RU2071740C1 - Method for stimulating repair process in bone - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves approaching the distal portion of the regenerate to the proximal one after finishing distraction period to carry out compression of fat layer in the regenerate. EFFECT: enhanced effectiveness of bone regenerate formation.

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and is intended to stimulate the formation of bone regenerate with lengthening of the limbs in patients with orthopedic diseases.

 A known method of stimulating the adjustment of the regenerate during distraction transosseous osteosynthesis, including cyclic loads of the reagent zone with a frequency of 0.25 5.0 Hz and an amplitude of 0.15 0.30 mm per centimeter of its length (A. S. 1189440, USSR, class A 61 B 17/56, publ. 07.11.85, bull. 41).

 A known method of gradually increasing the strength properties of a newly formed bone, including a gradual increasing load on the leg and dosed approach of the apparatus supports 0.25 mm 11 2 times a day (Methodical recommendations "Surgical lengthening of the lower extremities according to Ilizarov", Kurgan, 1990, p. 29 30 )

 However, when implementing the known method, the formation of a continuous mineralized bone regenerator is passively expected, which requires a long period of fixation of the fragments (within several months) and only after that they begin to stimulate the creation of a durable bone reagent, bringing the supports closer together in the 0.25 mm mode, 1 2 times per day.

 The present objective of the invention is the development of such a method of stimulating the reconstruction of bone regenerate, which will significantly reduce the fixation period of the elongated segment after a period of distraction and, accordingly, shorten the treatment period of an orthopedic patient.

 The problem is solved in that in the method of stimulating the reparative process, including the application of axial load, after the end of the distraction period, hard fragments are simultaneously brought together to contact the vertices of the proximal and distal parts of the bone regenerate and the compression of the connective tissue layer.

 The method is as follows.

 It is known that with lengthening of bones, a distraction regenerate is formed, on the roentgenogram of which a central part is identified, which is called the “regenerate growth zone” and histologically represents a connective tissue layer, and two peripheral parts: the proximal and distal dense newly formed mineralized bones. Extension of the limb is continued until its length exceeds the planned value by the height of the "growth zone" of the regenerate (usually 0.5 to 1.0 cm or less). During treatment, the patient constantly carries out axial load on the limb when walking. After the end of the distraction period, simultaneous rapprochement of the bone fragments to the contact of the vertices of the proximal and distal parts of the bone regenerate and compression of the connective tissue layer are performed. Necrosis of cellular elements of the connective tissue layer stimulates proliferative processes at the vertices of the proximal and distal parts of the bone regenerate in contact. Stimulation is associated with the action of mediators of the first system and hormones. When using the proposed method of stimulation, a rapid fusion of bone fragments occurs.

 Examples of the method.

 Experimental studies conducted on outbred dogs. The control series of the experiment consisted in the operative lengthening of the tibia of the animal in a known way of lengthening using the Ilizarov apparatus. Elongation at a rate of 0.75 mm per day lasted 28 days, as a result of which the tibia lengthened by 18 20% of the initial length. After the end of the distraction period, the fixation period lasted from 98 to 112 days. The formation of distraction regenerate was monitored radiologically and histologically.

 In the experimental series of the experiment, the extension of the lower leg was carried out similarly to the control group of animals. Then, an extension was made by an amount corresponding to the height of the growth zone. After the end of the distraction period, the bone fragments were brought together simultaneously until the tops of the parts of the bone regenerates came into contact and the connective tissue layer was compressed.

 On the radiograph after 14 days of fixation, direct contact of the proximal and distal parts of the bone regenerates after compression and a thin line of enlightenment at the site of the necrotic connective tissue layer are visible. On the histotopogram of the same bone, a line of the acellular necrotic zone is visible.

 After 49 days of fixation as a result of rapid regeneration of bone tissue, a complete fusion of the bone occurred, which is confirmed by a histotopogram.

 The dynamics of mineralization of the distraction regenerate were monitored by measuring the optical density of X-ray diffraction patterns on an IFO-451 microphotometer. In the control series of the experiment, the optical density of the distraction regenerate (line P) after the end of the distraction period for 45 days remained at the same level (23 25%). Up to 100 140 days, the optical density gradually increased to 70 75% of the diaphysis density of healthy bones.

 When stimulated by the proposed method (line P), the optical density of the distraction regenerate reached 100% in 35–40 days, after which this indicator begins to decline, which indicates not only the consolidation of bone fragments, but also the beginning of the formation of the bone marrow canal.

 An example of the method in clinical practice.

 Patient D., 22 years old. Diagnosis: post-traumatic shortening of the right thigh 4 cm. Surgery of the post-operative osteotomy of the right thigh, osteosynthesis by Ilizarov apparatus. The distraction started on day 6 and continued at a rate of 1.25 mm per day for 32 days. From the first day of distraction, the patient walked with the application of axial load on the operated limb. After the end of the distraction period, simultaneous rapprochement of the bone fragments to the contact of the vertices of the proximal and distal parts of the bone regenerates and compression of the connective tissue layer was performed. After that, bone fragments were fixed in the achieved position for 14 days, i.e., the fixation period per 1 cm of elongation was 3.5 days. At the control examination after 2 months, the patient walked with a full load on the operated leg.

 The use of the proposed method of stimulating the reparative process in clinical departments when lengthening the limbs allows to reduce the fixation time of the lengthening limb by the transosseous osteosynthesis apparatus by 3 to 4 times, depending on the length of the lengthening, the etiology of shortening, and the age of the patient.

Claims (1)

 A method of stimulating the reparative process, including the application of axial load, characterized in that after the end of the distraction period, bone fragments are brought together simultaneously until the tips of the proximal and distal parts of the bone regenerate come into contact and the connective tissue layer is compressed.