RU2404782C1 - Method for treatment of patients with lower jaw fracture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to oral surgery, and may be used for treatment of patients with lower jaw fracture. For this purpose, preparation Neoselen is included into conventional course of therapy. Mode of Neoselen introduction - 250-300 daily for 10 days.

EFFECT: introduction of Neoselen in specified, specially selected high doses, makes it possible to eliminate imbalance of lipid peroxidation, to stimulate osteogenesis.

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Description

The invention relates to medicine, namely to maxillofacial surgery, and can be used in the treatment of patients with a fracture of the lower jaw.

The problem of injuries of the maxillofacial region continues to be one of the most important topics in surgical dentistry (Dufash I.Kh., 2003, Ivaschenko N.I., 2006, Telny R.Yu., 2008). Currently, among the causes of death and disability in Russia, injuries are in second place, second only to cardiovascular diseases. Maxillofacial injuries account for up to 8% of all traumatic injuries. Fractures of the lower jaw and their treatment remain one of the urgent problems of traumatology of the maxillofacial region. Among all injuries of the facial bones, they occur most often and make up from 26 to 87% (Shvyrkov MB, 1999).

A constant increase in maxillofacial injuries, an increase in the severity of maxillofacial injuries, including fractures of the lower jaw, accompanied by the presence of teeth and fragments in the fracture line, infection of the fracture zone by microflora growing in the oral cavity, uncontrolled administration of antibiotics without taking into account the sensitivity of microorganisms to them , a decrease in overall immunological resistance, late patients seeking medical help, significantly increases the risk of development, and often leads to the development of inflammatory complications

Reparative processes in the lower jaw occur in conditions of an infected bone wound, against the background of impaired microcirculation and tissue hypoxia, when osteoplastic function is sharply reduced (Dynin I.I. et al., 2004). In addition, the jaw bone tissue has an extremely low potential for regeneration due to the low content of the hematopoietic bone marrow (Perova MD, 2005). Any damaging effect on human tissues causes activation of oxidative stress with increased formation of reactive oxygen species, as well as the development of an imbalance in and antioxidant systems (Petrovich Yu.A., 2001; Pradhan D. et al., 2000). In this regard, in conditions of bone injury, it is justified to use antioxidant drugs that regulate the relationship between the pro- and antioxidant systems of the body, which can help optimize the regeneration processes, and therefore accelerate their healing (Ageev A.S. et al., 2006).

The developed inflammatory complications lead to a violation of reparative osteogenesis, delayed consolidation of fragments, increase temporary disability and the patient’s stay in hospital, worsen the quality of life and often lead to repeated surgery (Berdyuk I.V., 2005; Shvyrkov MB, 1999) .

Conducted research on the medical-scientific and patent literature revealed various methods of treating a fracture of the lower jaw.

The well-known "Method of treating a fracture of the jawbone" No. 1191060 (A61I 17/00, 1985, BI No. 42) by reposition, immobilization of bone fragments and antibiotic therapy using gangleron. The disadvantage of this method is the occurrence of side effects on the administration of the drug (Shargorodsky A.G.).

The well-known "Method for the complex treatment of fractures of the lower jaw" No. 220011 (A61K 31/734, 2003) by optimizing the diet and introducing a dietary supplement of calcium alginate. The disadvantage of this method is the lack of influence on the optimization of the first and second phases of osteoregeneration.

The closest in technical essence and taken as a prototype is a method of treating a fracture of the lower jaw, which provides the patient with specialized care, including reposition and immobilization of fragments, the appointment of conventional drug therapy and the additional use of selenmethionine orally at a dose of 100 μg for 10 days, electrophoresis 1% Astragalus solution to the fracture area (Kozlova M.V., 1992).

The disadvantage of this method is the low effectiveness of the treatment due to insufficient activity of the process of bone formation due to the low dosage of selenium, as well as the use of the drug without regard to the stage of regeneration.

To increase the effectiveness of the treatment of a fracture of the lower jaw, selenium preparations are administered daily, for example, Neo-Selen at a dose of 250-300 mcg for 10 days.

The method is as follows.

From the moment of admission to the hospital, patients with a fracture of the lower jaw have been provided with specialized care, including reposition and immobilization of fragments and a course of generally accepted therapy - antibacterial, desensitizing, anti-inflammatory.

In order to stimulate bone formation processes by eliminating the imbalance of lipid peroxidation processes in patients with a fracture of the lower jaw according to the proposed method, in addition to the generally accepted course of therapy, the drug Neoselen at a dose of 0.5-0.6 ml (250-300 μg) is included in the course of 10 days, diluted in 100 ml of water, once a day per os after meals for 10 days.

