RU2228526C2 - Method for testing chronic osteomyelitis treatment results - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves analyzing results of biochemical, radionuclide and radiological examinations by determining phosphatase index, electrolyte system index and glycolysis system index in biochemical examinations to compare them to radiopharmacological preparation accumulation degree data in bone tissue and X-ray examination data. The values of phosphatase index being greater than 13, electrolyte system index from 160 to 200, glycolysis system index being less than 50, radiopharmacological preparation accumulation degree from 160 to 180% and no residual bone cavities and osteosclerosis and/or osteoporosis manifestations being observed at the end of treatment course, stable osteomyelytic process arrest is to diagnosed. The values of phosphatase index being less than 8, electrolyte system index being greater than 200, glycolysis system index being greater than 70, radiopharmacological preparation accumulation degree from 180 to 200% on the background of osteosclerosis and/or osteoporosis manifestations being observed, conclusion is drawn for an additional conservative treatment course to be carried out. The values of phosphatase index being between 8 and 13, electrolyte system index being less than 160, glycolysis system index being from 50 to 70, radiopharmacological preparation accumulation degree being greater than 220% on the background of residual bone cavities combined with osteosclerosis and/or osteoporosis manifestations being observed, unsatisfactory treatment result conclusion is drawn. EFFECT: high level of examination results objectivity.

Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with chronic osteomyelitis.

Known methods for evaluating the results of treatment of patients with chronic osteomyelitis based on the analysis of X-ray data, biochemical studies, as well as the results of radionuclide studies (1, 2). However, evaluating the results by the indicated parameters is of a private nature and with each type of study it is possible to evaluate only a one-sided picture of the state of individual body systems.

At the same time, being a systemic disease, chronic osteomyelitis affects the functioning of the body as a whole and requires an integrated approach to assessing the results of treatment.

The objective of the invention is to develop a method for evaluating the results of treatment of patients with chronic osteomyelitis, providing for an objective picture of the patient's condition after a full course of medical rehabilitation.

This problem is solved by the fact that in the method, which includes the analysis of the results of biochemical, radionuclide and radiological studies, during biochemical studies, the phosphatase index, the systemic index of electrolytes and the systemic glycolysis index are determined, they are compared with the degree of accumulation in the bone tissue of the radiopharmaceutical 99 tc of pyrophosphate and data X-ray studies, and with values at the time of completion of the course of treatment:

- phosphatase index of more than 13,

- systemic index of electrolytes from 160 to 200,

- systemic glycolysis index less than 50,

- the degree of accumulation of the radiopharmaceutical from 160 to 180%,

in the absence of residual bone cavities in the patient, the phenomena of osteosclerosis and / or osteoporosis, a persistent relief of the osteomyelitis process is judged;

with values:

- phosphatase index less than 8,

- systemic index of electrolytes more than 200,

- a systemic glycolysis index of more than 70,

- the degree of accumulation of the radiopharmaceutical from 180 to 200% against the background of the phenomena of osteoporosis and / or osteosclerosis concludes the need for an additional course of conservative treatment;

and with values:

- phosphatase index from 8 to 13,

- systemic index of electrolytes less than 160,

- systemic glycolysis index from 50 to 70,

- the degree of accumulation of the radiopharmaceutical more than 220% against the background of residual bone cavities in combination with the phenomena of osteoporosis and / or osteosclerosis conclude that it is unsatisfactory.

New in the proposed method is that during biochemical studies determine the phosphatase index, the systemic index of electrolytes and the systemic glycolysis index, compare them with the degree of accumulation in the bone tissue of the radiopharmaceutical and the data of x-ray studies, and at the values at the time of treatment:

- phosphatase index of more than 13,

- systemic index of electrolytes from 160 to 200,

- systemic glycolysis index less than 50,

- the degree of accumulation of the radiopharmaceutical from 160 to 180%, in the absence of residual bone cavities in the patient, the phenomena of osteosclerosis and / or osteoporosis judge the persistent relief of the osteomyelitis process;

with values:

- phosphatase index less than 8,

- systemic index of electrolytes more than 200,

- a systemic glycolysis index of more than 70,

- the degree of accumulation of the radiopharmaceutical from 180 to 200%

against the background of the phenomena of osteoporosis and / or osteosclerosis, they conclude that an additional course of conservative treatment is necessary;

and with values:

- phosphatase index from 8 to 13,

- systemic index of electrolytes less than 160,

- systemic glycolysis index from 50 to 70,

- the degree of accumulation of the radiopharmaceutical more than 220% against the background of residual bone cavities in combination with the phenomena of osteoporosis and / or osteosclerosis conclude that it is unsatisfactory. The above allows us to conclude that the proposed method meets the criterion of "novelty."

