MD1552Z - Method of restoring diaphyseal defects of the tibia - Google Patents
Method of restoring diaphyseal defects of the tibia Download PDFInfo
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- MD1552Z MD1552Z MDS20200136A MDS20200136A MD1552Z MD 1552 Z MD1552 Z MD 1552Z MD S20200136 A MDS20200136 A MD S20200136A MD S20200136 A MDS20200136 A MD S20200136A MD 1552 Z MD1552 Z MD 1552Z
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- tibia
- sutured
- incision
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- 230000007547 defect Effects 0.000 title claims abstract description 17
- 210000002303 tibia Anatomy 0.000 title claims abstract description 12
- 238000000034 method Methods 0.000 title claims description 12
- 210000000988 bone and bone Anatomy 0.000 claims abstract description 29
- 239000004568 cement Substances 0.000 claims abstract description 8
- 125000006850 spacer group Chemical group 0.000 claims abstract description 8
- 239000003242 anti bacterial agent Substances 0.000 claims abstract description 4
- 230000002421 anti-septic effect Effects 0.000 claims abstract description 4
- 230000003115 biocidal effect Effects 0.000 claims abstract description 4
- 230000001054 cortical effect Effects 0.000 claims abstract description 4
- 239000012634 fragment Substances 0.000 claims abstract description 4
- 239000002184 metal Substances 0.000 claims abstract description 4
- 244000309466 calf Species 0.000 claims description 6
- 210000001519 tissue Anatomy 0.000 abstract description 6
- 239000003814 drug Substances 0.000 abstract description 4
- 238000002316 cosmetic surgery Methods 0.000 abstract description 2
- 230000001172 regenerating effect Effects 0.000 abstract description 2
- 208000006735 Periostitis Diseases 0.000 abstract 1
- 210000003460 periosteum Anatomy 0.000 abstract 1
- 210000004027 cell Anatomy 0.000 description 4
- 230000010354 integration Effects 0.000 description 4
- 239000012528 membrane Substances 0.000 description 4
- 210000004204 blood vessel Anatomy 0.000 description 3
- 230000035515 penetration Effects 0.000 description 2
- 206010016654 Fibrosis Diseases 0.000 description 1
- 206010052779 Transplant rejections Diseases 0.000 description 1
- 238000010171 animal model Methods 0.000 description 1
- 230000010478 bone regeneration Effects 0.000 description 1
- 210000000845 cartilage Anatomy 0.000 description 1
- 238000002591 computed tomography Methods 0.000 description 1
- 230000003111 delayed effect Effects 0.000 description 1
- 210000003414 extremity Anatomy 0.000 description 1
- 230000004761 fibrosis Effects 0.000 description 1
- 238000010562 histological examination Methods 0.000 description 1
- 210000003141 lower extremity Anatomy 0.000 description 1
- 238000004377 microelectronic Methods 0.000 description 1
- 230000000877 morphologic effect Effects 0.000 description 1
- 230000008520 organization Effects 0.000 description 1
- 210000004663 osteoprogenitor cell Anatomy 0.000 description 1
- 102000004169 proteins and genes Human genes 0.000 description 1
- 108090000623 proteins and genes Proteins 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
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- Materials For Medical Uses (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la traumatologie şi chirurgia plastică, medicina regenerativă şi ingineria tisulară, şi poate fi utilizată pentru plastia defectelor diafizare ale tibiei şi altor oase tubulare lungi. The invention relates to medicine, in particular to traumatology and plastic surgery, regenerative medicine and tissue engineering, and can be used for the plasty of diaphyseal defects of the tibia and other long tubular bones.
Este cunoscută metoda de tratament chirurgical al defectelor osoase tubulare lungi prin metoda membranei induse şi plastia cavităţii restante osoase cu os spongios morsocat [1]. The method of surgical treatment of long tubular bone defects is known through the induced membrane method and plasty of the remaining bone cavity with mortised cancellous bone [1].
Dezavantajele metodei cunoscute constau în aceea că osul în această grefă nu este demineralizat, nu are o structură morfologică asemenea unui os tubular, nu asigură pătrunderea bună a celulelor gazdei şi vaselor sangvine în grefă. Aceasta în final se soldează cu integrarea şi organizarea morfo-funcţională mult mai întârziată a grefei în zona de plastie. The disadvantages of the known method are that the bone in this graft is not demineralized, does not have a morphological structure similar to a tubular bone, does not ensure good penetration of host cells and blood vessels into the graft. This ultimately results in much delayed integration and morpho-functional organization of the graft in the area of plasty.
