RU2355344C2 - Bone graft preparation method - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: method involves the following actions: bone fragments are washed with flowing main water within 40 minutes. Then they are boiled within 90 minutes in 0.9% sodium chloride solution. Residual bone marrow, coagulated blood and periosteum are mechanically removed from the surface of treated bone thereafter boiled again within 90 minutes in fresh sterile 0.9% sodium chloride solution. Bone fragments are washed in sterile 0.9% sodium chloride solution within 5 minutes. Further bone fragments are preserved in sterile vacuum-sealed glass pots filled with sterile 0.9% sodium chloride solution with gentamycin added. The pots are stored in medical refrigerators at temperature 3 to 6 degrees centigrade.

EFFECT: method allows reducing risk of infectious complications and time of defect replacement in osteoplasty.

2 cl, 1 ex

Description

Our invention may be applicable in the preparation of transplants for osteoplastic surgery.

There are various methods of preparing bone grafts, including demineralization, lyophilization, etc.

A known method of preparing bone grafts, including freezing, followed by drying from a frozen state (Yumashev G.S. Bone grafting by lyophilized homotransplant. Medgiz, 1963, p.18-23).

As the closest analogue, we took a method for preparing bone grafts for autoplasty according to RU 2120245 C1, 10.20.1998. According to this method, the first stage is the surgical treatment of the comminuted fracture area, removal of non-viable tissues and bone fragments, and Ilizarov fixation. The removed bone fragments are cleaned, demineralized, and preserved. After healing of the soft tissues, the removed bone fragments are reintroduced to the extraction site.

A common disadvantage of the known methods for preparing transplants is the lack of a clear algorithm for the preparation of transplants.

The objective of our invention is to develop a clear algorithm for the preparation and storage of bone grafts, which helps to prevent the risk of any infectious complications associated with transplants, to ensure the replacement of a bone defect in a short time, to provide the possibility of creating a bank of bone grafts that can be used for various types of bone grafting .

This problem is solved by certain actions: washing, boiling, machining, performed in a certain sequence.

According to our method, the following steps are taken to prepare bone grafts.

Bone fragments are removed during surgical treatment of the lesion. Next, the removed free bone fragments are processed as follows: washed under running tap water for 40 minutes, boiled for 90 minutes in a 0.9% sodium chloride solution, mechanically remove bone marrow residues, caked blood from the surface of the processed bone fragments with surgical instruments, and periosteum, re-boil for 90 minutes in a fresh sterile 0.9% sodium chloride solution, wash the bone fragments in a sterile 0.9% sodium chloride solution for 5 minutes, then to nserviruyut bone fragments in sterile, hermetically sealed glass jars filled with a sterile solution of 0.9% sodium chloride solution supplemented with gentamicin, further stored in a medical refrigerators at a temperature of 3 to 6 degrees Celsius. If bone grafts were not used within 30 days of storage, then bone grafts are processed as follows: bone fragments are washed for 5 minutes in a fresh sterile solution of 0.9% sodium chloride, boiled in a fresh sterile solution of 0.9% sodium chloride in for 60 minutes, bone grafts are washed in a sterile 0.9% sodium chloride solution for 5 minutes, canned in sterile, hermetically sealed glass jars filled with a sterile solution of 0.9% sodium chloride with gentamicin .

We describe the actions of our method in more detail.

The removed free bone fragments and sequesters from the area of the gunshot fracture during surgical treatment, as well as necrosts after resection of bone fragments affected by chronic osteomyelitis, were subjected to special processing according to the algorithm below:

1. Rinse under running tap water for 40 minutes;

2. Boiling in an enamel bowl for 90 minutes in a 0.9% sodium chloride solution;

3. Mechanical removal from the surface of the scrap bones with surgical instruments (scissors, a scalpel, resection knife) of the remnants of bone marrow, clotted blood and periosteum, subject to aseptic and antiseptic rules;

4. Repeated boiling in an enamel bowl for 90 minutes in a fresh, sterile 0.9% sodium chloride solution;

5. Washing of scrap bone fragments in a sterile 0.9% sodium chloride solution for 5 minutes. Sowing fingerprints from bone fragments for sterility and sensitivity to antibiotics;

6. Preservation of scrap bone fragments in sterile, hermetically sealed glass jars with a capacity of 200 or 400 ml, filled with a sterile solution of 0.9% sodium chloride with the addition of the osteotropic antibiotic gentamicin (240 mg or 480 mg, respectively);

7. Storage of scrap bone preserved in such a way was carried out in medical refrigerators at a temperature of 3 to 6 degrees Celsius for up to 30 days.

If during these periods the transplants were not used for their intended purpose, then the algorithm of subsequent actions was as follows:

1. With observance of the rules of asepsis and antiseptics, the cans were uncorked, the saline solution and fingerprints from bone fragments were taken for sterility;

2. Bone fragments were washed for 5 minutes in a fresh sterile solution of 0.9% sodium chloride;

3. Boiling in a fresh sterile solution of 0.9% sodium chloride for 60 minutes;

4. Washing of scrap bone fragments in a sterile 0.9% sodium chloride solution for 5 minutes. Sowing fingerprints from bone fragments for sterility and sensitivity to antibiotics;

5. Preservation of scrap bone fragments in sterile hermetically sealed glass jars with a capacity of 200 or 400 ml, filled with a sterile solution of 0.9% sodium chloride with the addition of the osteotropic antibiotic gentamicin (240 mg or 480 mg, respectively);

The method of preparing bone grafts according to our method may be applicable to various options for bone grafting. Prepared grafts can be used as allografts, i.e. for transplanting to another wounded. They can be used for subsequent autotransplantation to the site of damage.

