RU2256419C2 - Method for treating chronic osteomyelitis of long tubular bones - Google Patents

Abstract

FIELD: medicine, traumatology, purulent surgery.

SUBSTANCE: after performing fistulosequestrnecrectomy, multiple revascularizing osteoperforations with Kirschner's needle in area of pathological focus one should carry out total cutting trepanation of medullary canal from the side of sequestral cavity with the help of a spheroidal cutting, fulfill linear osseous trepanations in area of proximal and distal metaepiphyses out of two point incisions to combine metaepiphyseal sources of circulation with diaphyseal vascular system and apply the capacities of the nearest muscular area that provides optimal conditions for tissue regeneration.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to traumatology or purulent surgery, and can be used for osteoperforation in the treatment of chronic osteomyelitis of long tubular bones of various localization.

There is a method of surgical treatment of chronic osteomyelitis of long tubular bones, carried out by necsecestrectomy, performing multiple perforations from the sequestral cavity in a checkerboard pattern with the Kirschner needle in the direction of the nearest muscle mass and further filling of the cavity (Akzhigitov G.A. and other Osteomyelitis. - M .: Medicine, 1986, pp. 17-39).

However, the known method, slightly improving bone regenerative processes, does not have a significant effect on regional hemodynamics.

Closest in its technique is the method of surgical correction of regional hemodynamics, which is used for vascular insufficiency of limbs (Zueminovich F.N. Herald of surgery, 1991, No. 5-6, p.114-115).

However, the known method has significant disadvantages:

1. High probability of secondary infection of tissues at the sites of introduction of the trocar.

2. High invasiveness of the method associated with damage to soft tissues each time, if necessary, the formation of a trepanation hole in the bone.

3. Adverse conditions for wound healing associated with their localization.

The objective of the invention is the treatment of chronic post-traumatic osteomyelitis by improving blood circulation in the area of the pathological focus.

The method is as follows: after a fistulosequestrnecrectomy, multiple revascularizing osteoperforations with a Kirschner spoke in the area of the pathological focus, total milling restoration of the bone marrow canal from the side of the sequestral cavity with a spherical milling cutter is performed, linear trepanation of the bone is performed from two point sections in the region of proximal and distal meteal lesions mm and a length of up to 100 mm, which does not reduce the strength of the bones that combine the metaepiphyseal source and blood supply with the diaphyseal vascular system, using the capabilities of the nearest muscle mass, contribute to the improvement of regional blood circulation of the limb.

The invention is illustrated by the following figures.

Figure 1 shows a skin incision from which osteoperforation is performed.

Figure 2 in two projections shows the formation of the first trepanation holes.

Figure 3 in two projections shows the formation of a second trepanation hole.

Figure 4 in two projections shows the formation of the sixth trepanation hole.

Figure 5 in two projections shows the formation of the last trepanation holes.

The method is as follows: in the proximal and distal metaepiphyses of the affected bones from a point incision of soft tissues, taking into account the anatomical features, a trepanation hole is formed with a width of 4.5 mm and a length of up to 100 mm.

For a more accurate, consistent formation of overlapping holes, a special device is used that allows for “closed” minimally invasive linear osteotrepanation to any desired length.

The device consists of two cylinders: one with an inner diameter of 4.6 mm, the second with an inner diameter of 1.5 mm. Both cylinders have a working surface facing the bone, located at an angle of 45 ° to the longitudinal axis of the tool. A stylet is inserted into the cylinder of a larger diameter at the stage of passage of the instrument through the soft tissue to the bone. A thin spoke is introduced into the cylinder of a smaller diameter, arcuate in order to spring fix it in the tool. Speaking from the hole of the smaller cylinder of the tool, the spoke plays the role of a limiter, which is inserted into the hole formed by the drill and prevents the trocar from displacing during subsequent drilling. For proper tool orientation, ease of fixation and hand protection when working on its proximal part, there is an oval shape, a platform bent at an angle of 10 ° with a groove for fixing the guide needle.

Studies of the peripheral blood flow of the operated limb after 3 weeks and 6 weeks show its improvement compared with the preoperative period and with standard fistulosecvestrnecrectomy.

An example of a specific implementation of the treatment method:

Patient K., 38 years old. I was hospitalized in the second trauma unit of the clinical hospital No. 4. With Ds: Chronic post-traumatic osteomyelitis of the right tibia. Fistulous form. For the purpose of preoperative examination, the patient underwent ultrasound examination of the pathological lesion after filling it with a solution of hydrogen peroxide. A cavity with a size of 3.0 × 2.5 cm with a sequestration of 1.5 × 0.3 cm with a fistulous course was revealed.

After performing a fistulosequestrnecrectomy in the direction of the nearest muscle mass with a Kirschner spoke, holes in the cortical plate are staggered. Produced total milling trepanation of the medullary canal.

From a point incision along the posterior medial surface of the tibia through the muscle mass a hole was formed with a drill of 4.5 mm. A tool stop is introduced into the formed hole and a cortical plate 50 mm long is perforated in the proximal direction. Next, the trocar limiter is inserted into the distal opening of the hole and the cortical plate is perforated by another 50 mm. Thus, perforation of the cortical plate in the metaepiphyseal region 100 mm long was performed without impaired intramedullary blood flow.

Thus, the task of treating chronic osteomyelitis of long tubular bones has been achieved due to the fact that after performing fistulosekvestrnecrectomy, multiple revascularizing osteoperforations with a Kirchner needle in the area of the pathological focus, full-lumen milling trepanation of the bone marrow canal is performed from the side of the sequestral cavity of the bony fresco and the bony fresco metaepiphyses from two point incisions with minimal soft tissue trauma th to unite metaepiphyseal blood supply sources with diaphyseal vascular system using an array of possibilities the nearest muscle.

Claims (1)

A method of treating chronic osteomyelitis of long tubular bones, characterized in that after performing fistulosecvestrnecrectomy and multiple revascularizing osteoperforations with a Kirschner needle in the area of the pathological focus, full-lumen milling trepanation of the bone marrow canal is performed from the side of the sequestral cavity of the spherical obesity of the erythematosus of the erythematosus of the erythematosus and mucosa, from two point cuts.

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