Mai este cunoscută o metodă cu utilizarea unui tip de grefă din ţesut osteocondral demineralizat [2]. Another method is known using a type of graft made from demineralized osteochondral tissue [2].
Dezavantajele constau în aceea că cartilajul în această grefă nu este decelularizat, în el se păstrează celule care pot fi vizualizate la o eventuală scanare microelectronică sau examen histologic. Astfel, în această grefă mai este prezent material genetic alo- sau xenogen care poate conduce la rejet al transplantului şi fibrozarea acestuia. The disadvantages are that the cartilage in this graft is not decellularized, it retains cells that can be visualized in a possible microelectronic scan or histological examination. Thus, in this graft there is still allo- or xenogeneic genetic material present which can lead to rejection of the transplant and its fibrosis.
Problema pe care o rezolvă invenţia constă în extinderea arsenalului de metode utilizate pentru tratamentul defectelor oaselor tubulare lungi, în obţinerea unei grefe osoase auto- sau aloos, după dimensiunile necesare conform defectului, care permite o integrare mai bună a ţesutului în organismul gazdă, fără risc de rejet al transplantului. The problem solved by the invention consists in expanding the arsenal of methods used for the treatment of long tubular bone defects, in obtaining an auto- or allo-bone graft, according to the dimensions required according to the defect, which allows for better integration of the tissue into the host organism, without the risk of transplant rejection.
Esenţa invenţiei constă în aceea că la prima etapă se efectuează o incizie pe partea anteromedială a gambei, şi anume de la tuberozitatea mare a tibiei şi până la 1/3 distală a gambei, se efectuează deperiostarea osului tibial, se formează un defect osos circular de o lungime de 3,0 cm în 1/3 medie a tibiei, fragmentele osoase se fixează cu ajutorul unei plăci metalice şi şuruburi conform axei longitudinale, iar cavitatea defectului se suplineşte cu spacer de ciment cu un antibiotic, se efectuează lavaj cu soluţii antiseptice şi plaga se suturează pe straturi; la a doua etapă, şi anume după două săptămâni, se efectuează repetat incizia la acelaşi nivel, se înlătură spacerul de ciment, iar cavitatea restantă se manşonează cu o grefă de os cortical tubular proaspăt congelat, fiind prelevat şi procesat timp de 20 de zile până la intervenţie, iar plaga se suturează pe straturi, apoi la a 6-a săptămână se repetă incizia la acelaşi nivel şi se înlătură placa şi şuruburile, după care plaga se suturează pe straturi. The essence of the invention is that in the first stage, an incision is made on the anteromedial part of the calf, namely from the greater tuberosity of the tibia to the distal 1/3 of the calf, periosteal removal of the tibial bone is performed, a circular bone defect of 3.0 cm in length is formed in the middle 1/3 of the tibia, the bone fragments are fixed using a metal plate and screws according to the longitudinal axis, and the defect cavity is filled with a cement spacer with an antibiotic, lavage is performed with antiseptic solutions and the wound is sutured in layers; In the second stage, namely after two weeks, the incision is repeated at the same level, the cement spacer is removed, and the remaining cavity is lined with a freshly frozen tubular cortical bone graft, which is taken and processed for 20 days until the intervention, and the wound is sutured in layers, then at the 6th week the incision is repeated at the same level and the plate and screws are removed, after which the wound is sutured in layers.
Rezultatul constă în aceea că respectiva metodă este eficientă, sigură, calitativă şi economă, permite obţinerea unei regenerări osoase depline din punct de vedere morfo-funcţional pentru repararea defectului de ţesut osos tubular de orice lungime şi diametru. The result is that the method is efficient, safe, qualitative and economical, allowing for full bone regeneration from a morpho-functional point of view for repairing tubular bone tissue defects of any length and diameter.
Avantajele metodei revendicate constau în aceea că cavitatea restantă a membranei induse poate fi manşonată cu o grefa auto- sau aloos, care are capacitate de integrare rapidă în ţesutul gazdă şi risc minim de rejet datorită ţesutului osos proaspăt congelat, ce asigură o suprafaţă de contact mai mare cu celulele gazdei şi o pătrundere mai bună a vaselor sangvine. The advantages of the claimed method are that the remaining cavity of the induced membrane can be sleeve with an auto- or allograft, which has the capacity for rapid integration into the host tissue and minimal risk of rejection due to the fresh frozen bone tissue, which ensures a larger contact surface with the host cells and better penetration of the blood vessels.