Usually, we use the placement of scrap bone fragments in the muscles at the time of initial preservation (up to 30 days from the time of harvesting), then, after transplanting in the muscles, we place them at the site of damage, i.e. We perform bone autoplasty in three stages.

The effectiveness of bone autoplasty with bone grafts is presented in the following clinical examples:

1. Injured S. 25 years old, on September 25, 2000, while performing a counter-terrorist operation in Chechnya, he received a multiple gunshot fragmentation and wound wound of the right lower limb: a gunshot comminuted fracture of the diaphysis of the right femur in the lower third with displacement of fragments, a gunshot comminuted fragmentary fracture of the tibia in the middle and lower third with a primary bone bone-soft tissue defect, a gunshot comminuted fracture of the fibula in the middle third with the displacement of fragments, neuropathy of the fibula nerve with severe motor, sensory and trophic disorders. At the stages of medical evacuation, primary and repeated surgical treatment of wounds and stabilization of the fragments with the Ilizarov apparatus were performed. The wound process was complicated by chronic osteomyelitis of fragments of the tibia, the wounds on the thigh healed by secondary intention. 11/15/03 delivered by air to the State Military Command named after NN Burdenko from 1603 OVG Rostov. On admission, a bone-soft tissue defect was detected clinically and radiologically in the middle third of the right lower leg, and the bone defect of the tibia was 15 cm, and the bone necrotic fragment of the distal fragment, not covered by soft tissues, stood in the wound for 5 cm, copious purulent discharge with pseudomonas aeruginosa smell. In the soft tissues at the fracture level, bone densities of high density were X-ray visualized. 11.16.03 operated on - surgical treatment of the wound with removal of sequesters, resection of the distal fragment of the tibia over 3 cm, necrectomy of soft tissues, non-free skin plasty with oncoming triangular flaps, which made it possible to cover the exposed bone with soft tissues. Recycled bone tissue after removal of sequestration and resection of the tibia was prepared and preserved in a solution of antibiotics according to the above procedure. In the postoperative period, flow-aspiration drainage of the postoperative wound with antibiotic solutions was performed for 15 days. The osteomyelitis process was stopped. 12/05/03 reoperated - re-assembly of CDA, osteotomy of the tibia in the upper third, implantation of scrap bone grafts in the ligament on the ligature into the intermuscular space between the major and middle gluteal muscles behind the left ilium. Postoperative wounds healed by first intention. After 8 days, distraction of the osteotomized fragment in the upper third of the leg and distraction of a bone fragment of 6 cm in length along the fragmentary fracture line towards each other 1 mm per day in 4 doses was started. The remaining soft tissue defect 10 * 5 cm after performing non-free skin grafting was replaced as the bone fragments were distracted and joined. Maturation of the distal distraction regenerate was slow with the formation of intraosseous cysts and thinning like an hourglass. The duration of distillation was 98 days. Given the formation of hypotrophic bone distraction regenerate in the lower third, it was decided to perform bone autoplasty with scrap bone tissue, as well as bone autoplasty of the junction of bone fragments with cortical-spongy bone autografts, taken from the wing of the left ilium. 05/15/04 operated on - access to the old postoperative scar prepared bone autografts were extracted from the muscle sleeve. Two cortical-spongy transplants from the iliac crest 4 * 1 * 1 cm in size were taken from the same access. Of the three separate accesses 2-2.5 cm long, the area of distraction regenerate in the lower third of the leg was exposed. Cortical plates are introduced into the regenerate along the fibers in the region of the thinned regenerate, as well as in the region of bone cysts. Layered seam of wounds. At the junction of the bone fragments, channels with a diameter of 8 mm were drilled from two accesses of 1.0 cm in diameter, passing through both joined fragments, into which the bone autotransalantates were tightly hammered with impaction. The postoperative course is smooth, the wounds healed by primary intention. Repeatedly carried out rehabilitation treatment in the conditions of 6 CVKG. Subsequently, a distinct positive dynamics was noted until bone regenerates fully matured and consolidation at the junction of bone fragments and a gunshot fracture of the femur. The device was dismantled on 12/15/04. Fully restored supportability of the limb. By the decision of the VVK, he was declared fit for military service with minor restrictions.

Thus, within 12 months, the replacement of the tibial defect over 18 cm and the fusion of the gunshot fracture of the femur were achieved, which exceeds the average statistical treatment time by half, which confirms the effectiveness of the proposed method of bone autoplastic with bone tissue.

Claims (2)

1. The method of preparation of bone grafts, including the removal of bone fragments during surgical treatment of the lesion, characterized in that the removed free bone fragments are processed as follows: washed under running tap water for 40 minutes, boiled for 90 minutes in 0.9% a solution of sodium chloride, mechanical removal from the surface of the processed bone fragments with surgical instruments of the remnants of bone marrow, clotted blood and periosteum, re-boil for 90 m in fresh sterile 0.9% sodium chloride solution, wash the bone fragments in a sterile 0.9% sodium chloride solution for 5 minutes, then bone fragments are preserved in sterile, hermetically sealed glass jars filled with a sterile solution of 0.9% sodium chloride with the addition of gentamicin, then stored in medical refrigerators at a temperature of from 3 to 6 ° C. 2. The method according to claim 1, characterized in that if bone grafts were not used within 30 days of storage, then bone grafts are processed as follows: bone fragments are washed for 5 min in a fresh sterile solution of 0.9% sodium chloride, boiled in a fresh sterile solution of 0.9% sodium chloride for 60 minutes, washed the bone grafts in a sterile 0.9% solution of sodium chloride for 5 minutes, canned in sterile, hermetically sealed glass jars filled with a sterile solution of 0.9% chloride soda I supplemented with gentamicin.