RU2304781C1 - Method for evaluating the results of surgical sanitation of inflammation focus in patients with chronic osteomyelitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: the present innovation deals with laboratory investigations in case of traumatological pathology. One should simultaneously carry out microscopic investigation of material sample out of inflammation focus and blood from cubital vein to study the growth of microorganisms in the focus and in case of its absence and at registering positive index of digestion in blood with test culture S.aureus 209 P inside neutrophil after incubation, the value of IgM being 0.5-1.3 against the norm, the value of C-reactive protein being up to 12.0 mg/l it is possible to conclude upon satisfactory result of therapy conducted. Application of the present method enables to evaluate the degree of inflammatory process in bony tissue and, also, the state of phagocytic function of neutrophils as the first line of protection against microbial invasion.

EFFECT: higher accuracy of evaluation.

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Description

The invention relates to medicine, namely to laboratory studies in traumatological pathology, and can be used to determine the possibility of surgical treatment for infection of the hip joint after endoprosthetics.

A known method for assessing the activity of the inflammatory process in osteomyelitis, including the separation of blood serum proteins into fractions, determining the content of albumin, alpha-2-globulin, gamma globulin and monitoring the change in their content during the disease (RF patent No. 2252419, IPC G01N 33/68 publ. 2005).

However, the above method does not allow to determine the degree of contamination of the focus of inflammation (or its absence), which is one of the criteria characterizing the presence and severity of the inflammatory process.

The closest is a method for evaluating the results of treatment of patients with chronic osteomyelitis (RF Patent No. 2228526, IPC G01N 33/48, publ. 2004). The method involves the analysis of the results of biochemical, radio-nuclide and radiological studies, and upon receipt of the relevant indicators conclude that the next course of treatment is necessary, a satisfactory or unsatisfactory result of the first stage of treatment.

However, when using this method, only factors affecting the regeneration of bone tissue are studied, and its condition is assessed after a full medical rehabilitation course is carried out, but the state of immunological parameters of the body’s anti-infection protection and, in particular, the first line of defense against microbial invasion is not taken into account.

The objective of the invention is to eliminate these drawbacks and improve the accuracy of evaluating the results of the first stage of the operation and the possibility of subsequent reconstructive surgery by objectifying the clinical diagnosis of the condition of the focus of inflammation in the bone tissue after surgical debridement and anti-infection factors protecting the patient’s body with an inflammatory process caused by conditionally pathogenic microorganisms.

To do this, in the method for evaluating the results of surgical debridement of the focus of inflammation in patients with chronic osteomyelitis, including microscopic examination of biological tissue, analysis of the research results, it is proposed to study simultaneously samples of material from the lesion and blood from the cubital vein in preparation for the second stage of surgery for 3-4 days , investigate the growth of microorganisms in the outbreak. In the absence of growth of microorganisms, upon registration in the blood of a positive value of the digestion index with a test culture of S.aureus 209 P inside the neutrophil after incubation, the IgM value is 0.5-1.3 from the norm, with a C-reactive protein value of up to 12.0 mg / l speak of a satisfactory result of treatment.

When using microbiological methods in the sample from the focus of inflammation, the presence or absence of growth of aerobic, facultative anaerobic and anaerobic microorganisms is determined. If there is growth in the sample, the number of grown colonies of each species is calculated, and the resulting concentration of microorganisms is expressed as the number of colony forming units in grams or milliliters of clinical material (CFU / g, ml). In parallel, in the blood sample taken on the same day from the patient’s cubital vein, using the immunoserological methods, the state of anti-infective protection of the body is determined by examining the phagocytic function of neutrophils as the first line of defense against microbial invasion.

Determination of the growth of microorganisms in the sample and the concentration of each grown species (CFU / g, ml) allows us to judge the type of pathogen, the degree of contamination of the focus of inflammation and the degree of relief of the inflammatory process in the bone tissue as a result of the first stage (surgical debridement) of the operation. Determination of the phagocytic function of neutrophils using the indicators indicated in the proposed method allows to determine the presence or absence of disturbances in the phagocytic function of neutrophils at the stages of microbial cell capture (IgM) and the ability of its destruction by neutrophil (digestion index - PI).

The fact that these data are analyzed in a complex allows us to determine the pathogen in the focus of inflammation, the immunoserological reaction of the patient’s body, and to judge the possibility of subsequent reconstructive surgery.

The implementation of the method shown in specific clinical examples.

Example 1

Patient V. N.P., 32 years old, (and / b No. 4808, 2000).

