RU2126970C1 - Method of prognostication of inflammatory processes development in patients suffered from crus fractures - Google Patents

Abstract

FIELD: medicine, more specifically, orthopedics, traumatology, immunology and prognostication of postoperative complications, in particular, inflammatory processes in patients suffered from open fractures of crus. SUBSTANCE: method includes determination of percentage of leucocytes in blood taken from cubital vein. Additionally determined is percentage of leucocytes in blood taken from femoral vein of injured extremity; calculation of percentage of leucocytes forming E-rosulas in blood taken both from cubital vein and blood from femoral vein on injured extremity; interpretation of research results. With values of leucocytes forming E-rosulas in blood from cubital vein in excess of 14% and in blood from femoral vein ranging from 19 to 52%, smooth postoperative period is prognosticated. EFFECT: higher prognostication efficiency. 3 tbl

Description

 The invention relates to medicine, and more specifically to orthopedics, traumatology and immunology, and for the early prediction of postoperative complications, namely, inflammatory processes in patients with open fractures of the leg.

A known method for determining the onset of the inflammatory process by blood analysis, in which an increase in the number of leukocytes to 20,000 in 1 mm ³ with a large number of neutrophils - up to 75% -80% in the formula - indicates the beginning of the inflammatory process (S.M. Ploticher "Laboratory diagnostic studies "The State Medical Publishing House of the Ukrainian SSR, 1962, p. 192).

 The disadvantage of this method is that from the moment of injury to the moment of examination and subsequent organization, usually 1 to 2 hours pass. This time is not enough to start the inflammatory process in the injured limb, i.e., no blood reaction is noted. This creates certain difficulties in predicting the development of the inflammatory process, in choosing the volume of surgical intervention and determining therapeutic tactics.

где МИ - миелоциты;
Ю - юные;
П - палочкоядерные;
С - сегментоядерные нейтрофилы;
Пл - плазматические клетки Тюрка;
Л - лимфоциты;
Мо - моноциты;
Э - эозинофилы.Closest to the proposed solution is a method for predicting the development of inflammatory processes in patients with leg fractures, including determining the percentage of leukocytes in the blood from the ulnar vein. Under the prediction of the development of inflammatory processes in this method is understood the determination of the presence or absence of intracavitary infiltrates and infiltrates in the soft tissues, in which a blood test is performed and the percentage of leukocytes calculate the infiltration index by the formula

where MI is myelocytes;
Yu - young;
P - stab;
C - segmented neutrophils;
Pl - Türk plasma cells;
L - lymphocytes;
Mo are monocytes;
E - eosinophils.

 Then determine the likelihood of an inflammatory process. With a smooth postoperative course, LII is on average 0.6 ± 0.09. If LII exceeds 1.4, complication usually arises (I. M. Kuznik, M. B. Kostyuchenok, “Wounds and wound infection”, M., 1990, p. 190).

 The disadvantage of this method is that it gives reliable results only with closed fractures of the lower leg. However, if the wound is drained, and the drainage of the postoperative wound is included in the mandatory volume of surgical intervention on the lower legs with open fractures, then the blood formula does not reflect the true state of the pathological focus.

 The objective of the invention is to provide a method that allows to increase the accuracy and to ensure the prediction of the course (smooth or complicated) of the postoperative period in patients with open fractures of the leg.

 The problem is solved in the invention by the fact that in the method for predicting the development of inflammatory processes in patients with leg fractures, including determining the percentage of blood leukocytes from the ulnar vein, the percentage of blood leukocytes from the femoral vein of the injured limb is additionally determined, then the percentage of leukocytes forming red blood cell outlets is calculated ram (E-sockets, E-ROCK) both in blood from the ulnar vein and in blood from the femoral vein of the injured limb, after which the results are interpreted studies, with the values of leukocytes forming E-sockets in the blood from the ulnar vein more than 14%, and in the blood from the femoral vein - from 19% to 52% predict a smooth course of the postoperative period.

 The drawing shows a graphical image of the values of E-ROCK, where the abscissa shows the value of E-ROCK in the blood from the femoral vein, and ordinate from the cubital vein.

