RU2160061C2 - Method for treating bone cysts - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making bone cyst puncture and removing its contents. The cavity is washed and drugs are introduced into it. Periosteum separation is carried out along the bone perimeter through a minimum cut in skin proximal and/or distal with respect to the cyst zone. EFFECT: improved blood circulation; activated osteogenic repair; accelerated treatment method. 6 dwg

Description

 The present invention relates to medicine, namely to orthopedics and traumatology, and can be used in the treatment of bone cysts.

 There is a method of treating bone cysts by perforation of the acid cavity and its drainage with the introduction of drugs: protease inhibitors, steroid hormones, denatured alcohol, and osteoplastic material in the form of venous autologous blood with bone “flour” from a demineralized matrix into the pathological cavity, a gypsum splint is applied to the limb . The process of constant drainage lasts 15 to 16 days. Before removing the catheters, in order to create a base of plastic material for osteogenesis, 10 to 20 ml of fresh venous autologous blood with bone “flour” from the demineralized matrix is injected into the cyst cavity. Then apply a gypsum circular gypsum dressing for 2 to 3 months. Intramuscularly, antibiotics are prescribed during treatment (1).

 Closest to the proposed is the treatment of bone cysts by puncturing the cyst cavity with a needle for intraosseous anesthesia. Intraosseous pressure is measured to clarify the activity of the process, content is taken for cytological and other studies. Then punctured with a second needle and washed with saline, and then with aminocaproic acid. In the osteolysis phase, 2 ml of contracal is injected into the remaining cavity. Kirschner spoke with multiple perforations of the walls of the cyst. With long-existing cysts with serous contents and thick connective tissue lining, treatment is aimed at enhancing osteogenic repair. In this case, after multiple perforation of the walls of the cyst, steroid hormones are administered. The procedure is completed by applying a sterile dressing and immobilizing the arm with a plaster cast and a scarf dressing. Punctures are performed at intervals of 3 to 54 weeks. The average number of punctures is 3 - 8. X-ray control after 1 - 3 months [2].

However, known methods of treatment have significant disadvantages:
1. Treatment by known methods does not affect the causative factor of cyst formation (circulatory disorders in the affected area), therefore, only mechanical filling of the cyst cavity occurs, without improving blood circulation.

 2. The use of hormonal preparations, allogeneic flour from demineralized bone matrix during treatment leads to sensitization of the child's body.

 3. The long term immobilization of the limb and bed rest leads to muscle atrophy and impaired limb function, because Subsequently, rehabilitation treatment is required.

 4. Prolonged drainage of the cyst cavity can cause infectious complications.

 5. A preventive course of antibiotic therapy leads to resistance of the body.

 The task to which the proposed method of treatment is directed is to reduce the duration of treatment by improving blood circulation and activating osteogenic repair in the cyst zone.

 The problem is solved due to the fact that after puncture of a bone cyst, its contents are removed, the cavity is washed and drugs are administered. New in solving the problem is that the periosteum is additionally peeled along the perimeter of the bone through a minimal skin incision proximal and distal to the cyst zone.

 Flaking off the periosteum along the perimeter of the bone through a minimal skin incision improves blood circulation in the cyst area due to the formation of perioste-medullary anastomoses, which will radically change hemodynamics (inflow-outflow) in the affected area and will lead to normalization of intraosseous pressure, and also activates the process of osteogenic repair in the cavity cysts.

 Performing exfoliation of the periosteum distally and proximal to the cyst zone will enhance the stimulation of blood circulation with the greatest coverage of the affected area. In the case of the location of the cyst, periarticular detachment of the periosteum is performed on only one side, excluding trauma to the articular formations.

 Patent studies on subclass A 61 B 17/56 and analysis of scientific and medical information reflecting the current level of treatment for bone cysts did not reveal technologies identical to the proposed one. Thus, the proposed method for the treatment of bone cysts is new.

 The interconnection and interaction of the essential methods of the proposed method of treatment ensures the achievement of a new technological and medical result in solving the problem, namely, to reduce the treatment time by improving blood circulation and activating osteogenic repair in the cyst zone.

 Thus, the proposed technical solution has an inventive step.

 The proposed method for the treatment of bone cysts can be widely applied in the field of practical health care, does not require exceptional funds for implementation, and in addition, the treatment is carried out on an outpatient basis.

 The essence of the proposed method is as follows: a cyst is punctured under intravenous or intramuscular anesthesia, the contents of the cyst cavity are removed with a syringe. A second puncture is made and the cavity is washed to clean wash water. 1 ml of the drug Contrycal (protease inhibitor) or Gordox 10 ml is injected into the cyst cavity. A catheter is inserted through one of the needles for further drainage of the cyst for 2 to 4 days. Then, a minimal incision of the skin is made proximal and distal to the pathological lesion and the periosteum is removed through it along the perimeter of the bone. One stitch to the wound. The procedure is completed by applying a sterile dressing. The catheter is removed after 2-4 days, until the cessation of the cyst contents is stopped.

 If necessary, re-puncture of the cyst cavity is done after 25 to 30 days. If there is a significant amount of discharge, the catheter is reinstalled for 2 to 4 days.

 1 month after the first puncture, a control x-ray examination is done, which is repeated 2 months before the transition of the active phase (osteolysis) to the phase of activity decrease (delimitation). Control after 3-6 months - until the stage of restoration of bone tissue in the cavity of the cyst.

