Method of stimulating reparative processes in treatment of intraarticular fractures

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to traumatology, and deals with elaboration of problems of treating traumatic affection of joints. Results, carried out in experiment, make it possible to suggest the following method of treating intraarticular fractures. Immobilisation of joint with recovery of anatomically correct interrelationship, stabilisation and further training movements in joint by means of apparatus of external fixation are performed. After recovery of anatomically correct interrelationship, not later than 3 days after trauma, joint surfaces are brought apart for the width which up to 50% exceeds the width of joint space of unaffected joint. During 4-5 days 24-hour drop-by-drop introduction of 0.9% sodium chloride solution into joint cavity is performed. Simultaneously one time per day freshly prepared solution consisting of 40% glucose solution, 5% ascorbic acid solution and autologic blood plasma, taken in volume ratio 1:2:7.

EFFECT: method ensures considerable reduction of fracture treatment terms in comparison with such treated by method of tranosseous osteosynthesis with application of apparatuses of external fixation due to enhancement of reparative regeneration processes.

3 dwg

 

The invention relates to medicine and can be used in the treatment of traumatic injuries of the joints.

There is a method of stimulation of reparative chondrogenesis when intra-articular bone and cartilage damage, providing for the introduction into the cavity of the joint, the area of the integumentary disorders of cartilage and subchondral bone fibrin clot derived from autologous blood (Form # 98114560/14, publ. 27.07.1998).

The disadvantage of this method is its complexity and the difficulty of controlling the position of a fibrin clot after placing it in the damaged area.

There is a method of treatment of joint pathology in animals, providing immobilization of the joint recovery anatomically correct relationship with external fixation device, the evacuation of the contents of the glenoid cavity, introduction to the joint area of drugs, stable fixation and subsequent development of movements in the joint (Application No. 2008152874/21, publ. 10.07.2010).

However, the conduct of drug therapy in the known method is directed to the sequential elimination of the consequences of traumatic lesions of bone and cartilage tissue. This increases the duration of treatment due to both time consuming restore the integrity of damaged anatomical structures and associated need and the mobilization of the joint, and due to the increase of the time of the subsequent recovery of its functions.

Object of the invention is the reduction of treatment time.

This task is solved in that in the method of stimulation of reparative processes in the treatment of intra-articular fractures involving the immobilization of the joint recovery anatomically correct relationship, the introduction into the joint cavity of drugs, stabilization and subsequent development of movements in the joint with external fixation device, after recovery anatomically correct relationship, not later than 3 days after injury, conduct cultivation of the articular surfaces of the width to 50% longer than the width of the joint space intact joint, and within 4-5 days of exercise - drip into the joint cavity of 0.9% solution of sodium chloride and, at the same time, once a day, a freshly prepared solution consisting of 40% glucose solution, 5% solution of ascorbic acid and autologous plasma blood collected in a volume ratio of 1:2:7.

The invention is illustrated by the description, an example of the experimental use and illustrative material, which shows:

figure 1 - radiograph of the left hip joint before removing apparatus 14 days after surgery;

figure 2 - microfoto guy who tological slice of the acetabulum in the zone of fusion of the fragments, received on the 14th day after surgery, stained with hematoxilin and eosin, Ob, 10;

figure 3 - microfoto histological slice of the joint lining of the acetabulum in the damage zone, obtained at 14 days after surgery, stained with hematoxilin and eosin, about. 10, OK. 10.

The method is as follows.

In operating conditions, after anesthesia and treatment of the surgical field, produce osteosynthesis of the affected joint with external fixation device. When executed well-known methods of fixing elements - spokes and/or studs-screws - on several levels spend (or console enter) adjacent to the affected joint areas adjacent bone segments. The free ends of the clamps fixed on the supports of the device, which by means of the threaded rods and hinge units are connected with the possibility dosed raznomastnogo move and spread.

If necessary, shift feet and respectively fixed limb segments or fragments restore anatomically correct relationship of the components of the joint. After recovery anatomically correct relationship of the affected joint of its articular surfaces are bred for quantity, not more than half greater than the normal width of the joint space. The criterion given in the om case, choose the width of the pair of healthy joint or focus on the average size of the joint space.

