RU2515685C1 - Method for replacing bone defect with presence of central osteomyelytic focus in children - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: bone surface is approached. The involved areas are treated, and the devitalised tissues are removed. An osteosynthesis of the involved segment is performed with the use of an external fixation apparatus. That is followed by an osteoperforation of an adjoining epiphysis from the bottom of the treated cavity at a depth of an epiphysial plate, and disintegration. The disintegration is performed by both an osteotomy, and an intraoperative epiphysiolysis. The osteoperforation procedure may involve only one canal of a greater diameter formed instead of the number of canals. The operation is completed by performing a control X-ray radiography; the wound is closed, and a drainage system is inserted. The postoperative period involves a gradual advance within a defect separated as a result of the disintegration of the epiphysis of the intermediate fragment. The advances are varied within 0.5-1.0 mm/day. Once the advanced fragment gets in contact to an end of the opposite fragment, the apparatus is transmitted into the stable fixation until the bone consolidation and transformation of the formed bone regenerate into a mature bone tissue.EFFECT: method enables replacing the bone defect and compensating the osteomyelytic cavity.3 cl, 4 dwg, 1 ex

Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of children suffering from chronic osteomyelitis.

There is a method of replacing a bone defect and compensating for an osteomyelitis cavity, which provides for the formation of a bone fragment by an osteotomy performed through an osteomyelitis cavity and its metered movement in the defect until it contacts the end of the opposite fragment (A.S. USSR No. 1039488).

However, this method is applicable in cases of small volume of marginal bone cavities. Its use in the presence of significant cavities in volume is associated with a weakly expressed regenerative process, which leads to incomplete compensation of the cavity and, as a result, to the possibility of developing a relapse of the disease.

There is a method of replacing a marginal bone defect, involving its processing, the formation of an adjacent, lower- or overlying portion of the bone corresponding to the size of the defect of the marginal fragment and its dosed movement using an external fixation device (Transosseous osteosynthesis in the treatment of patients with chronic osteomyelitis: in 2 hours / V.I. Shevtsov, A.I. Lapynin, N.M. Klyushin. - Kurgan, 2001; p.20-21).

However, this method does not replace a concomitant bone defect. In addition, in conditions of impaired blood supply, the use of this method is also fraught with the possibility of developing postoperative complications.

The objective of the invention is to develop a method that provides simultaneous replacement of a bone defect and compensation of a centrally located osteomyelitis cavity in children.

This problem is solved by the fact that in the method of replacing a bone defect with the presence of a centrally located osteomyelitis lesion in children, including processing the bone with removal of non-viable tissues, the formation of the bone fragment and its metered movement in the defect until it is completely compensated by the external fixation apparatus, after processing cavities from the side of its bottom to the germinal zone perforate the adjacent pineal gland and violate its integrity. It is provided that the perforation is performed by forming a single channel, and the integrity of the pineal gland is produced by epiphysiolysis.

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

Figure 1 - x-ray of the lower leg of patient X. before treatment;

Figure 2 (a, b) - radiographs of the lower leg of patient X. during treatment;

Figure 3 - x-ray of the lower leg of patient X. 3 years after treatment.

The method is as follows.

After anesthesia and treatment of the surgical field through an incision of the soft tissues, access to the bone surface is carried out and known methods are used to process its affected areas with the removal of non-viable tissues, including sequestrectomy surgery. After that, osteosynthesis of the affected segment is performed using known techniques using an external fixation device. When it is performed, fixing knitting needles at several levels are passed through bone fragments, including through the pineal gland adjacent to the treated cavity. In a tense state, the spokes are mounted on external supports installed at the appropriate level, which are interconnected by threaded rods and hinged nodes with the possibility of their metered multi-plane movement. Further, from the bottom of the treated cavity with the help of an electric drill, osteoperforation of the adjacent epiphysis to a depth of the sprout zone is performed, and then its integrity is violated. In this case, the integrity violation can be performed both by osteotomy and by intraoperative epiphysiolysis, and when osteoperforation is performed instead of several channels, one channel of a larger diameter can be formed. The operation is completed by performing control radiography, suturing the wound with the installation of a drainage system. In the postoperative period, dosed movement is performed in the defect zone of the intermediate fragment isolated as a result of violation of the integrity of the pineal gland. The pace of movement varies between 0.5-1.0 mm / day. Upon reaching the contact of the transferred fragment with the end of the opposite fragment, the apparatus is transferred to stable fixation mode until the bone is consolidated and sections of the formed bone regenerate are rearranged into mature bone tissue. Additional immobilization of the limb after dismantling the apparatus, as a rule, is not required. The patient is prescribed a course of exercise therapy with a gradually increasing load on the operated limb.

