RU2357736C1 - Method of aseptic whirlbone necrosis and perthers disease treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly orthopedics and extracorporal treatment methods, and can be applied in aseptic whirlbone necrosis and Perther disease treatment. Method involves venous blood sampling in amount of 300 ml with further blood separation into erythrocyte mass and plasma. Obtained erythrocyte mass is diluted by 200 ml of 0.9% physiological solution and administered intravenously to patient. 100 ml or patient's plasma is placed in thermostat and incubated for 20 minutes at 37°C. Further 20 mg of vasoprostan medicine is added to incubated plasma, and obtained mix is administered to patient by drop infusion for 1.5-2 hours once a day for 10 days.

EFFECT: enhanced efficiency of the pathology treatment due to vasoprostan binding to plasma proteins and prolonged vasoprostan circulation in blood, resulting in arterial blood circulation improvement, venous stasis blocking in aseptic necrosis zone and significant acceleration of whirlbone acceleration.

2 tbl, 2 ex, 4 dwg

Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of aseptic necrosis of the femoral head and Perthes disease.

There are various methods of conservative treatment of aseptic necrosis of the femoral head and Perthes disease including: standard pharmacotherapy aimed at improving microcirculation [1, 4], increasing the tone of the veins [4, 5], stimulating regeneration [6].

In turn, all of the above methods have several disadvantages:

1) low effectiveness of pharmacological preparations;

2) these funds only increase stagnation of venous nature in stage I and II of the disease;

3) a large percentage of disability.

Closest to the proposed is a method of infusion use of antiplatelet agents (pentoxifylline, pyricarbate) in patients with Perthes disease [2, 3]

However, this method also has several disadvantages:

1) the level of the drug in the blood, after intravenous administration, mainly depends on the rate of infusion and cardiac output;

2) selectively affects only platelets, without affecting other parts of hemostasis;

3) causes thrombocytopenia;

4) does not affect the musculature of the vessel wall.

The objective of the proposed method is to increase the effectiveness of the treatment of aseptic necrosis of the femoral head and Perthes disease.

The task is achieved due to the fact that the patient is taken 300 ml of blood from a vein, followed by its separation into red blood cells and plasma, the resulting erythrocyte mass is diluted with 200 ml of 0.9% saline and returned to the patient intravenously, and plasma in an amount of 100 ml incubated in an incubator for 20 minutes at t ° = 37 ° C, followed by the addition of 20 mg of the drug "Vazaprostan", the resulting mixture is administered to the patient intravenously, drip in the range of 1.5-2 hours once a day for 10 days.

The method is as follows:

1) the patient is sampled from a vein in an amount of 250-300 ml;

2) vials with exfused and heparinized blood are centrifuged for 15 minutes at a speed of 2000 rpm, after which the plasma is exfused;

3) the erythrocyte mass is diluted with 0.9% saline in an amount (200 ml) and returned to the patient intravenously;

4) the patient’s plasma in an amount of 100 ml in a hemacone is placed in a thermostat and incubated for 20 minutes at a temperature of 37 ° C to activate protein in blood plasma;

5) after incubation in blood plasma add 20 mg of the drug "Vazaprostan";

6) the resulting mixture is administered intravenously to the patient over a period of 1.5-2 hours, once a day for 10 days;

7) on the 15th and 60th day and 90th day after treatment, a dopplerographic study is performed in the medial envelope of the artery and vein of the thigh.

