RU2429794C1 - Method of surgical management of nonunion fractures and false joints of long bones - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method includes providing an approach followed by decortication within an injury of repair osteogenesis throughout 2/3 perimetres of a bone tube, implantation of CollapAne granules in a split of a coritical layer. The decortication covers a healthy bone tissue in proximal and distal directions from a consolidation disturbance area to bleeding segments. Along the whole length of a decorticated segment, there are 3-8 longitudinal lines of holes. A drill of the diameter 2.0 mm is used. The hole depth reaches an opposite coritical layer. Then they are transformed in longitudinal channels spaced 2.0-2.5 mm. Then the channels are filled with CollapAne gel.

EFFECT: higher clinical effectiveness in false joints and nonunion fractures of long bones.

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Description

The invention relates to medicine, in particular to surgery, and may find application in the treatment of pseudoarthrosis and non-congested fractures of long bones with a satisfactory position of bone fragments.

There is a method of treating delayed consolidation, non-overgrown fractures and false joints of long bones by decortication in combination with spongy autologous bone grafting (Müller M.E., Algover M., Schneider R., Willinger X. Guide to internal osteosynthesis. M .: 1996, p. .721). Soft tissue is dissected to the bone (along with the periosteum). A longitudinal section of the periosteum is converted into a T - or H-shaped. Using a bit through a longitudinal section of the periosteum, the cortical layer of the bone is split for 2/3 of its circumference. The spongy bone taken from the ileal crest of the patient after mechanical treatment (grinding, etc.) is placed in the splitting of the cortical layer of the bone in the area of the main surgical intervention. Sutures are applied to the soft tissue in such a way that transplanted bone tissue is clamped in the splinter of the cortical layer. Plastic surgery can be combined with one or another variant of osteosynthesis depending on the type of false joint or fracture. In the postoperative period, antibiotics are prescribed to prevent infectious complications.

The disadvantages of this method are:

1) an operation to take autobone from a donor site;

2) the need for mechanical preparation of the taken autobone for plastic surgery (fitting to the bed, grinding, etc.);

3) the duration of surgery;

4) a high likelihood of developing an infection due to the lengthening of the time of the operation;

5. The need for mandatory use of antibiotics in the postoperative period.

There is also known a method of treating false joints and non-congested fractures of long bones, which consists in dissecting soft tissues to the bone, isolating a false joint or non-congested fracture subperiostally, performing decortication for 2/3 of the perimeter, and KollapAn granules are implanted into the cortical layer. The split-off plates of the cortical layer are pressed to their bed using ligatures held around the bone. In the event of a bone defect in the area of the pseudoarthrosis, KollapAn is additionally placed in the form of plates, overlapping the defect zone. Soft tissue is sutured along with the periosteum. For three days before surgery, patients are prescribed Wobenzym 5-6 tablets three times a day, followed by a dose reduction to 3-5 tablets within 5-6 days after surgery, which ensures bone formation and reduces postoperative complications (RF Patent No. 2172146 , “A method for the treatment of non-overgrown fractures and false joints of long bones”, authors: Musalatov H.A., Germanov V.G., Gordeev G.G., Invention Bulletin No. 23, 2001).

The disadvantages of this method are:

1) a possible splitting of the detachable cortical layer at the time of osteotomy, which complicates the further fixation of CollapAn granules in the cleft of the cortical plate;

2) a decrease in the effectiveness of the operation in cases of a significant decrease or complete absence of blood circulation in the cortical layer in the zone of violation of reparative processes.

The objective of the invention is to increase the effectiveness of surgical treatment of pseudoarthrosis and non-consolidated fractures of long bones in conditions of reduced or complete absence of cortical circulation in the zone of impaired reparative processes due to blood flow from neighboring healthy sections of the bone tube.

The problem is solved by the method of surgical treatment of non-congested fractures and false joints of long bones, including creating access, decortication in the area of reparative osteogenesis disturbance for 2/3 of the perimeter of the bone tube, implantation of CollapAn granules into the cortical layer, characterized in that they capture healthy bone during decortication tissue in the proximal and distal directions from the zone of violation of consolidation to the appearance of bleeding sites (at least 2.0-2.5 cm), along the entire length of the decorticated of the site create 3-8 rows of holes with a drill with a diameter of 2.0 mm deep to the opposite cortical layer, turn them into longitudinal channels with a distance between them of 2.0-2.5 mm, which are filled with KollapAn gel.