The practical use of the method is illustrated by the following clinical observation.

Patient X., 13 years old, was admitted to the hospital with a diagnosis of: Defect - diastasis of the upper third of the left tibia 10.0 cm with the presence of a centrally located osteomyelitis lesion at the level of distal metadiaphysis; Chronic hematogenous osteomyelitis, fistulous form.

To restore the integrity of the bone and eliminate the osteomyelitis process, the patient underwent surgery: Sequestrnecrectomy of the osteomyelitis lesion, intraoperative epiphysiolysis of the distal growth zone, osteosynthesis with an external fixation device of the left leg.

During the operation, after anesthesia and treatment of the surgical field, three spokes were drawn through the proximal metaphysis of the tibia, 2 spokes were drawn through the distal pineal gland. Through the proximal end of the distal fragment of the bone held 2 spokes. The spokes are mounted on three outer ring supports, which are connected by threaded rods. A solution of methylene blue was introduced into the fistulous course. Through a soft tissue incision in c / 3 of the lower leg, access to the surface of the bone was made. In the projection of the fistula, the entrance to the osteomyelitis lesion (sequestral box) was determined. An autopsy was performed, the bone sequestration of 4.5 × 0.8 cm was removed, the pathological granulation tissue was removed, and the cavity was treated. Then, from the bottom of the treated cavity, an channel with a diameter of 0.7 cm was formed using an electric drill to the distal germinal zone and its epiphysiolysis was performed. The operation was completed by performing control radiography and suturing the wound with the installation of a drainage system (Figure 1).

In the postoperative period, dosed movement was performed in the defect zone of the intermediate fragment isolated as a result of epiphysiolysis. The rate of movement ranged from 0.5-1.0 mm / day. The duration of distraction was 120 days. As a result, a bone regenerate of 9.0 cm in size was formed at the level of the distal pineal gland with the simultaneous filling of the osteomyelitis cavity by it. Upon reaching the contact of the transferred fragment with the end of the opposite fragment, the apparatus was transferred to the stable fixation mode, which was maintained for 123 days (Fig. 2, a, b). After dismantling the apparatus, the limb was fixed with a posterior plaster cast for one month. After this, the patient underwent a course of exercise therapy with a gradually increasing load on the operated limb.

As a result of treatment, restoration of the integrity of the left tibia and supporting ability of the limb was achieved, the osteomyelitis process was stopped with the compensation of the osteomyelitis cavity. At the follow-up examination after 3 years, the achieved treatment result is preserved: there are no signs of disease recurrence, the limb axis is correct, the movements in the knee joint in full, in the ankle 90 ° / 120 °, walks without additional support equipment with compensation for shortening 1.0 cm with full load on the operated limb (Figure 3).

Practical use of the method showed that its application provides the possibility of simultaneous replacement of a bone defect and compensation of a centrally located osteomyelitis cavity in children suffering from chronic hematogenous osteomyelitis.

Claims (3)

1. A method of replacing a bone defect with the presence of a centrally located osteomyelitis lesion in children, including treating the bone with the removal of non-viable tissues, forming a bone fragment and its metered movement in the defect until complete compensation using an external fixation apparatus, characterized in that after processing the cavity, from the side of its bottom, to the sprout zone, perforation of the adjacent pineal gland is carried out and its integrity is violated. 2. The method according to claim 1, characterized in that the perforation is performed by forming one channel. 3. The method according to claim 1, characterized in that the violation of the integrity of the pineal gland is produced by epiphysiolysis.

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