Analysis of available sources of information on the problem of evaluating the results of treatment of patients with chronic osteomyelitis shows that the proposed technical solution is not obvious and does not follow from the level of knowledge achieved in this area, which allows us to judge whether it meets the criterion of “inventive step”.

The applicability of the method is confirmed by the fact of its successful clinical use in the RTC "WTO" named after academician G.A. Ilizarov.

The method is as follows.

After a full course of rehabilitation treatment, in patients with chronic osteomyelitis, a complex of studies is performed, including the determination of biochemical, radionuclide and radiological indicators using known methods and based on the data obtained, the treatment results are evaluated.

Moreover, in the course of biochemical studies, the phosphatase index, the systemic index of electrolytes and the systemic glycolysis index are determined.

Under the phosphatase index is understood the ratio of the indicator of the thermolabile fraction of alkaline phosphatase to acid phosphatase; the systemic index of electrolytes is understood as the ratio of the product of the concentration of calcium and chlorine electrolytes to the concentration of phosphate ion; the systemic glycolysis index is the ratio of the product of the activity of lactate dehydrogenase by the coefficient of lactate pyruvate to the ratio of the H and M subunits of this enzyme.

Along with the determination of biochemical parameters, radionuclide studies are carried out, on the basis of which the degree of accumulation of the radiopharmaceutical in bone tissue is determined, and standard radiography is also performed to determine the structure of bone tissue in the affected area and to identify residual cavity formations.

Based on the analysis of the data obtained, it is concluded that the osteomyelitis process is completely stopped if:

- phosphatase index of more than 13,

- systemic index of electrolytes from 160 to 200,

- systemic glycolysis index less than 50,

- the degree of accumulation of the radiopharmaceutical from 160 to 180%

in the absence of residual bone cavities in the patient, the phenomena of osteosclerosis and / or osteoporosis.

With the same values:

- phosphatase index less than 8,

- systemic index of electrolytes more than 200,

- a systemic glycolysis index of more than 70,

- the degree of accumulation of the radiopharmaceutical from 180 to 220%

against the background of residual effects of osteoporosis and / or osteosclerosis, they conclude that an additional course of conservative treatment is necessary.

And with the values:

- phosphatase index from 8 to 13,

- systemic index of electrolytes less than 160,

- systemic glycolysis index from 50 to 70,

- the degree of accumulation of the radiopharmaceutical over 220%

against the background of residual bone cavities in combination with the phenomena of osteoporosis and / or osteosclerosis, they conclude that the treatment outcome is unsatisfactory.

The practical implementation of the method is illustrated by the following clinical observations.

Example 1. Patient C., 14 years old, diagnosis: chronic hematogenous osteomyelitis of the right femur, fistulous form, osteomyelitis cavity 10 × 2 cm, excess length of the right femur five centimeters, sick nine years. At the place of residence repeatedly, unsuccessfully operated; walks with a cane, shortening compensates for orthopedic shoes.

On a radiograph in the lower third of the right femur, the osteomyelitis cavity is 10 cm long. Pathogenic staphylococcus isolated from the purulent focus is sensitive to cephalosporins, gentamicin and carbinicillin.

On the scans, the distribution of the radiopharmaceutical (RFP) was heterogeneous, there was a focus of hyperfixation of the drug in the affected area. Around it is a zone of diffuse increase in activity with a transition to the adjacent metaphysis (a clear sign of inflammation). The severity of the inflammatory focus was 321.5%. According to the radiological examination, the second degree of prevalence of the osteomyelitis process has been established.

Sequestrnecrectomy of the right femur was performed within healthy tissues, transverse osteotomy through the middle of the cavity. The walls of its anterior external access are completely excised along with scar tissue. The femur is exposed within the osteomyelitis cavity. The granulations lining the cavity are removed. Necrectomy of the affected area of the bone within healthy tissues. The ends of the fragments after the osteotomy are connected according to the type of “Russian castle” until tight contact. Osteosynthesis by Ilizarov apparatus. Soft tissue sutured in layers.

The fixation period of the apparatus was 63 days.

