RU2315570C1 - Method for optimizing reparative osteogenesis in tubular bones - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with optimizing reparative osteogenesis at treating the fractures of tubular bones. The method deals with intramedullar introduction of Kirschner's needles and applying the apparatus of external fixation onto affected limb. Moreover, during the whole period of fixation it is necessary to fulfill vibration impact in the apparatus onto a Kirschner's needle per 30 min thrice daily. The innovation in question enables to considerably shorten the terms of consolidation of the fractures in long tubular bones.

EFFECT: higher efficiency of optimization.

2 ex, 2 tbl

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to optimize reparative osteogenesis in the treatment of fractures of tubular bones.

The method of stimulation of osteogenesis with the ossein-hydroxyapatite complex in the form of the drug “Osteogenon” [Rodionova S. S., Kolondaev A. F., Skolov V. A., Markov S. A. // Bulletin of Traumatology and Orthopedics. N.N. Pirogova. 2001. - No. 4. - P.41-46]. The disadvantage of this method is the long-term administration of tablets inside (6 tablets per day for at least 1 month), in addition, the drug is contraindicated in patients with hypercalcemia and hypercalciuria, patients with urolithiasis or a predisposition to it. The drug should be used in small doses or refuse to take.

Currently, the surgical method is also being used to correct sluggish consolidating fractures by stimulating the reparative process with a free spongy autograft using less traumatic methods [Rukavishnikov A.S. Low-traumatic free bone grafting as a way to stimulate osteogenesis in cases of violation of the consolidation of fractures of the leg bones. Abstract. dis. Cand. honey. sciences. Rukavishnikov A.S. Military Medical Acad. SPb. 2000].

The disadvantages of the method are as follows

1. Injury - carrying out 2 operations.

2. The risk of purulent complications.

3. The risk of complications of anesthesia.

4. The possibility of migration of a bone autograft from implantation sites, which may entail delayed consolidation, the formation of a pseudoarthrosis or improper fracture fusion.

Recently, a new biocomposite material, Osteomatrix, has been used to treat sluggish consolidating fractures [M.V. Lekishvili, A.V. Balberkin, M.G. Vasiliev, A.F. Kolondaev, A.L. Baranetskiy. Yu.V. Buklemishev // Bulletin of Traumatology and Orthopedics. I.N. Pirogova. - 2002. - No. 4 - S.80-83; Ivanov S.Yu., Bizyaev N.F., Panin A.M. and others // New in dentistry. - 1999. - No. 2. - P.37-41 .; Merkulov V.N., Lekishvili M.V., Dorokhin A.I. // Bulletin of traumatology and orthopedics. - 2000. No. 4. - S.-22-25].

The disadvantages of the method are as follows.

1. Injury - the inability to administer the Osteomatrix drug without incision of the fracture site or the false joint.

2. The increasing risk of infectious complications in the fracture area due to the presence of an operative incision.

3. The need for the most complete filling of a bone defect.

The literature provides information on the use of the combined technique, which consists in the intramedullary holding of 2 Kirschner spokes and the imposition of the Ilizarov apparatus [Popkov D.A. // Bulletin of Traumatology and Orthopedics. N.N. Pirogova. - 2005. - No. 2. - S.-65-69]. The undoubted disadvantages of this technique is the need for regular tensioning of the spokes in the holders, as well as the insufficient structural strength under twisting action.

A new effective method for optimizing reparative osteogenesis has been developed, which can significantly reduce the consolidation of fractures of long tubular bones.

The method is as follows. In the operating room, after preliminary reposition of bone fragments on the operating table, through a channel drilled at an acute angle to the longitudinal axis of the bone, at the level of the proximal or distal metadiaphysis (depending on the fracture zone), a pre-bent Kirschner needle to the distal or proximal ( depending on the fracture zone) metaphysis. Moreover, the diameter of the drilled channel should be several millimeters larger than the diameter of the input Kirschner spoke, this is a prerequisite for further effective vibration of the spoke along its entire length. The end of the knitting needle is left exposed over the skin. The next step is the installation of an external fixation device of the rod type and the final reposition of bone fragments in it. Then, the needle held intramedullary is fixed in the spoke holder of the external fixation device to prevent its migration. On the 3rd day after the operation (i.e., by the time of swelling of the soft tissue), the end of the Kirschner needle is released from the spoke, connected to a portable vibrating device and, thus, the Kirschner vibrating needle is applied to the endost. At the end of the session, the needle is again fixed in the spoke holder of the external fixation device. The described effect is carried out 3 times a day for 30 minutes during the entire period of fixation in the external fixation apparatus. Upon reaching the consolidation of the fracture (established by radiography) under sterile conditions, the external fixation apparatus is removed and the Kirchner knitting needle is removed from the bone marrow canal.