Comparison of treatment results was performed in 24 patients at the age of the first and second childhood. The follow-up was 15; 60; 90 days. To assess the effectiveness of treatment, dopplerography data were studied in the control group and the study group. During treatment, it was found (Table 1) that the proposed method allows to improve the speed indicators of arterial blood flow relative to the control group. On day 15, in the medial envelope of the artery, the maximum blood flow velocity (Vmax) decreased by 5.8%, the minimum blood flow velocity (Vmin) increased by 37.7%, the rheographic index (RI) decreased by 7.6% with an increase in artery diameter of 1 , 28 times. The indicators in the medial envelope of the vein increased: Vmax increased by 25.6%, Vmin by 19.4%, RI by 29.1%, with a 1.3-fold decrease in vein diameter, which indicated normalization of arterial and venous blood flow in the study group relative to the control. On day 60, the study group showed the most pronounced significant changes in indicators, characterized by a moderate increase in arterial and venous blood flow within the normal age range: in the artery, Vmax decreased by 4.9%, Vmin increased by 8.2%, RI decreased by 2.1% , the diameter of the artery increased 1.18 times. In venous blood flow: Vmax increased by 21.7%, Vmin by 12.2%, RI by 13.7%, with a decrease in vein diameter by 1.27 times relative to the control group. On day 90, in the artery, Vmax decreased by 2.4%, Vmin increased by 15.1%, RI decreased by 6.7%, and the diameter of the artery increased 1.11 times. Venous blood flow indices Vmax also increased by 16.5%, Vmin by 7.2%, RI by 13.3%, with a 1.13-fold decrease in vein diameter relative to the control group (Table 1).

In the control group, the periods of restoration of organ blood flow were long and amounted to 98.4 ± 4.7 days, while in the study group of children, the restoration of hemodynamics in GBK was recorded already on the 15th day from the start of treatment (Table 2).

Thus, the proposed method prolongs the clinical effect of the drug due to its binding to plasma proteins (albumin) and its longer circulation in the blood. This leads to an improvement in arterial blood flow, blocking of venous stasis in the area of aseptic necrosis and contributes to a significant acceleration of the regeneration of the femoral head, which allowed to reduce the duration of treatment by 2.8 times and significantly improve the effectiveness of treatment.

Table 1 Comparative results of a dopplerographic study of children in the control and main groups in the medial envelope of the artery and vein of the thigh Indicators Before conservative treatment (n = 25) Control Group (n = 12) The study group (n = 12) 15 days after treatment 60 days after treatment 90 days after treatment 15 days after treatment 60 days after treatment 90 days after treatment Vmax, cm per second (a.) 59.1 ± 0.1 58.2 ± 0.2 57.5 ± 0.4 55.9 ± 0.2 55.7 ± 0.6 54.7 ± 0.6 54.6 ± 0.6 Vmin, cm per second (a.) 11.4 ± 0.2 12.2 ± 0.3 14.5 ± 0.4 15.8 ± 0.3 15.7 ± 0.5 16.7 ± 0.5 17.1 ± 0.5 RI, units (but.) 0.79 ± 0.01 0.78 ± 0.01 0.75 ± 0.01 0.73 ± 0.01 0.73 ± 0.02 0.70 ± 0.02 0.69 ± 0.0.1 d, mm (a.) 1.4 ± 0.1 1.5 ± 0.1 1.6 ± 0.1 1.7 ± 0.1 1.8 ± 0.1 1.9 ± 0.1 1.9 ± 0.1 Vmax, cm per second (v.) 16.0 ± 0.2 16.4 ± 0.3 17.5 ± 0.4 19.3 ± 0.2 20.1 ± 0.3 21.3 ± 0.3 22.5 ± 0.5 Vmin, cm per second (v.) 11.8 ± 0.2 12.2 ± 0.2 13.1 ± 0.3 13.9 ± 0.4 14.1 ± 0.2 14.7 ± 0.2 14.9 ± 0.3 RI, units (v.) 0.24 ± 0.01 0.26 ± 0.01 0.29 ± 0.01 0.30 ± 0.01 0.31 ± 0.02 0.33 ± 0.01 0.34 ± 0.0 2 d, mm (v.) 2.7 ± 0.2 2.6 ± 0.2 2.6 ± 0.2 2.5 ± 0.1 2.1 ± 0.2 2.1 ± 0.2 2.2 ± 0.1 - statistically significant differences compared with the group before conservative treatment (P <0.05)

table 2 Comparative results of the terms of normalization of blood flow and recovery of children in the control and main groups Groups Normalization Dates
blood flow (day) Recovery time (months) Control group 98.4 ± 4.7 13.3 ± 1.5 Study group 15.1 ± 1.6 4.7 ± 0.2

