulsed electric currents on reparative processes in the proximal femur in a young epiphyseolysis defined by the authors in accordance with electrophysiological distribution of electric potential along the length of the bone. Experimental data (Z/B Friedenberg, ..Brighton, 1966, Sec, Coy, 1977, 1989) showed that electric currents in the region of the metaphysis have a more negative charge than in the diaphysis. Based on this fact, the authors worked out the optimal stimulation modes, sufficient for stimulation of osteogenesis from 5 to 10 µa.

Carrying out activity in the field p is Arsenalnoe metaphysis with the physiological frequency of 1 Hz is reasonable. The authors in this mode guided by the fact that the neck and the femoral head are subjected to dynamic loading, which coincides with the frequency of relaxing human step equal to 1 Hz.

The method is as follows.

The treatment is carried out in two stages. The first phase will reposition of bone fragments by means of gradual elimination of the offset of the femoral head. For this patient under General anesthesia produce the imposition of skeletal traction for the distal metafit femur with internal rotation of the hip. During the month gradually spend a breeding hips to the maximum value, and then perform the control x-rays of the hip joints and make sure the correct position of the bone fragments.

In the second stage stabilize the proximal epiphysis (head) of the femur. With this purpose under General anesthesia and under the control of the x-ray screen in the area of osteolysis and pisarei plates implanted two rigid metal electrode, which use needles Beck with a dielectric coating made by the method of plasma spraying of ceramics or ultrapure silicon.

The implantation of electrodes produced with the assistance of medical drills from the outer surface of intertrochanteric femoral the spine. The electrodes conduct percutaneous parallel to the axis of the femoral neck. The working ends of the electrodes are set in pisarei lastinc to a depth of not less than 3 mm Electrical isolation spokes 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 of the hip joint implanted elastic electrode PEOU-1 (length 600 mm) or PEOU-2 (length 900 mm). Designated standing electrodes cover aseptic dressings. To skin the ends of the metallic elastic electrodes connected to the stimulator EOS-20-01 "Osteochon-2". For intraosseous hard electrodes serves pulse current of negative polarity, and the subcutaneous elastic electrode - positive polarity power from 5 to 10 μa with a frequency of 1 Hz, a voltage of 8.8 V, the total length of the front and cut a rectangular pulse is not more than 200 µs.

Impact of pulsed electric currents carry out in - cathode mode within 3-7 weeks (about 4 weeks) to complete closure of the germinative zone, i.e. to the full restoration of bone structure in the area of osteolysis.

Example. Patient 12 years. Diagnosis: juvenile apetizers of femoral head bone. Believes cerabolini during the year, when there is pain in the knee joints, which are increased during exercise. In the last days before admission to the hospital the pain was localized in the region of the hip joints. Diagnosed a month before admission to the hospital. Admission: complaints of pain in the hip joints. Child of heightened power. The length of the legs is the same, there is a sharp restriction of internal rotation and hip abduction. On radiographs of the hip joints in a direct projection and Lowenstein defined line resorption in the region of the epiphyseal growth zones of the femoral head bone and displacement of femoral head bone in the posteromedial direction.

The treatment by the proposed method. At the first stage of treatment imposed skeletal traction with internal rotation of the hips and gradually lead leg for four weeks. In the second stage, after the elimination of the offset of the femoral head bone, in the area of osteolysis each limb implanted two fixed electrodes which are used spokes Beck with a dielectric coating. They introduced percutaneous parallel to the femoral neck and set the working ends in pisarei plate to a depth of 3 mm To create an electric field through the trocar subcutaneously in the projection of the hip joint implanted elastic electr the waters of PEOU-1 length 600 mm To skin the ends of the metallic elastic electrodes connected to the stimulator EOS-20-01 "Osteochon-2". For intraosseous electrodes were applied pulse current of negative polarity, and the subcutaneous elastic electrode - positive polarity power 5 µa with a frequency of 1 Hz, a voltage of 8.8 V, the total duration and front cut rectangular pulses of 200 μs. Electrostimulation conducted for 12 weeks in the cathode mode. As a result of electrical stimulation of osteogenesis occurred consolidation of femoral head bone, disappeared zone resorption, in their place is determined by the area of sclerosis. All stages of treatment and the period after it was uneventful. After removal of the electrodes and removal of skeletal traction, the patient is assigned exercise therapy, massage, physiotherapy. Was discharged for outpatient treatment in a satisfactory condition with full range of motion in the hip joints. In 6 months from start of treatment allowed dosed axial load on the limb. The follow - up period of 3 years. Recurrence of the disease was not detected.