The essence of the proposed method is illustrated by clinical examples:
1. Patient B. 13 years. The medical history 50273. Was admitted to the clinic ITO VSNTS SB RAMS, diagnosis: Bone cyst of the lower third of the right femur in the active phase (cavity dimensions 5.5 x 7 cm).

 On March 18, 1997, an operation was performed under intravenous anesthesia: treatment and diagnostic puncture of the cyst, detachment of the periosteum of the field was made by a bone marrow puncture of the medial metaphysis of the right femur. Removed 60 ml of hemorrhagic discharge. 3 cm anterior to the first needle punctured with a second needle. The cystic cavity is washed with saline, aminocaproic acid, to clean washings. Gordox introduced 10.0 ml. The second needle is removed. A catheter is inserted through the first. A skin incision 1.5 cm long was made 5 cm distal to the punctures along the front-inner surface of the thigh. The soft tissues are pulled apart in a blunt manner. A special curved raspator longitudinally dissected and exfoliated the periosteum along the entire perimeter of the bone. One stitch to the wound. Aseptic dressing.

 For two days in the cavity of the cyst was a drainage catheter without plugs. On the first day, the dressing was abundantly wet with hemorrhagic discharge. Aspirated received 6 ml of hemorrhagic discharge. On the second day, the bandage was slightly wet, and no discharge was obtained through the catheter. The catheter is removed.

 After 1 month, repeated puncture was performed, in which 15 ml of hemorrhagic discharge was obtained. On the first day, the dressing was slightly wet. There is no discharge through the catheter; the catheter is removed.

To assess the condition of the vascular system, background reovasography of the lower extremities was performed, while it was revealed that the asymmetry coefficient was:
- before surgery - 16.7%;
- 1 month after the detachment of the periosteum - 1.8%;
- after 6.5 months - 1.8%.

 It was found that the outflow of blood improves, as a result of which the decrease in the asymmetry of the volumetric blood flow, namely, the rheographic index decreases in comparison with the initial data.

 As an illustration, radiographs are given before treatment, 1.5 months after surgery and 6.5 months after surgery (Fig. 1, a, b; Fig. 2, a, b; Fig. 3, a, b, respectively). FIG. 1, a, b March 5, 1997. In the metaphysis of the femur along the inner edge, a pathological lesion is defined, occupying 2/3 of the bone diameter, 5.5 x 7 cm in size. The pathological lesion is not uniform, with a large-cellular structure with tender septa. Swelling with a thinning of the cortical layer is noted along the posterior-inner edge. The focus is delimited from a healthy bone. Figure 2, a, b April 28, 1997, the size of the outbreak is the same. An increase in the density of the contents of the cyst is determined. The focus is a multi-chamber milk-cell structure with denser partitions. FIG. 3, a, b. 6.5 months after the operation, there are areas of healthy bone tissue against the background of the fine-mesh structure of the lesion.

 Example No. 2. Patient K. 10 years. Case history 50170. He was admitted for treatment to the clinic ITO VSNTS SB RAMS. Diagnosis: Bone cyst of the middle third of the right humerus. In the anamnesis; in another medical institution, 5 stages of the traditional puncture method of treatment with weakly positive dynamics over 1.5 years were carried out.

 Upon admission to the ITO, the cavity size was 8 x 2.8 cm. An operation was performed under intramuscular anesthesia: cyst puncture in the area of the diaphysis of the right humerus and detachment of the periosteum. During puncture, 50 ml of hemorrhagic discharge was obtained. A catheter is inserted. On the front surface proximal to the pathological focus produced periosteum detachment. One stitch to the wound. Aseptic dressing. Cysts were drained for 4 days, 6, 3, 2, 0 ml, respectively, were obtained, after which the catheter was removed.

 Subsequently, another puncture was performed, in which 5 ml of hemorrhagic discharge was obtained.

To assess the state of the vascular system, background rheovasography was performed, at which the following asymmetry coefficients were established:
- before the operation was 32.8%;
- after surgery - 8.5%.

 It was found that the outflow of blood improves, as a result of which the decrease in the asymmetry of the volumetric blood flow, namely, the rheographic index decreases in comparison with the initial data.

 As an illustration, radiographs are taken before surgery and 3 months after surgery (Fig. 4 and Fig. 5, a, b, respectively).

 FIG. 4. In the diaphysis of the right humerus, a pathological lesion is determined, occupying the entire diameter of the bone, dimensions 8 x 2.8 cm. The pathological lesion is not homogeneous, with a coarse-cellular structure and delicate partitions. The cortical plate is thinned. The focus is delimited from a healthy bone.

 FIG. 5, a, b. The size of the focus is the same. The bone structure is denser. Against the background of homogeneous dense bone tissue, dense bone partitions are traced. Cortical plates are denser. Bloating decreased.

 Thus, the proposed "Method for the treatment of bone cysts" in comparison with other known methods of treatment can reduce treatment time by improving blood circulation and enhancing osteogenic repair in the cyst zone.

Sources of information:
1. RF patent N 2069995, BI N 34, A 61 B 17/56.

 2. Diseases and injuries of the upper limbs in children. Sat scientific works under the editorship of prof. V.L. Andrianova, Leningrad, 1988, p. 75 - 79.

Claims (1)

 A method of treating bone cysts, which consists in puncturing the cavity of the cyst, removing the contents, followed by washing the cavity and administering medications, characterized in that the periosteum is further peeled off along the bone perimeter through a minimum skin incision proximal and / or distal to the cyst zone.

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