RU2396917C1 - Method of surgical treatment of osteoid-osteomas and osteoblastomas of bones in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to orthopedics. Topography of pathologic focus is performed by axial scanning with application of computer tomography. After placement in area of pathologic focus localisation of skin X-ray contrastive markers, axial scanning is repeated and point of guiding pin introduction, angle of its inclination and depth of guiding pin penetration into pathologic focus are determined. After that after performing general anesthesia as anesthetic assistance, under control of computer tomography guiding pin is introduced transcutaneously through bone wall into pathologic focus until it exits the focus. After carrying out layer-by-layer dissection of skin, soft tissues and bone exposure, along guiding pin to exposed bone brought is cannulated hollow blade and ablastic removal of bone together with pathologic focus is performed to healthy bone. On skin cuts sutures are applied. In localisation of pathologic focus in area of large vascular-nervous bundle, after carrying out layer-by-layer dissection of skin, soft tissues and bone exposure retractor is used.

EFFECT: method ensures reliable removal of pathologic focus of small size, minimal resection of pathologic focus, reduction of bone sclerosis, elimination of hemotransfusion presence, reduction of time of surgical intervention performance, early social adaptation of patient.

2 ex, 2 cl, 6 dwg

Description

The invention relates to medicine, in particular to orthopedics, to methods for surgical treatment of osteoid osteomas and osteoblast bones in children, and can be used in surgical, trauma and other hospitals.

A known method of surgical treatment of osteoid-osteomas and osteoblasts of bones in children, including layer-by-layer dissection of the skin and soft tissues, exposure of the bone and removal of the pathological lesion using cutaneous radiopaque marks and the precise passage of the knitting needle through the bone into the pathological lesion under the control of a computer tomograph (see application for invention of the Russian Federation No. 2004113389, IPC A61B 17/00, 2005).

However, the known method in its use has the following disadvantages:

- does not provide reliable removal of the pathological focus due to its small size,

- does not provide visual access to the pathological focus due to heavy bleeding,

- does not provide minimal resection of the pathological focus in compliance with oncological principles,

- does not reduce bone sclerotization,

- does not always exclude the presence of blood transfusion,

- the duration of the surgical intervention,

- does not provide early social rehabilitation of the patient.

The objective of the invention is to provide a method for the treatment of osteoid osteomas and osteoblast bones in children.

The technical result is the achievement during surgical intervention of reliable removal of a pathological lesion of small size, ensuring minimal resection of the pathological lesion in compliance with oncological principles, ensuring reduced sclerotization of the bone, eliminating the presence of blood transfusion, reducing the time for performing surgical intervention, as well as ensuring early social rehabilitation of the patient.

The technical result is achieved by the fact that the proposed method of surgical treatment of osteoid osteomas and osteoblasts of bones in children, including layer-by-layer dissection of the skin and soft tissues, exposure of the bone and removal of the pathological focus using cutaneous radiopaque markers and accurate passing of the needle through the bone into the pathological focus under computer control tomograph, while performing the topography of the pathological focus axial scanning using computed tomography, after placement in the area of the lock lysis of the pathological focus of cutaneous radiopaque markers re-axial scan and determine the insertion point of the guide needle, the angle of inclination and the depth of penetration of the guide needle into the pathological focus, then after performing general anesthesia as an anesthetic, under the control of computed tomography, the guide needle is inserted percutaneously through the bone wall to the pathological focus before exiting it, after performing a layered dissection of the skin, soft tissues and exposure to cannulated hollow milling cutter and ablastic bone removal together with the pathological focus to a healthy bone, along with a guide needle to the exposed bone, sutures are made on the skin incisions. At the same time, when a pathological focus is localized in the region of a large neurovascular bundle, after performing layer-by-layer dissection of the skin and soft tissues and exposure of the bone, an expander is used.

The method is as follows. The topography of the pathological lesion is performed by axial scanning using computed tomography. After placement of cutaneous radiopaque markers in the localized area of the pathological focus, a second axial scan is performed and the insertion point of the guide needle, its angle of inclination and the penetration depth into the pathological focus of the guide needle are determined. Then, after performing general anesthesia as an anesthetic aid under the control of computed tomography, a guide needle is inserted percutaneously through the bone wall into the pathological focus before exiting it. A layer-by-layer dissection of the skin and soft tissues is performed with exposure of the bone at the location of the guide needle. In this case, with the localization of the pathological focus in the region of the large neurovascular bundle, a retractor is used. A cannulated hollow cutter is brought down to the exposed bone along the guide needle and ablastic bone removal is performed together with the pathological focus to a healthy bone. Suture skin incisions.

Among the essential features characterizing the proposed method for surgical treatment of osteoid osteomas and osteoblast bones in children, the following are distinguishing:

- topography of the pathological lesion by axial scanning using computed tomography,

- performance after placement in the localization of the pathological focus of cutaneous radiopaque markers of repeated axial scanning and determining the point of introduction of the guide needle, its angle of inclination and the depth of penetration of the guide needle into the pathological focus,

- after performing general anesthesia as an anesthetic aid, the transdermal introduction under the control of computed tomography of the guide needle through the wall of the bone into the pathological focus before exiting it,

- after performing layer-by-layer dissection of the skin, soft tissues and exposing the bone, bringing the cannulated hollow cutter along the guide needle to the exposed bone and performing ablastic bone removal together with the pathological focus to a healthy bone with suturing the skin incisions,

- the use of a retractor after performing layer-by-layer dissection of the skin and soft tissues and exposure of the bone when localizing a pathological focus in the region of a large neurovascular bundle.