The essence of the method is as follows. In a patient from the ulnar vein from the lesion and the femoral vein of the injured limb, a blood sampling of 2.5 mm is performed. into sterile tubes with 0.5 ml. heparin solution (200 u / ml). 3 ml are poured into centrifuge tubes. ficollverographin solution (solution density 1.076 g / cm ³ ). Gently layered blood with a Pasteur pipette. The tubes are equilibrated and centrifuged for 35 minutes. at 1500 rpm The interphase ring of lymphocytes is sucked off. The cell suspension is washed twice with medium 199 for 5 minutes, the pellet is resuspended in medium 199. Into a test tube with 0.2 ml. suspensions of lymphocytes (2 • 10 ⁶ cells / ml) contribute 0.2 ml of 1% suspension of sheep erythrocytes. The contents of the test tube are mixed by shaking, centrifuged at 1000 rpm. within 5 minutes Then incubated at 4 ^o C for 30 minutes The pellet is carefully resuspended by slightly shaking the tubes and the number of leukocytes forming rosette with sheep erythrocytes (E-ROCK) per 100 cells is counted in the native preparation. The result is expressed as a percentage. For a rosette-like, a cell is considered to which 3 or more sheep erythrocytes have attached. Interpret research results as follows. A smooth postoperative period is possible only if the number of E-ROCK in the blood from the ulnar vein is more than 14%, while the level of E-ROCK in the blood from the femoral vein of the affected limb varies from 19 to 52%.

 The invention is illustrated by the following examples.

 Example 1. Patient G., medical history 173410, 24 years. He was undergoing treatment at the orthopedics clinic for an open comminuted fracture of the left lower leg bones in the middle third with moderate soft tissue damage, an open fracture of the calcaneus of the left foot.

 In immunological testing, the number of E-ROCK in the blood from the ulnar vein is 25%, in the blood from the femoral vein of the injured limb - 17%. Upon admission conducted: 1). Femoral artery catheterization on the left; 2). Primary surgical treatment of wounds of the left leg and foot, drainage. 3). Transosseous osteosynthesis of bones of the left lower leg and foot by Ilizarov apparatus. In the postoperative period, comprehensive treatment was performed. The course of the wound process was complicated by suppuration of soft tissues. Secondary healing. The term of inpatient treatment was 26 days.

 Example 2. Patient B., N case history 215858, 16 years. He was treated in an orthopedics clinic with a diagnosis of “Open comminuted fracture of the middle third of the bones of the right lower leg with displacement of fragments, moderate damage to soft tissues”. Upon admission to the hospital, the patient underwent primary surgical treatment of wounds, drainage, transosseous osteosynthesis of the lower leg with the Ilizarov apparatus. A laboratory examination revealed that the number of E-ROCK in the blood from the ulnar vein was 30%, in the blood of the limb - 19%. The postoperative period was uneventful. Wound healing by primary intention.

Example 3. Patient B. N medical history 173881, 16 years old. He was undergoing treatment at the orthopedics clinic for an open fracture of the lower third of the leg, extensive damage to the soft tissues. Laboratory testing was performed in which E-ROCK in the blood from the ulnar vein was 18%, in the blood from the femoral veins of the affected limb - 52%. upon admission to the hospital, surgery was performed:
1. Catheterization of the femoral artery.

 2. Primary surgical treatment of the right lower leg, drainage.

 3. Osteosynthesis of the bones of the lower leg with the Ilizarov apparatus.

 The postoperative period was uneventful, healing by primary intention. The term of inpatient treatment was 21 days.

Example 4. Patient M., medical history number 176947, 37 years old. Was admitted to the hospital with a diagnosis. "An open fracture-dislocation of the talus. Torn wounds with extensive damage to the soft tissues of both legs." During immunological testing, the number of E-ROCK in the blood from the ulnar vein is 56%, in the blood from the femoral vein of the injured limb - 53%. Upon admission:
1. Catheterization of the femoral artery.

 2. Primary surgical treatment of wounds, drainage.

 3. Osteosynthesis of bones by the Ilizarov apparatus.

 The postoperative period was complicated by suppuration of wounds, purulent osteoarthritis of the joint, ascending thrombosis of the femoral artery. The patient was transferred to the wound infection department, where a necrectomy of the left ankle joint and revision of the femoral artery were performed. Subsequently, plastic granulation wounds. The total hospital stay was 98 days.

 Example 5: Patient M., medical history number 221420, 27 years. He was admitted to the orthopedics clinic with a diagnosis of "Open fracture of the left lower leg bones in the distal third. Moderate soft tissue damage. During immunological testing: E-ROCK in the blood from the cubital vein - 25%, in the blood from the femoral vein - 21%.

Surgery performed:
1. Primary surgical treatment of wounds of the left leg, drainage.

 2. Transosseous osteosynthesis of the left lower leg with the Ilizarov apparatus. The postoperative period was uneventful. Primary healing. The term of inpatient treatment was 21 days.