After dismantling the apparatus, biochemical, radionuclide and radiological studies were performed. When analyzing the data obtained, it was found that

- phosphatase index is equal to 14,

- systemic index of electrolytes -170,

- systemic glycolysis index - 45,

- the degree of accumulation of radiopharmaceutical - 165%,

X-ray organotypic rearrangement of bone tissue without signs of residual cavities is noted. The patient fully loads the operated limb, movements in the joints - in full, there are no wounds and fistulas. The aforementioned made it possible to state the complete relief of the osteomyelitis process.

Example 2. Patient D., 39 years old, was admitted to the clinic of the RTC “WTO” with a diagnosis of chronic post-traumatic osteomyelitis of the left thigh, fistulous form; osteomyelitis cavity 3 × 3.5 cm; incorrectly fused fracture, varus-rotational deformation of 150 °, with a rotational displacement of 40 °; shortening 6 cm.

To eliminate the osteomyelitis foci, restore the length and axis of the limb of the patient, the operation was performed: sequestrectomy, osteotomy of the left thigh through the osteomyelitis cavity; osteosynthesis by Ilizarov apparatus.

Distraction 79 days, fixation 93 days.

The surgical wound healed by first intention, the fistula closed after surgery. Additional immobilization was not required.

After the course of treatment according to the proposed method, studies were performed, as a result of which the following values of the desired indicators were established:

- phosphatase index - 7,

- systemic index of electrolytes - 210,

- systemic glycolysis index - 80,

- the degree of accumulation of the radiopharmaceutical - 210%,

with radiologically expressed osteoporosis of the hip throughout. The results obtained made it possible to recommend the patient an additional course of therapeutic treatment to stop the phenomena of osteoporosis.

Example 3. Patient Z., 40 years old, was admitted with a diagnosis of chronic hematogenous osteomyelitis of the right thigh, which suffers from the age of seven. Unsuccessful sequestration necrectomy before entering the RTC "WTO" was performed 16 times. At the time of treatment, an osteomyelitis cavity was identified in the upper third of the right thigh 12 × 2.0 cm, and at the border of the middle and lower third, the second cavity was 2.5 × 1.8 cm in size.

The osteomyelitis cavity in the upper third of the thigh was replaced by bone grafting, sequestrnecrectomy of the second distal cavity was performed. At the end of the course of treatment indicators:

- phosphatase index 11,

- systemic index of electrolytes 120,

- systemic glycolysis index 60.

- the degree of accumulation of the radiopharmaceutical - 410%,

with x-ray residual bone cavity measuring 2.5 × 1.8 cm in the lower third of the thigh with the phenomena of pronounced osteosclerosis throughout. These data allowed us to conclude that the treatment outcome was unsatisfactory. The patient was recommended surgery with osteosynthesis by Ilizarov apparatus.

The implementation of the method allows you to objectively evaluate the results of treatment of patients with chronic osteomyelitis.

Sources of information

1. X-ray-radionuclide diagnostics of reparative bone formation in the treatment according to Ilizarov of patients with malformed bone fractures of the lower extremities in conditions of chronic osteomyelitis. A.A. Sveshnikov, A.M. Aranovich, L.A. Smotrova, S.V. Ralnikova // Method. - Kurgan, 1994 .-- 11 p.

2. Yu.P. Baldin, K.S. Desyatnichenko. Assessment of the activity of reparative osteogenesis.// Method.Recommend. - Kurgan, 1991 .-- 22 p.

Claims (1)

A method for evaluating the treatment of patients with chronic osteomyelitis, including analyzing the results of biochemical and radionuclide and X-ray studies, characterized in that in biochemical studies determine the phosphatase index, the systemic index of electrolytes and the systemic glycolysis index, compare them with the degree of accumulation in the bone tissue of the radiopharmaceutical and radiological data studies and with values at the time of completion of the course of treatment: phosphatase index of more than 13, systemic ind ksa of electrolytes from 160 to 200, a systemic glycolysis index of less than 50, a degree of accumulation of a radiopharmaceutical from 160 to 180%, the patient's absence of residual bone cavities, osteosclerosis and / or osteoporosis, are judged on persistent relief of the osteomyelitis process, with values: phosphatase index less than 8, a systemic index of electrolytes of more than 200, a systemic index of glycolysis of more than 70, a degree of accumulation of a radiopharmaceutical from 180 to 200% against the background of the phenomena of osteoporosis and / or osteosclerosis conclude that additional the course of conservative treatment, and with values: phosphatase index from 8 to 13, systemic electrolyte index less than 160, systemic glycolysis index from 50 to 70, radiopharmaceutical accumulation degree of more than 220%, against the background of residual bone cavities in combination with the phenomena of osteoporosis and / or osteosclerosis conclude an unsatisfactory result.