SU1708361A1 - Method for treating acute hematogeneous osteomyelitis in children - Google Patents

Abstract

This invention relates to pediatric purulent surgery and is intended for the treatment of osteomyelitis of long tubular bones using irradiation with a helium-neon laser. The goal is to reduce the time of treatment due to the direct effect on the inflammatory focus. An emergency percutaneous osteoperfaction was performed with special needles with mandrels. A canal is created in the outbreak of inflammation. The light guide is inserted through the needle into the bone marrow canal, and then slowly passes along the canal by 3-2.5 cm, irradiating with the corresponding volume of the bone. Needles are inserted at an angle of 60-70 °. to the longitudinal axis of the channel. A day later, the evacuation of purulent contents from the medullary canal was performed. With daily irradiation, the duration of exposure is 5 minutes after each needle. The course of treatment is from 6 to 10 sessions. 3 (LISIDING refers to pediatric purulent surgery and is intended for the treatment of osteomyelitis of the long tubular bones using irradiation with a helium-neon laser. The purpose of the invention is to shorten the treatment time by directly affecting the inflammatory focus, which is achieved by that the irradiation is carried out intraosseously, with an output power of 10 mW, at least two needles held at an angle of 60-70 ° to the channel, for 5 minutes each, with a course of treatment of 6-10 sessions. The method is carried out as follows. and use an LG-38 helium-neon laser with an output power of 30 mW, which operates in a continuous mode and generates radiation in the red part of the spectrum with a wavelength of 632.8 nm. The laser is equipped with an attachment developed in conjunction with the IIF of the USSR Academy of Sciences, monofilament with a diameter of up to 1.0 mm. Output power at the end of the monofilament reaches 10 mW. Treatment of patients is carried out in a complex, according to the generally accepted method. Operation in an emergency order by the method of KP Aleksyuk (1967) - percutaneous osteoperopathy with special needles with mandrines in place inflamed and, using a sterile metallic conductor, a channel is created in the inflammatory focus that provides communication between the needles for intraosseous lavage (these needles are used for intraosseous lavage in the treatment of acute hematogenous osteomyelitis in the phase of ictramedullary abscess). A light guide is inserted through the needle into the bone marrow canal, and then slowly passes through its bone marrow canal to

Description

3-2.5 cm, irradiation p | ei this corresponding volume of the bone. For convenience, a fiber is inserted (as antibiotics are injected into the bone), the needles are inserted at an angle of 60-70 ° to the longitudinal axis of the channel, which gives an optical / uniform uniform irradiation around the entire bone circumference. A day after the operation, sterile conditions are carried out under sterile conditions / Io purulent contents from the bone marrow channel. After pre-sterilization of the distal end of the monofilament, it is introduced through the mists (alternately into each) into the bone marrow canal to a depth of 2.5-3 cm from the end of the needle. With abdominal irradiation, the duration of exposure is 5 minutes after each needle, with at least two needles installed, at 10 minutes. The course of treatment is from 6 to 10 sessions, until the general condition improves, while the purulent discharge from the medullary canal is absent.

Example. Patient III, 8 years old, was admitted to the clinic on February 17, 2007, with a diagnosis of arthritis of the right knee joint, on the 4th day of the disease. On admission, the child’s condition is heavy, complaining about the bolus in the right knee joint. Body temperature 38.5. The skin is pale, dry. Mucous dry-le. Vesicular breathing in the lungs, no wheezing, Heart sounds are dim, rhythmic. Pulse 100 beats per minute of satisfactory qualities. The abdomen is soft, painless. The liver and spleen are not enlarged. Human leg bent at the hip and knee joints. There is no visible infiltration of the hyperemus of the skin in the area of the right thigh. The contours of the hip vi knee sustez are not changed, but smoothness is noted in the area of the right naxosofi ek adki. The skin is not hot in the area of the right thigh. On palpation, the maximum tenderness is determined in the subversive area. Movement in the right knee joint is painful, but in full. In the right hip joint, the movements are sharply painful.

. With a diagnosis of acute hematogenous osteomyelitis of the upper metaphysis of the femur bone, a rebemum after appropriate preoperative preparation was operated on according to the method of KP Aleksyuk - percutaneous osteoperforam dvugts needles at an angle of 60-70 °. The first needle is placed at the point of maximum pain, along which the blood with pus under pressure of 210 mm of water column has flowed. The second needle was inserted distantly at 7 cm. Where the maximum soreness and zekrzshchalas. Blood was released from it with droplets of fat (pressure 110 mm of water supply). Using sterile metal fishing line, a message was created between the needles for intraosseous lavage (composition: 800 ml of physiological saline; penicillin 500 thousand Un; heparin 1500 thousand Un, termitin 200 PE). Immobilization on the Beller tire. The next day, the pus and blood are removed, the needles are washed with furazmlin (1: 5000-5.0 ml). Then, after preliminary sterilization of the distal end of the fiber, intraosseous irradiation with a helium-neon laser was carried out in each needle for 5 minutes (10 minutes in total). The course of laser therapy was 6 sessions and was discontinued after the improvement of the general condition of the patient, the normalization of the temperature III, the absence of purulent discharge from the bone-marrow canal.

In the postoperative period, a complex therapy was carried out: transfusion of entistaphylococcal plasma, albumin, 19% glucose, reopolyglucin, hemodez; Oxycillin HEO, thousand 4 times intramuscularly, lncomycin 300 mg / w / venous 2 times a day. Introduced diphenhydramine, calcium chloride, vitamins of group B. Ascorbic acid was administered in large doses.

After the third session of laser therapy, an increase in the separated serohemorrhagic character from the medullary canal was observed. However, this was not accompanied by increased pain in the limb, on the contrary - they were absent. This phenomenon was noted in all patients after the onset of GNL irradiation, which is associated with an increased blood flow in the area of inflammation. By the 7th day there was no purulent discharge from the medullary canal, the washing solution without pathological impurities. Due to the improvement in the condition of the child, the normalization of body temperature and the absence of purulent discharge, the needles were removed. In the future, the complex therapy was continued according to the method of adhesion.

Under Losev pus, Staphylococcus aureus is isolated. Changes in the blood side.

Blood test at admission: hemoglobin 120 g / l; red blood cells 4.7 million / mm; color index 0.77; ESR-55 Mm / h; leukocytes -4.5 g / l; P 4%; From 74%; L 16%; M 6%.

After 3 days: hemoglobin 114 g / l, erythrocytes 4.5 million / mm, color index 0.79; ESR of 43 mm / h, leukocytes 5.0 g / l; P 4%; C5.9%; E 1%; L34%, M2%,

On day 8: hemoglobin 124 g / l; spectrocytes 4.5 million / m; color index 0.82; ESR-32 mm / h, leukocytes 7.7 g / l; P 14%; C 71%; E 1%; L40%; M4%,

Claims (1)

Claim 40 A method for the treatment of acute hematogenous osteomyelitis in children by daily irradiation with a helium-neon laser, which is based on the fact that. in order to reduce the treatment time due to direct effect on the inflammatory focus, radiation is performed intraosseously with an output power of 10 mW through two needles held at an angle of 60-70 ° to the channel, for 5 minutes, for a treatment course of 6-10 sessions.