The patient was operated on for left-sided dysplastic coxarthrosis, an operation was performed - total replacement of the left hip joint with a cement endoprosthesis. 14 months after the operation, a fistula with purulent discharge formed in the area of the postoperative scar, radiological signs of destabilization of the endoprosthesis appeared, which required surgical debridement of the purulent focus, removal of the total endoprosthesis, installation of a cement spacer impregnated with antibiotics, and the establishment of aspiration-wash drainage. Removal of the spacer and repeated total arthroplasty was performed 4 months after the sanitizing operation against the background of normalization of immuno-microbiological parameters and negative results of inoculation of the puncture of the hip joint.

According to the proposed method, immuno-microbiological studies were carried out.

Microbiological examination: there is no growth of microorganisms in the wound.

Immunological studies: digestion index with test culture S.aureus 209 P inside the neutrophil after incubation (+) 20%, IgM = 1.4 g / l (1.07 from the norm) with a norm of 1.27-1.4 g / l, CRP = 6.0 mg / l with a norm of up to 6.0 mg / ml. These data indicate a satisfactory condition of the patient after the first stage of treatment and the possibility of carrying out the second stage of the operation.

After the second stage of the operation, a good clinical and radiological result was obtained. Currently, there are no pains and signs of inflammation in the hip joint. Movement in the hip joint is free, painless. He walks with a cane with a slight limp on his left leg.

Example 2

Patient K.D. V., 57 years old, (and / b No. 1474, 2004).

The patient was operated on for left-sided coxarthrosis. Total hip arthroplasty was performed. A year later, a fistula opened in the area of the postoperative scar. Surgical debridement, removal of the acetabular component of the endoprosthesis, and installation of a cement spacer impregnated with antibiotics were performed.

Microbiological examination: there is no growth of microorganisms in the wound.

Immunological studies: digestion index with test culture of S.aureus 209 P inside the neutrophil after incubation (+) 16%, IgM = 0.91, g / l (0.7 from the norm) with a norm of 1.27-1.4 g / l, CRP <6.0 mg / l; normal up to 6.0 mg / l. These data indicate the possibility of carrying out the second stage of the operation. Repeated hip arthroplasty with spacer removal, reinforcement of the acetabulum and bone alloplasty were performed. Over the next period, no signs of inflammation have been identified.

Example 3

Patient T.A. Yu., 34 years old, (and / b No. 17033, 2003).

The patient underwent total endoprosthetics of the left hip joint, made for a comminuted fracture of the head and neck of the femur, the edge of the acetabulum. In the postoperative period, the formation of a hematoma, prolonged wound healing. Five months later, signs of inflammation appeared in the area of the left hip joint. Surgical debridement was performed with the removal of the endoprosthesis and the installation of a cement spacer impregnated with antibiotics. After 1 year he was admitted for repeated arthroplasty.

According to microbiological (puncture of the hip joint) and immunoserological studies, signs of an ongoing inflammatory process were found: in the wound - the growth of S.aureus 10 ³ CFU / g, in the blood - the digestion index with the test culture of S.aureus 209 P inside the neutrophil after incubation (- 12%), the IgM value is 2.5 g / l (1.9 from the norm), CRP is 24.0 mg / l, with the norm being up to 6.0 mg / l. This indicates an unsatisfactory result of treatment and the impossibility of carrying out the second stage of surgical intervention.

Repeated sanitation of the focus of inflammation, replacement of the cement spacer, removal of the metal screw and the installation of cement "beads" impregnated with antibiotics were performed. Soon, a fistula with serous-purulent discharge formed, which functions to date. The second stage of surgical treatment is postponed until the inflammatory process is completely stopped.

Using the proposed method and the ongoing analysis of immuno-microbiological parameters make it possible to assess the degree of inflammatory process in bone tissue, as well as the state of the phagocytic function of nitrophils as the first line of defense against microbial invasion. The proposed set of studies, providing reliable data on the patient's condition and the possibility of further treatment, reduces the percentage of patients with completely lost limb functions.

Claims (1)

A method for evaluating the results of surgical debridement of a focus of inflammation in patients with chronic osteomyelitis, including microscopic examination of biological tissue, analysis of research results, characterized in that they simultaneously take samples from the lesion and blood from the cubital vein, investigate the growth of microorganisms in the lesion, and in the absence thereof when registering in the blood a positive value of the digestion index with the test culture of S.aureus 209 P inside the neutrophil after incubation, the IgM value is 0.5-1.3 from the norm, with the value of C active protein and 12.0 mg / l, talking about a satisfactory result of the treatment.