MD37Y -   Treatment method for pseudarthrosis - Google Patents

  Treatment method for pseudarthrosis

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Publication number
MD37Y
MD37Y MDS20080039A MDS20080039A MD37Y MD 37 Y MD37 Y MD 37Y MD S20080039 A MDS20080039 A MD S20080039A MD S20080039 A MDS20080039 A MD S20080039A MD 37 Y MD37 Y MD 37Y
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MD
Moldova
Prior art keywords
preparation
morphoinductive
pseudarthrosis
bone
determined
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MDS20080039A
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Romanian (ro)
Inventor
Viorel Nacu
Pavel CIOBANU
Filip GORNEA
Boris Topor
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Universitatea De Stat De Medicina Si Farmacie "Nicolae Testemitanu" Din Republica Moldova
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Priority to MDS20080039A priority Critical patent/MD37Z/en
Publication of MD37Y publication Critical patent/MD37Y/en
Publication of MD37Z publication Critical patent/MD37Z/en

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Abstract

Inventia se refera la medicina, in special la traumatologie. Esenta metodei de tratament al pseudartrozei include administrarea unui preparat morfoinductiv. Peste o luna de la administrarea preparatului morfoinductiv se efectueaza radiografia si daca se determina un proces de resorbtie a tesuturilor fibroase, atunci se apreciaza o evolutie favorabila a regenerarii reparatorii osoase. In cazul in care nu se determina procesul de resorbtie a tesuturilor fibroase, se efectueaza administrarea repetata a preparatului morfoinductiv. Totodata, in calitate de preparat morfoinductiv se utilizeaza cultura celulara osteomedulara sau matrice osoasa demineralizata. Revendicari: 2The invention relates to medicine, in particular to traumatology. The essence of the method of treatment of pseudarthrosis includes the administration of a morphoinductive preparation. X-ray is performed more than one month after the morphoinductive preparation is administered and if a fibrous tissue resorption process is determined, then a favorable evolution of bone repair regeneration is evaluated. If the fibrous tissue resorption process is not determined, the morpho-inductive preparation is repeated. At the same time, as a morpho-inductive preparation, osteomedullary cell culture or demineralized bone matrix is used. Claimant: 2

Description

Invenţia se referă la medicină, în special la traumatologie. The invention relates to medicine, especially to traumatology.

Este cunoscută metoda de tratament al pseudartrozei, care include administrarea unui preparat morfoinductiv ce conţine ţesut osos demineralizat mărunţit şi ţesut embrionar omogenizat [1]. The pseudarthrosis treatment method is known, which includes the administration of a morphoinductive preparation containing shredded demineralized bone tissue and homogenized embryonic tissue [1].

Dezavantajul acestei metode se exprimă prin faptul că nu reflectă integral procesul de regenerare reparatorie a ţesutului osos care are loc după stimularea cu preparate morfoinductive. The disadvantage of this method is expressed by the fact that it does not fully reflect the reparative regeneration process of bone tissue that occurs after stimulation with morphoinductive preparations.

Problema pe care o soluţionează invenţia propusă constă în elaborarea unei noi metode de apreciere a regenerării reparatorii osoase în pseudartroză. The problem that the proposed invention solves consists in the development of a new method of assessing bone reparative regeneration in pseudarthrosis.

Esenţa metodei de tratament al pseudartrozei include administrarea unui preparat morfoinductiv. Peste o lună de la administrarea preparatului morfoinductiv se efectuează radiografia şi dacă se determină un proces de resorbţie a ţesuturilor fibroase, atunci se apreciază o evoluţie favorabilă a regenerării reparatorii osoase. În cazul în care nu se determină procesul de resorbţie a ţesuturilor fibroase, se efectuează administrarea repetată a preparatului morfoinductiv. Totodată, în calitate de preparat morfoinductiv se utilizează cultură celulară osteomedulară sau matrice osoasă demineralizată. The essence of the pseudarthrosis treatment method includes the administration of a morphoinductive preparation. One month after the administration of the morphoinductive preparation, the X-ray is performed and if a process of resorption of the fibrous tissues is determined, then a favorable evolution of the reparative bone regeneration is appreciated. If the process of resorption of the fibrous tissues is not determined, repeated administration of the morphoinductive preparation is performed. At the same time, osteomedullary cell culture or demineralized bone matrix is used as a morphoinductive preparation.

