RU2260187C2 - Method for predicting postoperative period course in patients suffering from consequences of lower extremity large articulation injuries - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves additionally determining granulocytes-to-lymphocyte ratio in patients showing bactericide serum activity below 75%. The ratio being equal to or greater than 2.0, favorable development of postoperative course is to be predicted. The value being less than 2.0, pyo-inflammatory postoperative complications are to be predicted.

EFFECT: high accuracy of prognosis.

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Description

The invention relates to medicine, and more particularly to orthopedics, traumatology, laboratory diagnostics, and for the prevention of postoperative complications.

There is a method of prescribing biostimulants in the preoperative period (A.S. No. 946518) to patients with osteomyelitis, when the indication for the appointment of biostimulants is a decrease in the bactericidal activity of blood serum below 75%. The bactericidal activity of blood serum (BASK) due to 75% indicates the possibility of surgical intervention .

Closest to the proposed solution is a method for determining individual sensitivity to infection by trauma and orthopedic patients with planned surgical interventions. It is noted that in order to reduce the number of inflammatory complications, the bactericidal activity of blood serum is determined and surgical intervention is prescribed at a BASK level of 75-100% relative to the norm, and with a value of less than 75%, agents that increase natural immunity will be prescribed (A.с. . 1156645).

The disadvantage of this method is its low information content in the early (before surgery) prediction of a variant of the postoperative course in patients with injuries and consequences of injuries of large joints of the lower extremities, because from 10 to 40% of patients with this pathology have serum bactericidal activity values below 75%. And only 60% of them, after planned surgical interventions, develop purulent-inflammatory complications.

Consequently, the determination of the criteria that ensured the selection of the optimal time for carrying out the planned operation is relevant and of great practical importance.

The objective of the invention is to increase the accuracy of diagnosis and ensure early (prior to the planning of surgical interventions) prediction of the course of the postoperative period in patients with injuries and consequences of the grass of large joints of the lower extremities.

The problem is solved in that according to the method for predicting the course of the postoperative period with planned surgical interventions, including the study of the bactericidal activity of blood serum, with BASK less than 75%, the ratio of granulocytes to lymphocytes (Gr / Lf) is additionally determined in a patient’s blood sample. A value of Gr / Lf of 2.0 and higher indicates the possibility of performing surgery with a favorable prognosis. With a value of Gr / Lf less than 2.0 predicts a high probability of the development of purulent-inflammatory complications in the postoperative period.

The method is as follows.

An empty stomach is taken from a patient from a cubital vein on an empty stomach with a dry needle for injection into a clean dry tube in an amount of 2.5 ml. The serum is separated by centrifugation. When determining the bactericidal activity of blood serum in an experimental and control tube, one drop of an 18-20-hour test culture of E. coli is instilled. Then, 0.2 ml of the patient's serum is added to the test tube, and 0.2 ml of meat-peptone broth to the control. Samples are incubated in a thermostat at 37 degrees, after which 4.5 ml of meat-peptone broth is added to each and the resulting mixture is divided into two equal parts. Then they are incubated for 2.5 hours: one part of the sample at 37 degrees, and the second part at 4 degrees. After the incubation time, measure the optical density on KFK 2.

The percentage of bactericidal activity of blood serum is determined by the following formula:

where OP is the optical density of the sample.

Patients in whom BASK varies from 75% to 100% undergo surgery, suggesting a smooth course of the postoperative period (according to the prototype method).

For patients whose BASK value is less than 75%, an additional Gr / Lf index will be determined, for which the leukocyte formula is calculated.

The leukocyte formula is counted in stained blood smears. 100 leukocytes are found and the ratio of their individual species is expressed as a percentage.

The Gr / Lf index is determined by the formula:

With a BASK value of less than 75% and an index of Gr / Lf of 2.0 and higher, surgical intervention is recommended, suggesting a smooth course of the postoperative period.

If patients with a BASK value of less than 75%, the Gr / Lf index of less than 2.0 predicts the possibility of purulent-inflammatory complications after a planned operation.

The invention is illustrated by the following examples.

Example 1. Patient K., 43 years old. No. of case history 156259. I was treated in the orthopedics department of OKOKHBVL with a diagnosis of aseptic necrosis of the head of the right thigh. Right-sided coxarthrosis III degree.

At the clinical examination, the patient was offered surgical treatment for arthrodesisation of the right hip joint.

Conducted laboratory blood tests. The bactericidal activity of blood serum was 72%, the Gr / Lf index was 2.0.

After the operation - Arthrodesis of the right hip joint with 3 lobed nails with the movement of the patient's trochanteric postoperative period proceeded smoothly. Healing of the surgical wound by primary intention.

Example 2. Patient B., 42 years old, medical history No. 156188. He was treated in the orthopedics department of OKOKHVVL with a diagnosis of Right-sided coxarthrosis of the II degree, aseptic necrosis of the femoral head. Sivash endoprosthesis of the left hip joint.

In laboratory testing, it was found that the value of the bactericidal activity of blood is 65%, and the index Gr / Lf is 1.97.