 Example 6. Patient S., medical history number 173758, 38 years old. He was undergoing treatment at the orthopedics clinic with the diagnosis: "An open fracture of both bones of the right lower leg with displacement of fragments, extensive damage to the soft tissues."

 In laboratory testing, it was found that the number of E-ROCK in the blood from the ulnar vein was 14%, in the blood from the femoral vein - 22%.

Upon admission:
1. Catheterization of the femoral artery.

 2. Primary surgical treatment of wounds, drainage.

 3. Transosseous osteosynthesis of the right lower leg by Ilizarov apparatus. The postoperative period was complicated by deep suppuration of the soft tissues of the right lower leg, osteomyelitis of the tibia.

In the wound infection department, the patient underwent surgery:
1. Resection of the tibia of the right lower leg by 8 cm.

 2. Necrectomy of the right lower leg.

 The total term of inpatient treatment was 92 days.

 Example 7. Patient C., the number of medical history 175633, 36 years. He was admitted to the hospital with a diagnosis of “Cellular fracture of the tibia in the middle third, fracture of the fibula in the distal third with extensive reproduction of soft tissues. Extensive, ragged scalp wound of the left thigh”.

Surgery performed:
1. Catheterization of the femoral artery.

 2. Primary surgical treatment of wounds of the lower leg and thigh, drainage.

 3. Osteosynthesis by the Ilizarov apparatus.

 In laboratory testing: the number of E-ROCK in the blood from the ulnar vein is 38%, in the blood from the femoral vein - 30%. The postoperative period was uneventful. Wound healing by primary intention. The term of inpatient treatment was 24 days.

 Example 8. Patient L., the number of medical history 215072, 37 years. He was admitted to the hospital with a diagnosis of "Spiral fracture of the distal third of the bones of the right lower leg. Extensive soft tissue damage. Revealed during laboratory testing, the number of E-ROCK in the blood from the cubital vein is 48%, in the blood from the femoral vein - 38%.

Surgery performed:
1. Primary surgical treatment of wounds, drainage.

 2. Transosseous osteosynthesis of the bones of the right lower leg with the Ilizarov apparatus. The postoperative period was uneventful. Wound healing by primary intention. The term of inpatient treatment was 19 days.

 It can be seen from the examples that the smooth course of the postoperative period was observed with an E-ROCK in blood from the ulnar vein of more than 14%, and in blood from the femoral vein of the affected limb in the range from 19 to 52% inclusive.

 In the table. 1 shows the values of E-ROCK in the blood from the femoral vein, increasing from 9% to 62% and the corresponding prognosis and the actual course of the postoperative period. In the drawing, this corresponds to parts I, II, III, IV where the plotted points correspond to the values of E-ROCK in the blood from the ulnar vein and femoral vein of the affected limb. In the table. 2 shows the values of E-ROCK in the blood from the cubital vein, increasing from 4 to 52 and the corresponding prognosis and the actual course of the postoperative period. In the drawing, this corresponds to parts II, IV, V. Thus, in part II in the drawing, the E-ROCK parameters in the blood from the ulnar vein and the femoral vein of the affected limb are concentrated, in which a smooth course of the postoperative period is observed.

 If E-ROCK in the blood from the ulnar vein is less than 14%, then for any values of E-ROCK in the blood from the femoral vein of the affected limb, a complicated course of the postoperative period / suppuration of soft tissues, osteomyelitis / in the drawing are parts VI, V, VI /. If E-ROCK in the blood from the ulnar vein is more than 14%, then 1 variant of the clinical course of the postoperative period is possible. A smooth postoperative course is observed only if the E-ROCK in the blood from the femoral vein of the affected limb lies in the range from 19% to 52% / in the drawing this is part II /.

 It should be noted that the proposed method gives a coincidence of the prognosis and the actual course of the postoperative period in 95% of cases.

 In the table. 3 shows a comparison of the forecasting accuracy of our proposed prototype method. From the table. 3 it follows that the proposed method is much more accurate than the prototype, because in our method, additional blood parameters are investigated.

Claims (1)

 A method for predicting the development of inflammatory processes in patients with leg fractures, including determining the percentage of leukocytes in the blood from the ulnar vein, characterized in that the percentage of leukocytes from the femoral vein of the injured limb is additionally determined, and then the percentage of leukocytes forming E-rosettes as in blood is calculated from the ulnar vein, and in the blood from the femoral vein of the injured limb, after which the results of the study are interpreted, and with the values of leukocytes, I form More than 14% of E-sockets in blood from the ulnar vein, and from the femoral vein from 19 to 52%, a smooth course of the postoperative period is predicted.

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