Clinical example 1. Patient Andrei K., 11 years old, was admitted to DTOO GKB No. 20 on January 15, 06 with a diagnosis of Legg-Calve-Perthes disease (PD) on the left, stage III (fragmentation).

The child for 18.5 months complained of severe pain in the left hip joint (TBS) that occurred after exercise and walking. He was sent to the clinic for examination and resolving the issue of surgical treatment.

An objective examination of the state of moderate severity, according to internal organs and clinical analyzes without pathology. Locally: a restriction of the external rotation of the right thigh to 20 ° was revealed, a restriction of the internal rotation of up to 10 °. Doppler data before treatment: in the medial envelope of the artery Vmax (59.2 cm per second), Vmin (11.1 cm per second), RI (0.80 units), d (1.4 mm), in the medial envelope of the vein Vmax ( 15.9 cm per second), Vmin (11.5 cm per second), RI (0.23 units), d (2.73 mm)

An X-ray examination confirmed the diagnosis of Perthes disease (PD) on the left, the fragmentation stage (Fig. 1). An X-ray examination revealed that the left hip joint (TBS) corresponded to group III of clinical and radiological changes.

01/15/06 the child underwent surgery (tunnelization of the femoral neck with subsequent osteoperfection of the neck and femoral head with Ilizarov’s spoke) on the left TBS. After surgery, a patient was given a course of extracorporeal pharmacotherapy. 300 ml of blood is drawn from a vein to a patient, followed by its separation into erythrocyte mass and plasma, the resulting erythrocyte mass is diluted with 200 ml of 0.9% saline and returned to the patient by intravenous route, and 100 ml of plasma is incubated in an incubator for 20 minutes at t ° = 37 ° C, followed by the addition of 20 mg of the drug "Vazaprostan", the resulting mixture is administered to the patient intravenously, drip in the range of 1.5-2 hours once a day for 10 days. Doppler data as of January 30, 2006, in the medial artery envelope Vmax (55.2 cm per second), Vmin (16.3 cm per second), RI (0.70 units), d (1.85 mm), in the medial vein envelope Vmax (20.5 cm per second), Vmin (14.4 cm per second), RI (0.32 units), d (2.1 mm). 01/30/06, the radiograph showed a positive dynamics of the restoration of the structure of the femoral head. After the child received rehabilitation treatment, performed the prescribed orthopedic regimen. After 4.8 months. after the first operation during X-ray examination, V stage BP was detected (outcome) (figure 2).

An X-ray examination revealed a significant improvement in the clinical and radiological state of TBS compared with the preoperative period.

Thus, the use of extracorporeal infusion of vasaprostan in the treatment of PD was effective for the patient. In the course of treatment, it was possible to restore the clinical and radiological state of the affected TBS from III to I clinical and radiological groups, to completely restore the anatomical parameters of the femoral head (GBC), which allowed to reduce the treatment time by 2.8 times.

Clinical example 2. Patient Dima Sh., 7 years old, was admitted to DTOO GKB No. 20 on 10/17/05 with a diagnosis of Legg-Calve-Perthes disease on the right, stage III (fragmentation).

The child for 27 months complained of a feeling of fatigue, severe pain in the right TBS that occurred after exercise and walking. The CRH was sent to the clinic to examine and resolve the issue of conservative and surgical treatment.

