Method for restoration of haemostatic disturbances accompanying extremity fractures

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology, orthopaedics and leech therapy, and is applicable for the purpose of restoration of the haemostatis disturbances accompanying extremity fractures. That is ensured by applying the Ilizarov technique of transosseous osteosynthesis which is combined with leech therapy covering a skin projection of the fracture in the following schedule: one leech three times a week.

EFFECT: invention provides faster restoration of the microcirculation disturbances and stimulates the postoperative regeneration processes accompanying treating the extremity fractures.

1 dwg, 1 tbl, 2 ex

 

The invention relates to medicine, namely to traumatology, orthopedics and hirudotherapy, namely in the treatment of patients with trauma injuries for the correction of the hemostatic system.

Known methods of applying the treatment for various diseases and pathologies of the person, namely: a Method of treatment of scoliosis I-II degree (application No. 2005118228, publ. 2006.12.20), a Method of treating degenerative disc disease of the lumbar spine (application No. 2004122284, publ. 2006.01.27), a Method of treating osteochondropathy (patent No. 2195947, publ. 2003.01.10). The method of treatment of varicose veins (patent No. 2231360, publ. 2004.06.27), the Method of treatment of acute vascular optic neuropathy (patent No. 2281071, publ. 2006.08.10). Hirudotherapy is also used in the treatment of internal diseases as anti-inflammatory, anti-ischemic, anti-inflammatory agents, as well as to normalize the hemostatic indices (Ishkanian G.S. 1991, Savinov V. 2004, Kamenev O.Y 2006).

However, found in the sources we were not able to find information on the application of hirudotherapy in the treatment of patients with trauma injuries for the correction of the hemostatic system.

The present invention is to accelerate the restoration of microcirculatory disorders and stimulate regenerative processes in fractures of KOs is her limbs in the period of treatment by the method of transosseous osteosynthesis by Ilizarov.

The problem is solved in that in the method of recovering hemostatic disorders in fractures of the extremities, including the treatment method of transosseous osteosynthesis by Ilizarov, at the same time are leeching on the area of the cutaneous projection of the fracture mode: one leech three times a week.

The present invention is explained detailed description, clinical examples, a table and a picture showing an example of setting a leech on the area of the cutaneous projection of the fracture.

The method is performed in the following way.

In the postoperative treatment (2-3 days after the application of transosseous osteosynthesis) was added leeching mode: 1 leech 3 times a week on the area of the cutaneous projection of the fracture. The total number of sessions can range from 4 to 12 depending on the severity of the damage to the musculoskeletal system. The session lasts 20-40 minutes, leech utilized according to the requirements of the waste group C. On place attachment is applied with a cotton-gauze bandage on 14-16 hours.

Clinical observation restore hemostatic disorders in fractures of the extremities can be confirmed by a study.

For the past three months have seen a group of 60 patients with injuries of the musculoskeletal system. For the purity of ASCS is adowanie patients were divided into two groups. The average age of the patients 42,93.8 years, 38 men and 32 women.

In the first group of 32 people - the control group - leeching during treatment was not applied.

In the second group of 28 people - studied group during treatment was applied hirudotherapy (GT).

In the study group with 2-3 days after application of Ilizarov frame for 14-28 days used GT mode on one console leeches on the skin projection of the fracture three times a week (6-9 sessions). The duration of the session depended on the time of complete saturation of leeches. Leeches were used only once and subsequent disposal. After the procedure was applied with a cotton-gauze bandage.

The study of hemostasis was performed on hemocoagulase "Diagnostica STAGO" ("Technology standard", France), aggregometry "Aggregation analyzer ("Biola", Russia). To assess the validity of the differences of the results of the study and control groups used the parametric criteria student's t and Fisher.

The study of hemostasis groups (see table) revealed that the difference in treatment between the individual normal indicators of activated thromboplastin time (APCV) after injury and surgery was studied in a group of 1.461,09, in the control of 8.91,6 (p<0,01). The difference between normal prothrombin lie is neither (PV) in the study group 0,090,07, in the control - 2,21,3 (p<0,05). The level of fibrinogen in the treatment process is in the group of 4.40.7 g/l in the control of 5.71.1 g/l (p<0,01). The intermediate products of transformation and destruction of fibrin (; fibrin monomer complex) after surgical treatment was 12.74.4 mg/100 ml, decreased during treatment in the study group and 3.81.1 mg/100 ml in control only to 10.73.1 mg/100 ml (p<0.01) for the accepted norm of this indicator is less than 3.5 mg/100 ml

From this survey we can conclude that in the control group revealed hypercoagulation changes in agrigentum condition of the blood, such as hyperfibrinogenemia and expressed thrombinase. In the study group observed only easy thrombinase and indicators within normal limits".

These studies showed that the use of HT in the treatment of fractures of the method of transosseous osteosynthesis relieves post-traumatic tension coagulation and anticoagulation systems of blood and creates more favorable conditions for reparative processes, as evidenced by positive clinical dynamics.

Clinical example No. 1.

Patient I., aged 30. Medical card No. 1114 (28394). Came in with a diagnosis of Closed spiral fracture of the medial third of the right tibia and the lower third of the fibula offset the eating of fragments", operation: Closed transosseous osteosynthesis right tibia by Ilizarov".

In the postoperative observation period was added leeching mode: 1 leech 3 times a week on the area of the cutaneous projection of the fracture (the lower half of the tibia) total 4 sessions (see Photo). Duration of inpatient treatment was 23 days. The duration of the fixation period of 58 days. A gradual increase in load. Started to work after 70 days after injury.

Clinical example No. 2.

Patient P., aged 26. Case history No. 751 (70315). He admitted with a diagnosis of Closed spiral fracture of the lower third of the tibia and the upper third of the fibula of the right leg with displacement of fragments", operation: "Closed transosseous osteosynthesis right tibia by Ilizarov".

In the postoperative observation period was added leeching mode: 1 leech 3 times a week on the area of the cutaneous projection of the fracture (the lower half of the lower leg, foot) total 8 sessions. Duration of inpatient treatment was 18 days. The duration of fixation is 76 days. A gradual increase in load. Started to work through 116 days after injury.

The use of the proposed method in the clinic "RISC "RTO" them. Acad. Gailizarov" health District is hurt allows you to accelerate the restoration of microcirculatory disorders and to stimulate regenerative processes in the period of rehabilitation treatment for fractures of the extremities.

Method of recovering hemostatic disorders in fractures of the extremities, including the treatment method of transosseous osteosynthesis by Ilizarov, characterized in that at the same time are leeching on the area of the cutaneous projection of the fracture mode: one leech three times a week.



 

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