Avantajele constau în aprecierea corectă a fazelor de regenerare reparatorie în pseudartroze, ceea ce ne permite de a interveni la timp şi operativ pentru a stimula osteogeneza reparatorie deprimată, îmbunătăţind astfel calitatea tratamentului şi reducând perioada de vindecare şi recuperare. The advantages consist in the correct assessment of the phases of reparative regeneration in pseudarthrosis, which allows us to intervene in time and operatively to stimulate depressed reparative osteogenesis, thus improving the quality of treatment and reducing the healing and recovery period.

Inocularea preparatului morfoinductiv duce la stimularea procesului reparator osos şi permite de a aprecia etapele procesului de regenerare. The inoculation of the morphoinductive preparation leads to the stimulation of the bone repair process and allows to appreciate the stages of the regeneration process.

Metoda se execută în felul următor: pacientului, căruia i-a fost stabilit diagnosticul de pseudartroză, local, după anestezie, i se administrează preparatul morfoinductiv - celule osteomedulare sau matrice osoasă demineralizată, după o lună de la inoculare se face radiografia şi se determină dacă a survenit faza de resorbţie, în cazul în care faza de resorbţie a survenit, se consideră că procesul reparator al osului decurge normal şi timp de 4…5 luni pseudartroza se va consolida, dacă la o lună de la inocularea preparatului morfoinductiv nu se determină prima fază de resorbţie, atunci se apreciază că procesul decurge nefavorabil şi se repetă administrarea preparatului morfoinductiv. The method is performed as follows: the patient, who was diagnosed with pseudarthrosis, locally, after anesthesia, is administered the morphoinductive preparation - osteomedullary cells or demineralized bone matrix, one month after the inoculation, an X-ray is taken and it is determined whether it occurred the resorption phase, if the resorption phase has occurred, it is considered that the bone reparative process proceeds normally and for 4...5 months the pseudarthrosis will consolidate, if one month after the inoculation of the morphoinductive preparation the first phase of resorption is not determined resorption, then it is assessed that the process proceeds unfavorably and the administration of the morphoinductive preparation is repeated.

Rezultatul constă în determinarea clară a etapelor de regenerare reparatorie osoasă în pseudartroze, care permite aprecierea corectă a tacticii de tratament, reducerea perioadei de vindecare şi micşorarea cheltuielilor. The result consists in the clear determination of the stages of reparative bone regeneration in pseudarthrosis, which allows the correct assessment of treatment tactics, the reduction of the healing period and the reduction of expenses.

Administrarea preparatului morfoinductiv, baza căruia o formează celulele osteocartilaginoase, embrionare, fetale sau alte preparate morfoinductive, în zona regenerării deprimate a osului, unde predomină ţesutul fibros, provoacă de la început resorbţia structurilor fibroase cu formarea pe acest teren a ţesutului osos primar şi transformarea lui treptată în os compact cortical cu formarea canalului osteomedular la nivel diafizar, sau parţial spongios - în patologia metafizară. The administration of the morphoinductive preparation, the basis of which is formed by osteocartilaginous, embryonic, fetal cells or other morphoinductive preparations, in the area of depressed bone regeneration, where fibrous tissue predominates, causes from the beginning the resorption of fibrous structures with the formation of primary bone tissue on this ground and its transformation gradual in compact cortical bone with the formation of the osteomedullary canal at the diaphyseal level, or partially spongy - in metaphyseal pathology.

După inocularea preparatului morfoinductiv în regiunea pseudartrozei, se activează regenerarea reparatorie caracterizată radiologic în prima fază prin mărirea spaţiului interfragmentar, ce se explică prin activizarea osteoclastelor şi macrofagelor în această regiune, urmată de a doua fază, în care radiologic creşte opacitatea ca rezultat al formării ţesutului osos nou, şi faza a treia de remodelare, în care radiologic se vizualizează canalul osos medular. After the inoculation of the morphoinductive preparation in the region of the pseudarthrosis, the reparative regeneration characterized radiologically is activated in the first phase by increasing the interfragmentary space, which is explained by the activation of osteoclasts and macrophages in this region, followed by the second phase, in which radiologically the opacity increases as a result of tissue formation new bone, and the third remodeling phase, in which radiologically the medullary bone canal is visualized.