Experimental studies of the proposed method for surgical treatment of osteoid osteomas and osteoblast bones in children have shown its high efficiency. The proposed method for the surgical treatment of osteoid osteomas and osteoblasts of bones in children, when used, ensures the reliable removal of the pathological focus during surgical intervention, despite its small size, ensures minimal resection of the pathological focus with observance of oncological principles, reduces bone sclerotization, and also eliminates the presence of blood transfusion. In addition, the proposed method allows to reduce the time for performing surgical intervention, as well as to provide early social rehabilitation of the patient.

The essence of the proposed method for surgical treatment of osteoid-osteoma and osteoblast of bones in children is illustrated by drawings, in which Fig. 1 shows a computer tomogram of visualization of osteoid-osteoma of the left talus with cutaneous radiopaque markers, in Fig. 2 - placement of a guide needle directly into the tumor, in Fig. .3 - transdermal conducting of the guide needle, Fig. 4 - removal of a tumor using a cylindrical hollow cutter, Fig. 5 - X-ray of the left ankle joint during removal of a tumor using zovaniem hollow cylindrical cutters and Figure 6 - a control computer tomogram after tumor removal.

The implementation of the proposed method for surgical treatment of osteoid osteomas and osteoblast bones in children is illustrated by the following clinical examples.

Example 1. Patient M., 16 years old, was admitted to the department of pediatric bone pathology and adolescent orthopedics of the Federal State Institution of Cytology and Cytology with complaints of pain in the cervical spine.

Using computed tomography revealed osteoblastoma of the third cervical vertebra 6 mm in size.

The patient underwent surgery - interlaminectomy of the third cervical vertebra with the tumor.

The topography of the pathological lesion was performed by axial scanning using computed tomography. After placing cutaneous radiopaque markers in the localized area of the pathological focus, a second axial scan was performed and the insertion point of the guide needle, its angle of inclination and the depth of penetration into the pathological focus of the guide needle were determined. Then, the patient was anesthetized as anesthetic aid. Under the control of computed tomography, a guide needle was inserted percutaneously through the bone wall of the third cervical vertebra into the pathological focus before exiting it. Performed a layer-by-layer dissection of the skin and soft tissues with exposure of the bone at the location of the guide needle. A cannulated hollow cutter was brought to the exposed bone along the guide needle and ablastic bone removal was performed along with the pathological focus to a healthy bone. Sutured skin incisions.

As a result of surgical intervention, the complete removal of osteoblastoma of the third cervical vertebra is ensured. A minimum resection of the pathological focus is ensured in compliance with oncological principles, a decrease in bone sclerotization is ensured, and blood transfusion is also excluded.

The patient was discharged 5 days after surgery for outpatient aftercare. After 2.5 months, control radiographs revealed restoration of bone structures of the third cervical vertebra. Relapse of the underlying disease is absent.

Example 2. Patient P., 14 years old, was admitted to the Department of Pediatric Bone Pathology and Adolescent Orthopedics of the Federal State Institution of Cytology and Cytology with complaints of pain in the left foot.

Using computed tomography revealed osteoid osteoma of the left talus.

The patient underwent surgery - a minimal marginal resection of the osteoid osteoma of the left talus.

The topography of the pathological lesion was performed by axial scanning using computed tomography. After placement of cutaneous radiopaque markers in the localized area of the pathological focus, a second axial scan was performed and the point of introduction of the guide needle into the left talus bone, its angle of inclination and the penetration depth into the pathological focus of the guide needle were determined. Then, general anesthesia of the patient was carried out as an anesthetic aid. Under the control of computed tomography, a guide needle was inserted percutaneously into the left talus, into the pathological focus before exiting it. Performed a layer-by-layer dissection of the skin and soft tissues with exposure of the bone at the location of the guide needle. Since the pathological focus is localized in the region of the large neurovascular bundle, a retractor was used. A cannulated hollow cutter was brought to the exposed bone along the guide needle and ablastic bone removal was performed along with the pathological focus to a healthy bone. Sutured skin incisions.

As a result of surgery, the complete removal of osteoblastoma of the left talus is ensured. A minimum resection of the pathological focus is ensured in compliance with oncological principles, a decrease in bone sclerotization is ensured, and blood transfusion is also excluded.

The patient was discharged 5 days after surgery for outpatient aftercare. After 2.5 months, control radiographs revealed restoration of the bone structures of the left talus. Relapse of the underlying disease is absent.

Claims (2)

1. A method of surgical treatment of osteoid-osteomas and osteoblasts of bones in children, including placing in the localization of the pathological focus of cutaneous radiopaque markers, conducting a guide needle through the bone into the pathological focus under the control of computed tomography, layered dissection of the skin and soft tissues, exposure of the bone and removal of the pathological lesion, characterized in that the topography of the pathological lesion is performed by axial scanning using computed tomography, after placement in the region In order to localize the pathological focus of cutaneous radiopaque markers, a second axial scan is performed and the point of introduction of the guide needle, the angle of its inclination and the depth of penetration of the guide needle into the pathological focus are determined, then, after performing general anesthesia as an anesthetic, under the control of computed tomography, a transdermally guide needle is inserted through the wall of the bone into the pathological focus before exiting it, then, after performing layer-by-layer dissection of the skin, soft tissue and exposure of the bone, the guide spoke to bare bones fed cannulated hollow cutter and operate ablasticheskoe removing bones together with pathological hearth to healthy bone, sutured to the skin incisions. 2. The method according to claim 1, characterized in that when localizing the pathological focus in the region of the large neurovascular bundle after performing layer-by-layer dissection of the skin and soft tissues and exposing the bone, a retractor is used.

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