Under observation were 10 patients aged 21 to 35 years with delayed consolidation of diaphyseal fractures of long tubular bones. The distribution of fracture localization is presented in table 1.

Table 1. Fracture localization Number of patients Brachial bone 2 Elbow bone 2 Radius 2 Femur 2 Tibia 2

Depending on the treatment, patients were divided into 2 groups identical in fracture localization.

- 1 group of 5 people received treatment according to the proposed methodology.

- Patients of the 2nd group (5 people) were administered intramedullary introduction of 2 Kirschner spokes according to the known method [Popkov D.A. // Bulletin of Traumatology and Orthopedics. N.N. Pirogova. - 2005. - No. 2. - S.-65-69] and the subsequent installation of the rod-type external fixation apparatus with reposition of bone fragments in it, but without further vibration exposure to the Kirschner spoke.

During treatment, the x-ray picture of the fracture zones is monitored (once every 20 days, an x-ray of the osteoclasia zone is performed in 2 projections). It was found that with the proposed treatment method, the consolidation of diaphyseal fractures of long tubular bones occurs much earlier than the known technique used as a comparison technique. Data on the identified terms of fusion are presented in table 2.

Table 2. Fracture localization Days in days 1 group 2 group Brachial bone 40 60 Elbow bone 40 60 Radius 40 60 Femur 120 160 Tibia 80 one hundred

Thus, the table shows that the terms of the healing of fractures of long tubular bones of various localization when applying the proposed method are significantly reduced.

Example 1. Patient C., 21 years old. Received 2 hours after the injury with complaints of severe pain and impaired support of the right lower limb. During a clinical and radiological examination, the patient was diagnosed with a closed transverse undertrochanteric fracture of the right femur with a displacement of bone fragments in width and length. The patient was given skeletal traction for the condyles of the right femur, which functioned for 24 hours. The next day, the skeletal traction was dismantled and treated according to the proposed method: intramedullary, through a 4.5 mm diameter channel drilled in the femur, a 1.5 mm diameter Kirschner needle was inserted, the rod-type external fixation apparatus was applied and the bone fragments were finally repositioned into him. Then the patient, from the 3rd day after the operation and during the entire period of fixation in the device, independently (after preliminary training by a trauma doctor) carried out a vibrational effect on the Kirchner needle in a direction perpendicular to its axis with a frequency of 50 Hz and an amplitude of 2 mm using Pulsar portable vibrating massage device (introducing the 5 mm end of the Kirschner needle brought out over the skin directly into the rubber spherical nozzle of the vibration massage device through a specially made hole in it) for 30 minutes 3 times a day. During the entire period of treatment, the patient was active, did not show complaints of pain, and during a routine radiography, a tendency to accelerate fracture consolidation was revealed. A complete fusion of the fracture occurred 120 days after the start of treatment. There were no complications during treatment. A good anatomical and functional result has been achieved.

Example 2. Patient X., 26 years old. Received 6 hours after the injury with complaints of severe pain and impaired function of the left upper limb. During a clinical and radiological examination, the patient was diagnosed with a closed comminuted fracture of the middle third of the left humerus. The patient underwent skeletal traction for the condyles of the left humerus, which functioned for 2 days. After that, the skeletal traction was dismantled and treated according to the proposed method: intramedullary, through a channel 4.5 mm in diameter drilled in the humerus, a Kirschner needle, 1.5 mm in diameter, was inserted, the rod-type external fixation apparatus was applied and the bone fragments were finally repositioned in it . Then the patient, from the 3rd day after the operation and during the entire period of fixation in the apparatus, independently (after preliminary training by a trauma surgeon) carried out a vibrational effect on the Kirchner needle in a direction perpendicular to its axis with a frequency of 50 Hz and an amplitude of 2 mm using Pulsar portable vibrating massage device (introducing the 5 mm end of the Kirschner needle brought out over the skin directly into the rubber spherical nozzle of the vibration massage device through a specially made hole in it) for 30 minutes 3 times a day. During the entire period of treatment, the patient was active, did not show complaints of pain, and during the course of planned radiography, a tendency to accelerate fracture consolidation was revealed. A complete fusion of the fracture occurred 40 days after the start of treatment. There were no complications during treatment. A good anatomical and functional result has been achieved.

The main technical result is a significant reduction in the terms of the healing of fractures of long tubular bones when applying the proposed technique.

Claims (1)

A method for optimizing reparative osteogenesis in the tubular bones, including the intramedullary introduction of the Kirchner knitting needle and applying an external fixation apparatus to the affected limb, characterized in that during the entire period of fixation in the apparatus, a vibratory effect on the Kirschner spoke is carried out for 30 minutes 3 times a day.