The method is as follows. Dissect the soft tissue to the bone. A longitudinal section of the periosteum is turned into an H-shaped. A corticotomy is performed in the area of pseudarthrosis or non-fused fracture along 2/3 of the perimeter of the bone tube in the proximal and distal directions, extending the boundaries of the healthy bone by at least 2.0-2.5 cm, to bleeding areas. Over the entire length of the thus treated area, using a drill with a diameter of 2.0 mm, 3-8 (depending on the bone diameter) rows of holes are created with a depth of up to the opposite cortical layer and the longitudinal rows of holes are turned into longitudinal channels. The distance between the channels should be between 2.0-2.5 mm. CollapAn granules are implanted around the perimeter of the cortical plate. Channels are filled with CollapAn in gel release form. Soft tissue is sutured in a single block with the capture of the periosteum.

Intermedapatite CollapAn is a biosynthetic nanostructured material for bone grafting based on collagen, hydroxyapatite and antibiotic. A variant of the antibiotic that is part of the material is determined by clinical indications.

Clinical example.

Patient X., 42 years old, was admitted to the traumatology department of City Clinical Hospital No 7 with a diagnosis of an overgrown fracture with / 3 - in / 3 of the left tibia. Injury (open fracture of both bones of the left tibia) 9 months ago as a result of falling from a stepladder and hitting the lower leg with a left tibia. He was treated by skeletal traction in one of the hospitals. Suppuration of the wound was noted. Discharged in a graduated plaster cast with a satisfactory position of bone fragments. The wound was healed on an outpatient basis. In Anamnesis vitae alcoholism, syphilis. Regarding the latter, two weeks before admission, a course of antibacterial therapy is completed. Clinically, in the projection of the fracture, there is an inverted scar up to 2.0 cm in diameter and mild pathological mobility. Radiographically, a gap remains between the bone fragments against the background of hypertrophy of the articulating surfaces. The patient performed the following operation. In the projection of the fracture, soft tissues were dissected to the bone, the longitudinal section of the periosteum was turned into an H-shaped, corticotomy (decortication) was performed on 2/3 of the perimeter of the bone tube in the proximal and distal directions, stepping beyond the border with a healthy bone by at least 2.5- 2.0 cm, to bleeding sections of the bone tube. Within the length of the decorticated area, six longitudinal rows of holes with a depth of up to the opposite cortical layer were created with a drill 2 mm in diameter, which were turned into longitudinal channels located at a distance of 2 mm between each other. CollapAn granules were implanted around the perimeter of the cortical plate. The longitudinal channels were filled with KollapAnom-gel. CollapAn was saturated with blood from freshened bones and due to blood flow from neighboring healthy areas of the bone tube. Osteosynthesis was not performed. Soft tissue was sutured in a single block with the capture of the periosteum. Immobilization with a cast plaster bandage from the toes to the s / 3 thighs, reinforced by removing stitches with circular rounds of plaster bandage. The postoperative period is smooth. In the postoperative period, antibiotics were not prescribed. 4.0 months after the operation, the clinical and radiological picture of complete consolidation. The patient moves without the aid of crutches.

This method of treatment was used in three patients aged 42 to 54 years. The consolidation periods ranged from 4.0 to 5.5 months. Infectious complications were not observed in any case. The proposed method is more effective due to the connection of the detachable cortical plate with the periosteum, which prevents splitting of the detachable layer and facilitates the fixation of CollapAn granules in the splitting, as well as due to the additional blood flow to the area of reparative osteogenesis disturbance from neighboring healthy sections of the bone tube. The proposed method, if necessary, can be combined with any type of osteosynthesis. There is no need to use Wobenzym in the pre- and postoperative period and there is no need for antibiotic therapy in the postoperative period, which reduces the cost of treatment.

Claims (1)

A method for the surgical treatment of non-accrued fractures and false joints of long bones, including creating access, decortication in the zone of reparative osteogenesis disturbance for 2/3 of the perimeter of the bone tube, implantation of CollapAn granules into the cortical layer, characterized in that during decortication they capture healthy bone tissue in the proximal and distal directions from the zone of violation of consolidation to the appearance of bleeding sections, 3-8 rows of longitudinal rows of holes are created along the entire length of the decorted section with a drill with a diameter of 2.0 mm deep to the opposite cortical layer, turn them into longitudinal channels with a distance between them of 2.0-2.5 mm, which are filled with KollapAn gel.