Astfel, tipul de regenerare reparatorie prin resorbţie demonstrează eficacitatea considerabilă a preparatelor morfoinductive, care decurge în 3 faze bine determinate radiologic, iar activitatea celulelor embrionare, citochinelor şi proteinei morfogenetice restructurează regeneratul la pseudartroze în faza de resorbţie şi duce la formarea ţesutului osos, transformându-l ulterior în ţesut osos organo-tipic cu canal osteomedular. Thus, the type of reparative regeneration through resorption demonstrates the considerable effectiveness of morphoinductive preparations, which proceeds in 3 radiologically well-defined phases, and the activity of embryonic cells, cytokines and morphogenetic protein restructures the regenerated pseudarthrosis in the resorption phase and leads to the formation of bone tissue, transforming l later in organo-typical bone tissue with osteomedullary canal.

Exemplul 1 Example 1

Pacientul S., 32 ani, s-a adresat la CNŞPDMU cu pseudartroză atrofică a tibiei gambei drepte la 10 luni după traumatism: fractură deschisă de tibie pe dreapta în treimea medie Gustilio - Anderson II, după ostesinteză în aparatul Ilizarov. Sub control radiologic în focarul pseudartrozei a fost inoculat preparatul morfoinductiv din autocelule ale măduvei osoase. Ulterior au fost efectuate radiografii la 1, 2, 3, 4 luni. S-a constatat la o lună resorbţia ţesutului fibros din zona regenerării reparatorii, care reprezintă mărirea fisurii între fragmentele osului determinată radiologic. A fost apreciat că procesul decurge favorabil. După două luni se apreciază formarea ţesutul nou primar în zona regenerării reparatorii care înlocuieşte ţesutului fibros şi care se manifestă prin apariţia opacităţii la acest nivel. La patru luni radiologic se determină restabilirea structurii organo-tipice între fragmentele osoase. După un an osul este remodelat cu caracter cortical şi canal osteomedular. Este restabilită funcţia membrului. Patient S., 32 years old, came to CNŞPDMU with atrophic pseudarthrosis of the tibia of the right calf 10 months after the trauma: open fracture of the tibia on the right in the middle third Gustilio - Anderson II, after ostesynthesis in the Ilizarov apparatus. Under radiological control, the morphoinductive preparation from bone marrow autocells was inoculated into the pseudarthrosis focus. Afterwards, radiographs were taken at 1, 2, 3, 4 months. After one month, the resorption of the fibrous tissue in the area of reparative regeneration, which represents the enlargement of the crack between the bone fragments determined radiologically, was found. It was appreciated that the process is progressing favorably. After two months, the formation of new primary tissue in the area of reparative regeneration can be appreciated, which replaces the fibrous tissue and is manifested by the appearance of opacity at this level. After four months radiologically, the restoration of the organo-typical structure between the bone fragments is determined. After one year, the bone is remodeled with cortical character and osteomedullary canal. The member's function is restored.

Exemplul 2 Example 2

Pacienta P., 54 ani, s-a adresat la CNŞPDMU cu pseudartroză oligotrofică a tibiei gambei drepte la 8 luni după traumatism: fractură deschisă de tibie pe dreapta în treimea medie Gustilio - Anderson III A, după osteosinteză în aparatul Ilizarov şi plastie cutanată cu ţesuturi locale. Sub control radiologic în focarul pseudartrozei a fost inoculat preparatul morfoinductiv din matrice osoasă demineralizată. Radiograma efectuată la o lună după administrarea preparatului morfoinductiv nu a arătat schimbări în regiunea pseudartrozei, adică nu a survenit faza de resorbţie. A fost apreciată o evoluţie nefavorabilă, fiind administrat repetat preparatul morfoinductiv, care constă din celule osteomedulare şi matrice osoasă demineralizată. Peste o lună a fost apreciată faza de resorbţie, s-a constatat că procesul decurge favorabil. La 4 luni după aceasta a survenit consolidarea pseudartrozei. Pacienta a început tratamentul de recuperare. Patient P., 54 years old, came to CNŞPDMU with oligotrophic pseudarthrosis of the tibia of the right calf 8 months after the trauma: open fracture of the tibia on the right in the middle third Gustilio - Anderson III A, after osteosynthesis in the Ilizarov apparatus and skin plasty with local tissues . Under radiological control, the morphoinductive preparation from demineralized bone matrix was inoculated into the pseudarthrosis focus. The radiograph performed one month after the administration of the morphoinductive preparation showed no changes in the pseudarthrosis region, that is, the resorption phase did not occur. An unfavorable evolution was appreciated, the morphoinductive preparation, which consists of osteomedullary cells and demineralized bone matrix, was administered repeatedly. Over a month, the resorption phase was evaluated, it was found that the process is progressing favorably. 4 months after this, consolidation of the pseudarthrosis occurred. The patient started recovery treatment.