Example 2. Patient A.,10 years. Diagnosis: juvenile epiphyseal head of the left femur. From the anamnesis: considers himself sick about 6 months, when there was fatigue when walking, pain in the left hip joint, lameness. After minor trauma left Isobutanol joint complaints increased. The parents appealed to the district hospital where the child was examined by a surgeon, and then a rheumatologist.

After conservative therapy regarding injury of the hip joint were referred for consultation to the hospital, examined by a podiatrist suspected youth apetizers of the femoral head to the left. The diagnosis is confirmed radiographically. Identified initial degree of displacement of the femoral head to the left, areas of dystrophic changes (opening) in the field paramilitary zone, signs of osteoporosis of the femoral neck. Clinically: there is a limitation of abduction and internal rotation, a slight increase in external rotation of the hip, flexion in the hip joint is not broken. In the knee joint motion in full physiological volume. The muscles of the left thigh slightly hypotropia. LLD not found.

The patient was hospitalized at the Department of trauma Tushinskaya children's hospital. Upon receipt: satisfactory condition. Child of normal stature, high power. Skin and mouth clean. In organs without pathology. In the General analysis of blood and urine data electrocardiography revealed no pathology.

At the first stage of treatment imposed skeletal traction distal metafit left femur with internal rotation of the hip. In the month about the Eden gradual raising of the hips to the maximum value. After elimination of the offset of the femoral head in the second stage of treatment in the area of osteolysis under the control of the x-ray screen percutaneous, parallel to the axis of the femoral neck, implanted two rigid metal electrode, which are used spokes Beck with a dielectric coating. The working ends of the electrodes are installed in pisarei plate at a depth of 4 mm In the projection of the hip joint subcutaneously implanted two elastic electrode PEOU-1. To skin the ends of the electrodes connected to the stimulator EOS-20-01 "Osteochon-2". The limb is placed on the bus by Capitol records in the position of the lead and started the stimulation of osteogenesis in the lesion weak pulse electric current in - cathode mode. For intraosseous hard electrodes were applied pulse current of negative polarity, and the subcutaneous elastic electrode - positive force 8 µa with a frequency of 1 Hz, a voltage of 8.8 V, the total length of the front and cut a rectangular pulse is not more than 200 µs. 1.5 months from the start of stimulation electrodes are removed under General anesthesia. Control radiographs and MRI: there is a hardening and closure of the growth zone of the femoral head to the left, regional osteoporosis of the neck of the left femur. Anatomical relationships in the joint preservation of the s. Clinically: hypotrophy gluteal muscles on the left. A course of rehabilitation. Within 3 months on crutches without relying on the affected leg. The x-ray examination and CT scan - normal anatomic ratio in the proximal left femur saved, the head of the femur without signs of impaired circulation, normal forms. Pisarna cartilaginous plate with signs of closing the entire area of the femoral neck. Minor radiological reduction of bone density in paramilitary area of the proximal femur. Joint gap within normal limits.

At clinical examination, the child does not make complaints, length of the lower limbs are identical, the axial load on the left lower extremity, painless range of motion in the hip joint is full. Gait reveals moderate sparing of the left lower extremity. Relative hypotrophy gluteal muscles on the left.

Permitted dosed axial load on the affected limb. The child is released from school of physical education for one year. The follow-up period was 2 years. Recurrence of the disease was not detected.

A method of treating youth epiphysiolysis of the femoral head in children, characterized in that the treatment is carried out in two stages, the first stage is conducted reposition of bone fragments, in which the EO stage in the area of osteolysis implanted metal electrodes, which use needles Beck with a dielectric coating, while their conduct transcutaneous parallel to the axis of the femoral neck and set the working ends in the region of the epiphyseal growth zones to a depth of not less than 3 mm, and then subcutaneously implanted elastic electrodes in the projection of the hip joint, cutaneous ends of the electrodes connect the pacemaker, intraosseous electrodes serves pulse current of negative polarity, and the elastic electrode - positive polarity power from 5 to 10 μa with a frequency of 1 Hz, a voltage of 8.8 V, the total length of the front and cut a rectangular pulse is not more than 200 µs and carry out impact of pulsed electric currents around the clock to complete the circuit germ band.



 

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