An objective examination of the state of moderate severity, according to internal organs and clinical analysis - without pathology. Locally - a positive symptom of Trendelenburg was identified on the right and a limitation of the external rotation of the right thigh to 20 °. Dopplerography data before treatment: in the medial envelope of the artery Vmax (59.3 cm per second), Vmin (11.2 cm per second), RI (0.80 units), d (1.41 mm), in the medial envelope of the vein Vmax ( 15.8 cm per second), Vmin (11.6 cm per second), RI (0.24 units), d (2.71 mm).

An X-ray examination confirmed the diagnosis of PD on the right, the fragmentation stage (figure 3). An X-ray examination revealed that the right TBS corresponded to the III group of clinical and radiological changes.

On October 20, 2005, the child underwent surgical treatment (tunnelization of the femoral neck with subsequent osteoperfection of the neck and femoral head with Ilizarov’s spoke) and the use of standard conservative antiaggregant therapy. Doppler data on 01.22.06, in the medial artery envelope Vmax (55.7 cm per second), Vmin (15.9 cm per second), RI (0.73 units), d (1.73 mm), in the medial envelope vein Vmax (19.5 cm per second), Vmin (13.9 cm per second), RI (0.31 units), d (2.49 mm).

Since January 22, 2006, after registering on the radiograph the positive dynamics of restoration of the structure of the GBK, the child received rehabilitation treatment, performed the prescribed orthopedic regimen. After 14.2 months. after the first operation and conservative therapy during X-ray examination, V stage BP was detected (outcome) (Fig. 4).

An X-ray examination revealed an improvement in the clinical and radiological state of TBS compared with the preoperative period. Right TBS corresponded to the II clinical and radiological group.

Thus, the use of surgical treatment and standard conservative therapy was not effective enough in this patient. During the treatment, it was possible to improve the clinical and radiological state of the affected TBS from III to II clinical and radiological groups, however, it was not possible to fully restore the anatomical parameters of GBK corresponding to group I.

Compared with the prototype, the proposed method has the following advantages: persistent removal of venous stasis in the proximal femur, normalization of arterial blood flow, leading to improved processes of revascularization of the affected pineal gland and a significant acceleration of regeneration of the femoral head, which reduced the duration of treatment by 2.8 times.

BIBLIOGRAPHY

1. Bernstein S.S. Pathogenetic substantiation of some methods of treatment, early diagnosis and prevention of Legg-Calve-Perthes disease in children: Abstract. dis ... doctor. honey. sciences. - Semipalatinsk, 1995 .-- 35 p.

2. Gafarov, Kh.Z. Modern etiopathogenetic rationale for the treatment of Perthes disease / Kh.Z. Gafarov // Treatment of children and adolescents with orthopedic diseases of the lower extremities. - Kazan, 1995. - S.193-220.

3. Kotelnikov G.P., Mironov S.P., Miroshnichenko V.F. Traumatology and orthopedics. U-M .: GEOTAR-Media, 2006 .-- 400 s).

4. Studenkina, M.Ya. Osteochondropathy // Guide to Pediatric Arthrology / M.Ya. Studenkina, A.A. Yakovleva - L., 1987. - P.226-236.

5. Schulitz K.R., Dustmann I.O. Morbus Perthes. - Berlin: Springer, 1991 .-- 402 s.

6. Krauspe R., Raab P. Morbus Perthes // Orthopaede. - 1997. - 26, 3. - S.289-302.

Claims (1)

A method of treating aseptic necrosis of the femoral head and Perthes disease, including intravenous administration of antiplatelet agents under the control of dopplerography, characterized in that the patient is taken 300 ml of blood from a vein, followed by its separation into red blood cells and plasma, the resulting erythrocyte mass is diluted with 200 ml 0.9 % saline and returned to the patient intravenously, and plasma in an amount of 100 ml was incubated in an thermostat for 20 minutes at t-37 ° C, followed by the addition of 20 mg of the drug “Vazaprostan”, p mixture of radiation administered to the patient intravenously, drip in the range of 1.5-2 hours once a day for 10 days.

Images