RU2317023C1 - Method for treating osseous cavity after necrsequestrectomy - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: the present innovation refers to treating osseous cavity in patients with chronic post-traumatic osteomyelitis, so, after necrsequestrectomy one should irrigate an osseous cavity with aqueous solution of sodium chloride, then it is necessary to treat the cavity with 3%-hydrogen peroxide solution with subsequent removal of foam with 0.02%-chlorohexidine bigluconate aqueous solution. Then twice during 1 min it is necessary to treat osseous cavity with 0.9%-ozonized sodium chloride solution at ozone concentration being 9000-10000 mgl/l. After that, one should introduce the mixture of anti-infectious chemotherapeutic preparations along with ultrasound cavitation for 3 min at frequency of 40 kHz followed by treating the cavity with the flow of nitrogen monoxide for 5 min at concentration being 5000 mg/cu. m. The innovation enables to increase penetrating capacity of medicinal preparations due to matching the desired mode of cavitary treatment.

EFFECT: higher efficiency of antiseptic treatment.

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Description

The invention relates to medicine, namely to the field of surgical treatment of chronic diseases with post-traumatic osteomyelitis.

Purulent-inflammatory processes occupy a leading place in the structure of morbidity and mortality. Among them, chronic post-traumatic osteomyelitis is especially distinguished among them by the severity of the course, the difficulties of diagnosis and adverse outcomes.

To date, the operational method of treatment is the main and most effective in the treatment of this type of pathology.

Radical surgical intervention in itself involves not only the removal of the osteomyelitis focus as such, but also the elimination of favorable conditions for the existence of infection. The most important element of surgical intervention is necrosecvestrectomy with subsequent plastic surgery of the postoperative cavity. As a result, high-quality preparation of the cavity before graft plastic surgery is one of the necessary conditions for successful and effective treatment.

A known method of treating an operational wound by washing it with sea water, applying a bandage and subsequent suturing [1].

The disadvantage of this method is the relatively high number of relapses of osteomyelitis after treatment of bone cavities with sea water.

A known method of treating an surgical wound by treatment with an aqueous solution of a drug and suturing [2].

However, the use of this method does not exclude the possibility of postoperative complications and does not reduce the time of wound healing.

There is a method of treating purulent-inflammatory wounds by surgical treatment and washing with an antiseptic solution supplied to the wound surface in the form of a vortex flow [3].

The disadvantage of this method is the low effectiveness of the treatment.

A known method of treating the bone cavity with a solution of antiseptic fluid, for example, a solution of furatsilina [4].

The disadvantage of this method is the low penetration in bone tissue and often insufficient bactericidal activity in the treatment of the bone cavity.

A known method of treating an surgical wound by irrigation with an aqueous solution of a drug and subsequent suturing. Moreover, a sodium chloride solution with a concentration of from 3.0 to 3.2% was used as a drug [5].

The disadvantage of this method is the low efficiency of antiseptic treatment of bone treatment after sequestrectomy.

The aim of the invention is to increase the effectiveness of antiseptic treatment of bone cavities after necrosecestrectomy.

This goal is achieved by the fact that after irrigation with an aqueous solution of sodium chloride, the cavity is treated with a 3% hydrogen peroxide solution, foam is removed with a 0.02% aqueous solution of chlorhexidine bigluconate, it is treated with an ozonized 0.9% sodium chloride solution with an ozone concentration of 9000- twice for 1 minute. 10,000 mg / L, a solution of anti-infectious chemotherapeutic agents is introduced into the cavity with simultaneous ultrasonic cavitation for 3 minutes at a frequency of 40 kHz and the cavity is treated with a stream of nitrogen monoxide for 5 minutes with a concentration of 500 m g / m ³ .

Comparison of the proposed method with other solutions known in the field of medicine, showed its compliance with the criteria of the invention.

The proposed method for treating the bone cavity after necrosecestrectomy is implemented as follows.

A solution of sodium chloride of the declared concentration is placed in a bottle of 200-400 ml and saturated by barbating with an ozone-oxygen mixture for 5-10 minutes with an ozone concentration of 9000-10000 mg / l. The bone cavity is irrigated with an aqueous solution of sodium chloride with a concentration of 0.9%, then treated with a 3% solution of hydrogen peroxide, the foam is removed with a 0.02% aqueous solution of chlorhexidine digluconate, treated with an ozonized 0.9% solution of sodium chloride twice within 1 minute, which was already prepared in advance, a solution of anti-infectious chemotherapeutic agents is introduced into the cavity with simultaneous ultrasonic cavitation for 3 minutes at a frequency of 40 kHz and the cavity is treated with a stream of nitrogen monoxide for 5 minutes with a concentration of 500 g / m ^3.

Clinical example. Patient N., 35 years old, diagnosed with chronic post-traumatic osteomyelitis of the left tibia. Performed necrosecestrectomy. The cavity dimensions were 50 × 20 × 8 ml, irrigated with an aqueous solution of sodium chloride with a concentration of 0.9%, then treated with a 3% solution of hydrogen peroxide, the foam was removed with a 0.02% aqueous solution of chlorhexidine bigluconate, in the subsequent cavity was treated twice for 1 minute an ozonized 0.9% sodium chloride solution was injected into the cavity with a solution of anti-infectious chemotherapeutic agents with simultaneous ultrasonic cavitation for 3 minutes at a frequency of 40 kHz and the cavity was treated with a stream of nitrogen monoxide for 5 minutes with a concentration of 500 mg / m ³ . A graft was prepared according to the size of the bone cavity and a postoperative cavity was replaced with it. The wound was sutured in layers tightly. The wound healed by primary intention in one week with a good long-term result.

Using the proposed method allows to increase the effectiveness of antiseptic treatment of bone cavities after necrosecestrectomy, which in turn reduces the duration of treatment.

Using the proposed method is advisable in the purulent-surgical departments of medical institutions in the treatment of chronic post-traumatic osteomyelitis of the musculoskeletal system.

Information sources

1. Shakhnazarov A.B., Lukash I.V. Sea water and its therapeutic and prophylactic use. M .: Medicine, 1966. S.40-41.

2. Struchkov V.I. and other Purulent wound. M .: Medicine, 1975. S. 288-289.

3. Auth. testimonial. USSR No. 1593631, class A61B 17/00, 1990.

4. Khomich L.I. Chronic osteomyelitis Minsk, 1977.S. 94.

5. Auth. testimonial. USSR No. 1109168, cl. 61K 33/14, 1984.

Claims (1)

A method for treating a bone cavity after necrsecvestrectomy by irrigation with an aqueous solution of sodium chloride, characterized in that after irrigation with an aqueous solution of sodium chloride, the cavity is treated with a 3% hydrogen peroxide solution, foam is removed with a 0.02% aqueous solution of chlorhexidine bigluconate, twice during 1 min is treated with an ozonized 0.9% sodium chloride solution with an ozone concentration of 9000-10000 mg / l, a solution of anti-infectious chemotherapeutic agents is introduced into the cavity with simultaneous ultrasonic cavitation for 3 minutes with a frequency of 40 kHz and treat the cavity with a stream of nitrogen monoxide for 5 minutes with a concentration of 500 mg / m ³ .