RU1806788C - Method of treating chronic osteomyelitis - Google Patents

Abstract

Usage: in surgery. The inventive: twice with an interval of 8-9 days in the preoperative period, twice after 3-5 days after radical surgery, the patient's blood is irradiated with a helium-neon laser light guide with an output power of 8-10 mW, pressed to the skin in the area of the projection of the femoral artery under pressure 20-30 mm Hg, for 14-18 minutes Positive effect: elimination of traumatism, invasiveness, improvement of irradiation efficiency during treatment.

Description

The invention relates to medicine, namely to surgery, and can be used in the treatment of chronic osteomyelitis.

The aim of the invention is to reduce the morbidity.

The method is carried out as follows.

In the preoperative period, the end of the helium-neon laser fiber (wavelength 632.8 nm} with an output power of 8-10 mW is pressed against the skin over the projection of the femoral artery. The projection of the femoral artery in the femoral triangle is determined by palpation or ultrasound doppler. 30 mm Hg, which is determined by a manometer. A manometer sensor is connected to the end of the fiber, which allows to measure the pressure of pressing during the irradiation period. The irradiation is carried out for 14-18 minutes. The second irradiation session is carried out after 8-9 d after the first session.The operation consists in excising fistulas, removing purulent-necrotic tissues in the bones, treating the bone cavity and wounds with antiseptics, suturing soft tissue wounds, draining the bone cavity for 3-5 days after the second irradiation. In the postoperative period, for 3-5 days, immunological parameters of the blood are determined and laser blood is irradiated with the same parameters.

Example 1. Patient M., 32 years old. Diagnosis: exacerbation of chronic hematogenous osteomyelitis of the right femur. - Fistula of the right thigh. Chronic hematogenous osteomyelitis suffers for about 15 years. Repeatedly operated, including two radical operations; The last radical operation was 1 year ago, after which a fistula formed 3 months later. Radiography of the femur determines the destruction in the thickened and sclerosed middle. And the lower third of the femur, fistulography revealed that the contrast medium passes into the bone cavity. When scanning (radio isoel

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A topical study with Tepyrophosphate) revealed a focus of hyperfixation of the radiopharmaceutical in the middle and lower third of the right thigh. The study of the immunogram showed that there is a sharp deficit of immunocompetent cells, an imbalance at the level of regulatory cells which indicate a decrease in the immunological protection of the patient. A laser blood irradiation session was performed to stimulate the immune system. In order to eliminate trauma and invasiveness, a transdermal laser blood irradiation session was performed. Palpation of the left femoral artery in the femoral triangle. At the point of greatest pulsation, the end of the fiber, placed in a metal cuff, was pressed to the skin under a pressure of 20 mm Hg with a tripod. The pressure was determined and monitored during the irradiation process using a manometer whose sensor is connected to the end of the fiber. The output power at the end of the fiber was 8 mW. Irradiation was carried out for 18 minutes. The procedure was painless, non-traumatic for the patient. After irradiation, an immunogram was examined daily in a patient. The data showed that, after irradiation, pronounced changes in immune parameters occur, the normalization of which occurs 3-5 days after irradiation. By 9 days, the indicators changed, approaching the initial level.

9 days after the first irradiation, repeated irradiation was carried out according to the described method. 5 days after the second irradiation, an operation was performed - a fistula was excised, the femur was trepanded, purulent granulation of sequestra was removed, the bone wall was cut with cutters to healthy bone tissue, the wound was washed with solutions of hydrogen peroxide, chlorhexidine, and the soft tissue wound was dried and drained the bone cavity.

Examination of the immunogram immediately before the operation showed that the indices are within normal limits and do not differ much from those at the first irradiation. This indicates that percutaneous irradiation of the blood has a pronounced immunocorrective effect and the dynamics of the indices after the first and repeated irradiation are similar.

4 days after the operation, when determining the immunogram, it was revealed that the number of immunocompetent cells significantly decreased. Therefore, on the 5th day after the operation, blood was irradiated with a laser according to the proposed method. 9 days after surgery, i.e. in 4 days

after irradiation, the immune system is normal.

The patient’s wound healed by primary intention, he was discharged 11 days after

operations. Observation of 6 months. No relapse

Example 2. Sick Y., 29 years old. Diagnosis: exacerbation of chronic post-traumatic osteomyelitis of the left

tibia, fistula of the left leg ,. Osteomyelitis occurred after an open fracture of the tibia, about which was operated 3 years ago with the application of the Ilizarov apparatus. Up to 5 times, 2 times phlegmon was paraossal, abscesses were opened, subsequently a fistula was formed in the region of the left tibia. On admission, an X-ray examination revealed

0 the presence of a bone cavity with sequestration. In the middle third of the left tibia. A radioisotope study showed that the site of hyperfixation of the radiopharmaceutical (labeled technetium - pyrophosphate) in more than 5 tibia, which indicates a pronounced inflammatory process. The study of the immunogram showed that the number of immunocompetent cells decreased sharply.