The drug "Neoselen" is registered by the Russian Ministry of Health and Medical Industry No. 04-31 / 344. OKP code 9325740288. OKDP code 423257 dated 06/20/96, approved by the State Pharmacological Committee of the Ministry of Health of Russia (No. 11-15-2133 of 06/26/96) as a biological food supplement. The 0.05% NeoSelen solution contains 5000 µg sodium selenite, 95 ethyl alcohol and purified water and is a colorless transparent liquid. Available in vials of 0.05% solution of 10 ml. The drug is used in adults and children to prevent nutritional deficiency of selenium (in endemic areas). "Neo-selen" is a powerful antioxidant due to the ability of selenium to be included in the active centers of antioxidant enzymes.

The dose of the drug (250-300 μg) was empirically selected based on an assessment of the activity of bone formation in the fracture zone and determination of the level of selenium in the blood (Table 1, Table 2)

Table 1 Radiometric indices in patients with a fracture of the lower jaw before treatment and on the 20th day after treatment (imp./s) Dose of sodium selenite Before treatment After treatment 100 mcg 1301.14 ± 75.54 1515.14 ± 81.39 * 150 mcg 1301.14 ± 75.54 1623.16 ± 76.41 * 150 mcg 1301.14 ± 75.54 1693.35 ± 86.41 * 200 mcg 1301.14 ± 75.54 1702.14 ± 86.41 * 250 mcg 1301.14 ± 75.54 2379.68 ± 86.41 * 300 mcg 1301.14 ± 75.54 2521.13 ± 192, b4 ** 350 mcg 1301.14 ± 75.54 2520.16 ± 176.53 ** 400 mcg 1301.14 ± 75.54 2518.23 ± 182.61 ** 450 mcg 1301.14 ± 75.54 2520.46 ± 181.59 ** * - significance of differences P <0.05 between groups before and after treatment ** - significance of differences P <0.001 between groups before and after treatment table 2 Blood selenium content in patients with a fracture of the lower jaw (μg / l) Dose of sodium selenite Control (healthy people) 4 days (before treatment) 7 days 11 days 14 days 18 days 100 mcg 101.9 ± 4.4 88.0 ± 0.6 87.2 ± 0.7 84.3 ± 0.5 89.2 ± 0.6 89.1 ± 0.4 150 mcg 101.9 ± 4.4 88.0 ± 0.6 88.8 ± 0.4 90.1 ± 1.3 97.2 ± 1.7 97.7 ± 1.3 200 mcg 101.9 ± 4.4 88.0 ± 0.6 89.2 ± 1.1 91.2 ± 0.7 98.2 ± 0.9 100.2 ± 0.5 250 mcg 101.9 ± 4.4 88.0 ± 0.6 92.3 ± 0.6 96.8 ± 0.7 99.4 ± 0.8 106.4 ± 1.4 300 mcg 101.9 ± 4.4 88.0 ± 0.6 95.3 ± 0.7 100.1 ± 1.6 106.2 ± 1.2 126.2 ± 1.1 350 mcg 101.9 ± 4.4 88.0 ± 0.6 103.3 ± 1.1 120 ± 0.6 152 ± 1.2 172 ± 1.3 400 mcg 101.9 ± 4.4 88.0 ± 0.6 147.2 ± 0.9 178 ± 1.1 182 ± 1.7 200 ± 1,5

This method was used in the treatment of 68 patients with a fracture of the lower jaw (Table 3)

Table 3 Method of treatment Number of patients Initial Consolidation Dates Indicators of radiometry (imp / s) Duration of hospital treatment (bed day) Single fracture Double fracture Healthy people (n = 15) In 20 days In 6 months Traditional treatment 52 21.2 ± 1.4 33.5 ± 1.3 719.14 ± 81.39 1515.14 ± 81.39 1023.54 ± 64.75 26.4 ± 1.5 100 mcg selenium fifteen 21.1 ± 1.1 32.7 ± 0.8 1549.27 ± 61.47 1009.32 ± 52.38 25.4 ± 0.6 250-300 mcg selenium 68 18.2 ± 1.1 27.4 ± 0.8 2521.13 ± 192.64 723.53 ± 69.84 19.2 ± 1.1

The practical application of the claimed method is illustrated by examples from clinical practice.

Example 1

Patient P., 29 years old, medical history No. 265, was hospitalized on the 2nd day after being injured in the Department of Maxillofacial Surgery of the Dental Clinic of the Medical Academy of Chita with a diagnosis of a fracture of the lower jaw to the left with displacement of fragments. Subluxation of the tooth 3.8. On admission, he complained of pain and swelling in the lower jaw, painful closure of the teeth, numbness of the lip and chin on the left.

