RU2286107C1 - Method for preparing cranial fornix bones for transplantation - Google Patents

Abstract

FIELD: medicine, neurosurgery.

SUBSTANCE: one should prepare the bones of cranial fornix transplant for transplantation due to forming hollows at their external surface that don't penetrate a diploic plate. Then one should remove bone marrow due to applying 5%-hydrogen peroxide solution. Just before transplantation during operation it is necessary to sample recipient's bone marrow out of trabecular bone to fill in the hollows of the transplant prepared. The innovation enables to increase the quality of the applied transplant due to introducing osteogenesis-stimulating cells of bone marrow into the transplant.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, namely to neurosurgery, and for the replacement of the fat and myeloid brain of a donor removed from the bones of the cranial vault with the myeloid brain of the recipient, which improves the results of transplantation of bone allografts.

A known method of preparing the bones of the cranial vault for transplantation (Zotov Yu.V., Kasumov R.D., Savelyev V.I., Bukhabib E.B., Zotov V.Yu. Surgery of defects of the skull. - St. Petersburg, 1998. - 61 p. .), in which, during machining, cuts or round cavities intended to accelerate the growth of osteogenic tissue into them are applied to the transplants from the outside, not penetrating through their thickness. The method does not allow the bone marrow to be removed from the transplant and does not provide for the replacement of bone marrow elements in the cranial bones, which reduces their clinical value.

Closest to the claimed method is a method of preparing the bones of the cranial vault for transplantation (RF patent No. 2233588, publ. 10.08.2004, bull. No. 22), adopted as a prototype. After mechanical cleaning and the formation of recesses on their surface for 10-12 hours, they are kept at a temperature of 18 ± 5 ° С in 5% hydrogen peroxide prepared in a 5% sodium chloride solution, and then washed in distilled water at 5 ... 7 ° C for 24 hours. In this case, the working solution in the process of manufacturing transplants is changed every 2 hours.

The disadvantages of the prototype:

- the slow process of replacing the transplant with its own bone, due to the lack of recipient bone marrow cells that stimulate osteogenesis and are precursors of osteocytes;

- the removed bone marrow of the donor is not replaced by anything, there are empty cavities in the diploe.

The invention is aimed at creating a method for preparing the bones of the cranial vault for transplantation, which provides shorter terms for replacing the transplant with its own bone.

The specified technical result in the implementation of the invention is achieved by the fact that in the known method of preparing the bones of the cranial vault for transplantation by forming on their outer surface recesses that do not penetrate through the diploetic plate, removing bone marrow using a 5% hydrogen peroxide solution, the feature is that immediately before transplantation during surgery, the recipient’s myeloid brain, taken from the cancellous bone, is placed in the transplant diplopoe through the recesses.

The method is as follows: prepare the graft: a fragment of the cranial arch of the donor after mechanical cleaning and the formation of recesses on its surface for 10-12 hours is kept at a temperature of 18 ± 5 ° C in 5% hydrogen peroxide prepared in 5% sodium chloride solution, after which is washed in distilled water at 5 ... 7 ° C for 24 hours, then directly during the operation, the recipient’s bone marrow is taken from the cancellous bone (iliac bone, sternum) in the aseptic patient, following all the rules of asepsis ktsionno special needle. The obtained bone marrow is filled into the cells of the prepared demyelinated allograft. Saturation of the transplant through prepared openings with sterile fresh spongy bone marrow punctate helps to accelerate bone formation.

The inventive method of preparing the bones of the cranial vault for transplantation was developed and passed clinical trials at the All-Russian Scientific Research Institute named after Professor A.L. Polenov.

We give an example - an extract from the medical history: patient K., 25 years old, and / b 627-00, entered the RNHI for treatment on March 17, 2000 with complaints of a trepanation defect. He had a history of trauma from 06/28/1999, was operated on in a city hospital - a decompressive craniotomy was performed in the right parietal-temporal region, 07/06/99 reoperated in RNHI - the epi-subdural hematoma was removed. On craniograms from 03.21.00 a defect of the right parietal and temporal bones 7 × 7 cm was revealed.

A transplant was prepared: a donor bone fragment after mechanical cleaning and the formation of depressions on its surface for 12 hours (two cycles of 6 hours) was kept at a temperature of 18 ± 5 ° C in 5% hydrogen peroxide prepared in 5% sodium chloride solution, after which washed in distilled water at 5 ... 7 ° C for 24 hours. Subsequently, bone preparations deprived of fat and myeloid bone marrow were sterilized with a 0.1% antibiotic formalin solution and placed in a plastic bag.

03/29/00 the patient was operated on. During the operation, meningolysis and modeling of the prepared transplant were performed. Then, after treatment, the ilium crest was punctured with a thick needle, 3 ml of bone marrow puncture was obtained. The bone graft is installed in the defect and fixed with bone sutures, after which it is saturated with diploe puncture of the bone marrow of the recipient through the cells. The wound is sutured in layers. In the postoperative period, against the background of antibacterial, vascular, stimulating therapy, the state of the surgical wound is without features, healing by first intention, removal of sutures on the 10th day. 04/05/00 performed control craniography - the condition and position of the graft is satisfactory. The patient was discharged from the hospital in satisfactory condition 12.04.00 (on the 13th day after the operation).

Claims (1)

A method of preparing the bones of the cranial vault for transplantation, including the formation on the outer surface of the graft of the recesses that do not penetrate through the diploic plate, removal of the bone marrow using a 5% hydrogen peroxide solution, characterized in that immediately before the transplantation, bone marrow sampling is performed at the recipient brain from the cancellous bone, which fill the recesses of the prepared transplant.