Datorită formei tubulare creşte posibilitatea de îmbogăţire mai uniformă a transplantului cu celule osteoprogenitoare, totodată conţine o suprafaţă de contact mai mare pentru celulele gazdă şi vasele sangvine, aceasta în final asigură o integrare mai rapidă a transplantului. Due to the tubular shape, the possibility of more uniform enrichment of the transplant with osteoprogenitor cells increases, while it also contains a larger contact surface for host cells and blood vessels, which ultimately ensures faster integration of the transplant.
Metoda se realizează în modul următor. The method is carried out in the following way.
La prima etapă se efectuează prelucrarea aseptică a membrului inferior, se efectuează o incizie pe partea anteromedială a gambei, şi anume de la tuberozitatea mare a tibiei şi până la 1/3 distală a gambei, se efectuează deperiostarea osului tibial, se formează un defect osos circular de o lungime de 3,0 cm în 1/3 medie a tibiei, fragmentele osoase se fixează cu ajutorul unei plăci metalice şi şuruburi conform axei longitudinale, iar cavitatea defectului se suplineşte cu spacer de ciment cu un antibiotic, se efectuează lavaj cu soluţii antiseptice şi plaga se suturează pe straturi; la a doua etapă, şi anume după două săptămâni, se efectuează repetat incizia la acelaşi nivel, se înlătură spacerul de ciment, iar cavitatea restantă se manşonează cu o grefă de os cortical tubular proaspăt congelat, fiind prelevat şi procesat timp de 20 de zile până la intervenţie, iar plaga se suturează pe straturi, apoi la a 6-a săptămână se repetă incizia la acelaşi nivel şi se înlătură placa şi şuruburile, după care plaga se suturează pe straturi. Se efectuează Rx de control la fiecare etapă, finisând cu examenul de tomografie computerizată a membrului după 8 săptămâni. In the first stage, the lower limb is aseptically processed, an incision is made on the anteromedial side of the calf, namely from the greater tuberosity of the tibia to the distal 1/3 of the calf, periostealization of the tibial bone is performed, a circular bone defect of 3.0 cm in length is formed in the middle 1/3 of the tibia, the bone fragments are fixed using a metal plate and screws according to the longitudinal axis, and the defect cavity is filled with a cement spacer with an antibiotic, lavage is performed with antiseptic solutions and the wound is sutured in layers; in the second stage, namely after two weeks, the incision is repeated at the same level, the cement spacer is removed, and the remaining cavity is lined with a freshly frozen tubular cortical bone graft, which is taken and processed for 20 days until the intervention, and the wound is sutured in layers, then at the 6th week the incision is repeated at the same level and the plate and screws are removed, after which the wound is sutured in layers. Control X-rays are performed at each stage, ending with a computed tomography examination of the limb after 8 weeks.
Această metodă a fost utilizată în Banca de Ţesuturi pentru tratarea defectelor de os tubular lung pe modele animale cu rezultate mai bune comparativ cu lotul martor, unde a fost utilizată metoda membranei induse şi plastia cavităţii restante osoase cu os spongios morsocat. This method was used in the Tissue Bank for the treatment of long tubular bone defects in animal models with better results compared to the control group, where the induced membrane method and plasty of the remaining bone cavity with mortised cancellous bone were used.
1. Masquelet A.C., Fitoussi F., Begue T., Muller G.P. Reconstruction des os longs par membrane induite et autogreffe spongieuse. 2000, Jun., no. 45(3), p. 346-353 1. Masquelet A.C., Fitoussi F., Begue T., Muller G.P. Reconstruction des long bones par membranes induced et autograffe spongieuse. 2000, June, no. 45(3), p. 346-353
2. US 2007/0276506 A1 2007.11.29 2. US 2007/0276506 A1 2007.11.29
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20200136A MD1552Z (en) | 2020-10-26 | 2020-10-26 | Method of restoring diaphyseal defects of the tibia |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20200136A MD1552Z (en) | 2020-10-26 | 2020-10-26 | Method of restoring diaphyseal defects of the tibia |
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| Publication Number | Publication Date |
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| MD1552Y MD1552Y (en) | 2021-07-31 |
| MD1552Z true MD1552Z (en) | 2022-02-28 |
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| MDS20200136A MD1552Z (en) | 2020-10-26 | 2020-10-26 | Method of restoring diaphyseal defects of the tibia |
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