Local examination: swelling of the soft tissues of the submandibular and parotid-chewing area on the left. In the area of the chin skin there are hemorrhages of a purplish-cyanotic color. On the left is the symptom of Vincent. The mouth opens up to 3 cm with pain. The bite is separated from 4.8 to 3.7 by 0.8 cm. Tooth 3.8 is mobile of 2 degrees, percussion is sharply painless. At tooth level 3.8, there is a rupture of the mucous membrane with the sacred discharge, the mobility of bone fragments is determined. An orthopantomogram shows the line of bone tissue enlightenment running through the 3.8 hole obliquely to the corner of the lower jaw. The radiometry indices amounted to 1234 imp./s.

Upon receipt, tooth 3.8 was removed from the fracture line, the fragments were repaired and fixed with a double jaw splint. Assigned a complex of drug therapy: Sol. Lincomycini 30% - 1.0 v / m 3 times a day, Tab. Suprastini 0.025 2 times a day, Sol. Ketanov 1.0 IM 2 times a day for 7 days. A solution of Unsettled neutral (250 mcg) daily for 10 days.

After 2 days from the start of the drug, the intensity of pain in the fracture area significantly decreased, by 4 days the pain was completely stopped. Edema of soft tissues completely resolved by 6 days. On day 20, the mobility of fragments in the fracture zone was not determined. Radiometry data amounted to 1986 imp./s.

As a result of observation of patient P., within 6 months a successful consolidation of the fracture was noted. Radiometry data amounted to 721 imp./s, which corresponded to the indicators of a healthy person.

Example 2

Patient S., 22 years old, medical history No. 647, was hospitalized in the Department of Maxillofacial Surgery of the Dental Clinic of the Chita Medical Academy on the 6th day after an injury with a diagnosis of

Fracture of the lateral part of the body of the lower jaw to the right with the displacement of fragments.

Upon admission to the hospital, he complained of severe pain in the lower jaw, inability to close his teeth, swelling of the mucous membrane of the oral cavity and soft tissues, and worsening of the general condition.

At the time of the examination, the general condition was regarded as satisfactory.

Objectively: moderate swelling of the soft tissues of the submandibular and parotid-chewing regions on the right. In the region of the angle of the lower jaw there are subcutaneous hemorrhages in the stage of resorption. The mouth opens up to 3.0 cm with pain. The bite is separated from the tooth 4.3 to 3.7 by 0.8 cm, the intermediate fragment is displaced downward by 0.7 cm. Between the teeth 4.3 and 4.4 there is a rupture of the gum, the mucous membrane in this area is edematous, and palpation determines pain and mobility of bone fragments. Teeth 4.3 and 4.4 are intact, their percussion is painless.

The radiograph shows a line of bone tissue enlightenment, running between 4.3 and 4.4 to the edge of the jaw, the larger fragment is displaced downward by 0.8 cm. According to radiometry, the activity of cells in the fracture zone was 1657 imp./s.

On the day of admission, reposition and immobilization of fragments of the double-jawed tooth aluminum splint with hook loops and intermaxillary rubber traction was performed. Appointed: Sol. Lincomycini 30% - 1.0 v / m, Tab. Suprastini 0.025 2 times a day, Sol. Ketanov 1.0 i / m for pain, Neoselen neutral 300 mcg, diluted in 100 ml of water, daily for 10 days.

After 2 days, the patient noted a decrease in pain in the fracture zone, swelling of the mucosa was significantly reduced, the wound at the fracture site was epithelized on the 6th day. Soft tissue edema resolved on the 5th day. After 18 days, the stiffness of the fragments in the fracture area was determined.

Upon discharge from the hospital, the patient did not complain. The configuration of the face was not disturbed, the mouth opened in full, the teeth closed in the bite, the mobility of the fragments was not determined.

On the control roentgenogram, a fuzzy narrow line of bone tissue enlightenment is visible. According to radiometry, the activity of cells in the area of bone formation was 2132 imp./s.

The patient was discharged with recovery on 28 days.

As a result of observation of patient S. for 6 months, a successful consolidation of the fracture was noted. Radiometry data amounted to 719 imp / s, which corresponded to the indicators of a healthy person.

Bibliography

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Claims (1)

A method of treating a fracture of the lower jaw, consisting of surgery and drug therapy, including selenium preparations, characterized in that selenium is administered in the form of a biological dietary supplement “Neoselen” at a dose of 250-300 mcg daily for 10 days.