Regenerarea reparatorie prin resorbţie a fost determinată la 216 pacienţi cu pseudartroze la diferite oase, în CNŞPDMU, catedra ortopedie şi traumatologie USMF, laboratorul Inginerie tisulară şi culturi celulare: Reparative regeneration by resorption was determined in 216 patients with pseudarthrosis in different bones, in the CNŞPDMU, department of orthopedics and traumatology USMF, tissue engineering and cell cultures laboratory:

1. Pseudartroza oaselor scurte (os navicular, falange) la 7 pacienţi. Faza a 3-a a fost constatată la 2 luni după stimulare. 1. Pseudarthrosis of short bones (navicular bone, phalanges) in 7 patients. Phase 3 was observed 2 months after stimulation.

2. Pseudartroza oaselor antebraţului la 106 pacienţi. Faza a 3-a a fost constatată la 2,5...4 luni din momentul stimulării. 2. Pseudarthrosis of the bones of the forearm in 106 patients. The 3rd phase was found 2.5...4 months after the stimulation.

3. Pseudartroza oaselor lungi (tibie, humerus, femur) la 103 pacienţi, la care etapa a 3-a a fost constatată la 4...10 luni. 3. Pseudarthrosis of long bones (tibia, humerus, femur) in 103 patients, in which the 3rd stage was found at 4...10 months.

1. MD 1270 G2 2000.02.29 1. MD 1270 G2 2000.02.29

Claims (2)

1. Metodă de tratament al pseudartrozei, care include administrarea unui preparat morfoinductiv, caracterizată prin aceea că peste o lună de la administrarea preparatului morfoinductiv se efectuează radiografia şi dacă se determină un proces de resorbţie a ţesuturilor fibroase, atunci se apreciază o evoluţie favorabilă a regenerării reparatorii osoase, iar în cazul în care nu se determină un proces de resorbţie a ţesuturilor fibroase, se efectuează administrarea repetată a preparatului morfoinductiv.1. Pseudarthrosis treatment method, which includes the administration of a morphoinductive preparation, characterized by the fact that a month after the administration of the morphoinductive preparation, radiography is performed and if a fibrous tissue resorption process is determined, then a favorable evolution of regeneration is appreciated bone reparators, and in the event that a fibrous tissue resorption process is not determined, repeated administration of the morphoinductive preparation is performed. 2. Metodă conform revendicării1, caracterizată prin aceea că în calitate de preparat morfoinductiv se utilizează cultură celulară osteomedulară sau matrice osoasă demineralizată2. Method according to claim 1, characterized in that osteomedullary cell culture or demineralized bone matrix is used as the morphoinductive preparation
MDS20080039A 2008-12-18 2008-12-18 Method for treatment of pseudoarthrosis MD37Z (en)

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MD299Z (en) * 2010-03-03 2011-10-31 Ирина КЯН Process for demonstration of advertising and entertaining information in the salon of vehicle and device for its realization
MD332Z (en) * 2010-10-07 2011-09-30 Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова Method of tibia pseudoarthrosis plasty with a vascularized graft

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MD1270G2 (en) * 1998-12-15 2000-01-31 Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова Method for treatment of the hand navicular bone pseudarthrosis
MD2734G2 (en) * 2002-09-11 2005-12-31 Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова Method of reconstruction in the humeral capitellum pseudoarthrosis and the humerus valgoid deformity to children
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