After surgery, the revascularization of the head of the right thigh with a bone graft on the feeding leg of a sick trochanter caused a complication in the form of purulent arthritis of the hip joint.

Conclusion: Men of close age underwent surgical interventions comparable in severity. The BASK values for both are lower than 75%. A smooth postoperative period during planned surgery on the hip joint is possible with an index of Gr / Lf of 2.0 or more.

Example 3. Patient N., 64 years old. No. of medical history 259606. She was undergoing treatment at the orthopedics clinic of OKOKHVVL with a diagnosis of: consolidating in front of both ankles with displacement, rupture of the distal tibiofibular syndrome of the right tibia with subluxation of the foot outward. Diabetes.

At the clinical examination, the patient decided to undergo surgical treatment despite the fact that a laboratory study revealed a BASK value below 75% (namely 74%), but the Gr / Lf index was 4.10, which suggested a smooth course of the postoperative period.

After open reduction of subluxation, open reposition of both ankles and osteosynthesis with the plate and screws of the right ankle joint, the postoperative period was uneventful, the healing of surgical wounds by primary intention.

Conclusion: In reconstructive operations on the ankle joint, a decrease in BASK below 75% is not a contraindication to surgery if the index Gr / Lf is 2.0 or more.

Example 4. Patient N., 44 years old. No. of case history 251160, was treated at the orthopedics clinic of OKOKHBVL with a diagnosis of

soft tissue defect in the proximal third of the right tibia, intraarticular comminuted fracture of the proxial tibia epimetaphysis with a defect in the bone tissue of the external condyle. The patient underwent a two-stage surgical treatment, including osteonecrectomy of the proximal third of the right lower leg with subsequent plastic surgery of the wound defect with a thoracodorsal flap on microanastomoses and transosseous osteosynthesis of the right lower leg of Ilizarov apparatuses.

A laboratory blood test revealed a BASK value of less than 75% (namely 70%) with an index of Gr / Lf of 1.88.

In the postoperative period, in addition to the traditional antibacterial and anti-inflammatory treatment, the patient underwent a course of HBO.

In the area of postoperative wound, suppuration of soft tissues, healing by secondary intention developed.

Conclusion: When choosing the optimal period of surgical treatment of patients with injuries of the knee joint (BASK less than 75%), it is necessary to take into account the value of the Gr / Lf index. with its value less than 2.0, the likelihood of developing complications is high.

Table No. of medical history Gr / Lf index Postoperative period Forecast Actually 221474 1,04 Complicated Suppuration of the wound 173858 1.47 Complicated Bronchitis 245871 1,50 Complicated Osteomyelitis 172312 1.51 Complicated Suppuration of the wound 253186 1,62 Complicated Bronchitis 163532 1.71 Complicated Bronchitis 158610 1.82 Complicated Pneumonia 251166 1.88 Complicated Suppuration of the wound 156188 1.97 Complicated Wound suppuration, arthritis 229102 1.97 Complicated Abscess 169098 1.97 Complicated Bronchitis 167497 2.00 No complications Smooth 159259 2.06 No complications Smooth 248940 2.54 No complications Smooth 159285 2.59 No complications Smooth 166221 3.94 No complications Smooth 259606 4.10 No complications Smooth

The table shows information showing that it is impossible to achieve a positive effect outside the declared values.

The table shows the results of comparing the prognosis and the actual course of the postoperative period in patients with BASK less than 75% with an index of Gr / Lf less than 2.0, and more than 2.0.

From the table it follows that only within the declared value (with BASK less than 75% and the Gr / Lf index of 2.0 or more) is it possible to achieve a positive effect, i.e. smooth course of the postoperative period.

The proposed forecasting method allows for early diagnosis of the course of the postoperative period before the operation, improves diagnostic accuracy in comparison with the prototype method and gives a fairly high percentage of coincidence with the actual one. According to the claimed method, the discrepancy between the forecast and the actual course was 15.8%. According to the prototype method, the discrepancy between the forecast and the actual course of the postoperative period was 42.2%. The proposed method increases the efficiency of diagnosis relative to the prototype method by 26.4%.

The proposed method has a sick practical value, because makes it possible to predict the development of purulent-inflammatory complications. The positive effect compared to the prototype method allows you to expand the indications for planned surgical treatment of patients with injuries and consequences of lower limb injuries with BASK less than 75%.

The method is affordable, simple to implement, does not require expensive equipment and reagents. The determination of the bactericidal activity of blood serum, leukograms and the calculation of the Gr / Lf index takes about 3 hours.

Claims (1)

A method for predicting the course of the postoperative period in patients with consequences of injuries of large joints of the lower limb, including determining the bactericidal activity of blood serum, characterized in that for patients with bactericidal activity of serum less than 75%, the ratio of granulocytes to lymphocytes (Gr / Lf) is additionally determined in a patient’s blood sample and when this ratio is 2.0 or more, surgical treatment is recommended, suggesting a favorable course of the postoperative period, and when the ratio is anulocytes to lymphocytes less than 2.0 predict the possibility of purulent-inflammatory postoperative complications.