Then in the extended thus the articular cavity of the catheter, orienting and plunging its working end to the area with the most severe pathological changes. For visualization of the process of inserting the catheter, use the rod, made of radiopaque material. The free end of the catheter is fixed on one of the adjacent directly to the joint area of the supports of the apparatus. Simultaneously with the catheter install a drainage system and in the presence of pathological content in the articular cavity (blood, exudate, transudate, gases, etc) it partially or completely evacuated.

Further, if the osteosynthesis performed no later than 3 days after injury, then within 4-5 days of exercise - drip into the joint cavity of 0.9% sodium chloride solution and, simultaneously, once per day, a freshly prepared solution consisting of 40% glucose solution, 5% solution of ascorbic acid and autologous plasma blood collected in a volume ratio of 1:2:7.

Upon completion of the course introduction of the solution of the catheter in sterile conditions, remove and convergence feet normalize the width of the joint space. In the future, provide a stable fixation of the joint to restore the integrity of its components. At the same time it can be conducted to develop the active-passive movements with gradually increasing amplitude. After treatment, the apparatus is removed.

Practical use of the method illustrates the following experimental observation.

Under sterile conditions, after preparation of the surgical field, the dog was obtained model transverse fracture of the acetabulum of the left hip.

To restore the integrity and function of the joint animal made an indoor application of external fixation device. Offset feet produced simultaneously reposition of fragments of the left acetabulum, and the concentrations of the femoral head. After this articular surface spread of 0.7 mm, which is approximately 50% higher than the width of the joint space of the right hip joint.

Then in the articular cavity introduced a catheter, having its working end to the zone of fracture of the acetabulum. When the catheter revealed the presence of blood that was pumped out, and the joint cavity washed with 0.9% sterile solution of sodium chloride. For visualization of the process of inserting the catheter used a rod made of a radiopaque material. The free end of the catheter was fixed on one of the adjacent directly to the joint area of the supports of the apparatus. The operation is completed by performing x-ray control and stabilization systems of the device.

Immediately after the operation, during the course the e 5 days carried - drip into the joint cavity of 0.9% solution of sodium chloride. At the same time, once daily was administered 0.5 ml of freshly prepared solution consisting of 40% glucose solution, 5% solution of ascorbic acid and autologous plasma blood collected in a volume ratio of 1:2:7.

Upon completion of the course of drug therapy catheter under sterile conditions learned and convergence feet were normalized width of the joint space. Subsequently, until the dismantling of the apparatus was carried out by the development of active-passive movements in the left hip joint range of flexion-extension, abduction-cast, external and internal rotation with a gradual increase in the amplitude of movements.

Radiographically and clinically to 14 days after surgery showed consolidation of fragments of the acetabulum, which became the basis for the dismantling of the apparatus (figure 1). Conducted histological examination confirmed the achievement of complete bony fusion of the fragments (figure 2) and the regeneration of the joint lining of the acetabulum in the damage zone (figure 3).

The method applied in the treatment of 43 experimental animals with intra-articular injuries (17 knee and 26 hips), whose age ranged from 1 year to 3 years, body mass ranged from 5.5 to 28 kg of Terms is x anatomical and functional recovery was 14-21 days, on average, 30-50% less than in the treatment of similar injuries by the method of transosseous osteosynthesis with the use of external fixation devices.

The use of the proposed method in RISC "RTO" them. Acad. Gailizarov showed that its use provides a significant reduction of terms of treatment of intraarticular fractures, as well as the duration of the experimental work on the study of tissue regeneration in terms of transosseous osteosynthesis.

The method of stimulation of reparative processes in the treatment of intra-articular fractures involving the immobilization of the joint recovery anatomically correct relationship, the introduction into the joint cavity of drugs, stabilization and subsequent development of movements in the joint with external fixation device, characterized in that after the restoration anatomically correct relationship, not later than 3 days after injury, carry out the breeding of the articular surfaces of the width to 50% longer than the width of the joint space intact joint, and within 4-5 days of exercise - drip into the joint cavity of 0.9%sodium chloride solution and, at the same time, once in day, a freshly prepared solution consisting of 40%glucose solution, 5%aqueous solution of ascorbic acid and autologic the second plasma, taken in a volumetric ratio of 1:2:7.



 

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