0 normal, there is an imbalance of immunoregulatory cells. -This indicates that the immunological protection of the patient is reduced; To increase the immunological defense of the patient’s body, as well as with

5, transdermal laser irradiation of blood was used to eliminate the invasiveness and invasiveness of the treatment. The projection was determined in the right femoral triangle using ultrasound doppler

0 femoral artery. The end of the laser waveguide (helium-neon laser, wavelength 632.8 nm) - using a tripod, pressed to the skin in the projection of the femoral artery under a pressure of 30 mm Hg Pressure measurement 5 and control over it in the process of irradiation was carried out using a manometer, the sensor of which is coupled to the end of the fiber; The output power at the end of the fiber is 10 mW, irradiation was carried out for 14

0 min After irradiation, an immunogram was determined daily in a patient. Irradiation caused an increase in the number of T-, B-lymphocytes, their populations. In this case, the maximum increase in the indices of the 5 immune system occurred by 3-5 days, and by 8 days they decreased with approaching the initial level. Therefore, on the 8th day after the first irradiation, a second transdermal laser irradiation of blood was performed according to the described method. After 3 days

after the second irradiation, an operation was performed - fistulas were excised, the bone cavity was trepanded, sequestration, purulent granulations were removed, the walls of the bone cavity were cut with mills to healthy bone tissue, the wound was washed with solutions of hydrogen peroxide, chlorhexidine, the soft tissue wound was sutured and the bone bone was drained the cavity. The study of the immunogram immediately before the operation showed that 10 indicators of the immune system are within normal limits. 3 days after the operation, the patient noted increased pain in the wound area, the temperature rose to 39 ° C, at. An immunogram study found that 15 indicators of the immune system were reduced. On the 4th day after the operation, a transdermal laser blood irradiation session was carried out according to the described method. On the next day after irradiation, the pain in the area decreased, the temperature dropped to 37 ° C. 4 days after the irradiation, 8 days after the operation, the pain subsided completely, the temperature returned to normal, the immunogram showed that the number of immunocompetent cells was within the normal range.

In the patient, the wound healed by primary intention, it was discharged 12 days after surgery, observation 1 year, no relapse. -thirty

PRI me R 3. Sick V., 30 years. Diagnosis: exacerbation of chronic postoperative osteomyelitis of the right “humerus, Paraoaxial phlegmon of the right shoulder region, 2 years ago underwent 35 operations - submersible metal osteosynthesis for a closed fracture of the upper third of the right humerus. After surgery, the wound festering, a fistula formed. A week before admission, there were pains, swelling in the right shoulder region, which intensified at the time of admission, was accompanied by hectic temperature. The patient was urgently hospitalized. During the study, phlegmon 45 of the right shoulder region was revealed. An X-ray examination showed destruction of the bone around the metal fixative, thickening, and periosteal reaction. Examination of the immunogram showed that there was a decrease in the number of T- and B-lymphocytes, their subpopulations and a violation of the ratio of immunoregulatory cells, which indicated a violation of the immunological defense. 55 The patient underwent an urgent palliative operation - opening of a paoaxial phlegmon. One day after surgery, percutaneous laser irradiation of blood was performed as follows. Palpation

projections of the femoral artery in the left femoral triangle were determined. At the point of greatest ripple, the end of the laser fiber (helium-neon laser, wavelength 832.8 nm) with an output power of 9 mW was pressed against the skin under a pressure of 26 mmHg. The pressure was determined and monitored during the irradiation process using a manometer whose sensor is connected to the end of the fiber. Irradiation lasted 15 minutes. After percutaneous irradiation, an immunogram was determined daily, while it was found that the immune system began to increase from the next day. Normalization of the indicators occurred 3-5 days after irradiation, and by 8 days they decreased with approaching the initial level. Therefore, on the 8th day after the first irradiation, a second transdermal irradiation of blood was performed according to the described method. On the 12th day after opening the abscess and 3 days after the second irradiation, the inflammatory phenomena subsided in the wound, it cleared of pus, granulation appeared, examination of the immunogram showed normalization of the immune system. On the 4th day after the second irradiation, a radical operation was performed - metal fixatives, purulent granulations, necrotic bone fragments were removed, the walls of the bone cavity were treated to healthy tissue, the wound was washed with antiseptic solutions, the wound of soft tissues was sutured, and the bone cavity was drained. 3 days after the radical operation, when determining the immunogram, it was revealed that the indices of the immune system decreased. Therefore, to stimulate the immune system on the 3rd day after the radical operation, a transdermal laser blood irradiation session was performed according to the described method. Examination of the immunogram 4 days after irradiation showed that the immune system was within normal limits. .

In the patient, the wound healed by primary intention. She was discharged 12 days after the radical operation. Observation for 10 months. No relapse.

The proposed method in comparison with the known less traumatic; there is no danger of a blood clot, infection of the patient’s blood, the effectiveness of the exposure does not decrease during irradiation.

FORMULA AND SECTION

A method of treating chronic osteomyelitis, including irradiating blood with a helium-neo-new laser and removing a purulent-necrotic focus, distinguish-1

u and with the fact that, in order to reduce grass-Hg, with a capacity of 8-10 mW for 14-18

maticity, blood is irradiated with a fiber, min twice with an interval of 8-9 days to

pressed to the skin in the area of the projection of the poor operation and once after 3-5 days of the arterial artery under pressure 20-30 mm less than the operation.