RU2454188C1 - Method of drainage in case of osteomyelitis of bodies of lumbar vertebrae - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to spine surgery, and can be applied in case of osteomyelitis of bodies of lumbar vertebrae. Essence of method lies in drainage with application of silicone perforated tube. Drainage tube is preliminarily perforated in the middle third. Tube diameter is selected from 4 to 6 mm. Tube is passed by means of metal conductor through puncture of right lateral parts of fibrous ring on the edge of transverse process, on the right. Tube is laid in such a way that openings are on the wound bottom. Free end of tube is passed out through separate cut. Wounds are sutured tightly.

EFFECT: application of claimed invention will ensure reduction of higher intra-wound and intra-tissue pressure, outflow of serous-purulent exudate and sufficient mechanical cleaning of wound.

1 dwg, 1 ex

Description

The invention relates to medicine and can be used in clinical practice.

A known method of drainage with gauze swabs, including the use of gauze swabs to delimit the area of operation or the site of the disaster from the rest of the cavity.

The disadvantage of this method is the rapid loss of suction properties (within 6-8 hours), as a result of which the tampon can become a kind of plug that clogs the wound and disrupts the outflow of exudate from it (Kaplan A.V., Makhson N.E., Melnikova V. M. - “Purulent traumatology of bones and joints.” - Moscow. “Medicine”, 1985, p.138) In addition, frequent swab changes are required, which leads to soft tissue injury.

A known method of vacuum drainage according to Redon. The essence of this method is to bring the perforated tube to the wound cavity and create negative pressure in the wound cavity (due to cans with a warm solution or accordion) (V.I. Maslov. “Minor surgery.” - Moscow. “Medicine”, 1988. p. 86).

A significant drawback of using this method for purulent diseases of the spine is the lack of mechanical cleansing of the wound surface, the possibility of reverse casting of the discharge.

A known method of tubeless closed suction-washing drainage. The basis of the method is a double-lumen tube for infusion over a microchannel and aspiration over a wide channel. The fluid flows continuously, it fills the cavity and is sucked into the suction channel. For washing, it is necessary to create a free water cavity around the capture tube and eliminate the suction effect (Gulman M.I., Yu.S. Vinnik, S.V. Miller, S.V. Yakimov, G.E. Karapetyan, O.V. Anishina , D.V. Popova, O.S. Meshkova. - “Atlas of drainage in surgery.” - Krasnoyarsk, 2004, p. 18) In our opinion, the disadvantages of this method are obturation of the tube for 2-3 days with fibrin, dendrite blood clots.

The closest method is the active flow-washing drainage with two silicone tubes discharged through separate sections. According to one of them, the fluid is administered continuously throughout the day, and the other to remove it (Gostishchev VK, "Purulent Surgery Surgery. Guides for Doctors." - Moscow, Medicine, 1996, p. 25).

The method has several disadvantages:

- the output tube, which should be located at the bottom of the wound, forms an arc directed with the top up, which complicates the passive outflow of the discharge;

- clogging of the drainage system with fibrin, dendritis, blood clots and, as a result, difficulty washing;

- no negative pressure is created in the wound cavity;

- the risk of tubes falling out during patient activation. As a result, its use in osteomyelitis of the lumbar vertebral bodies will not meet the requirements.

The objective of the invention is the removal of increased intra-wound and interstitial pressure, the outflow of serous-purulent exudate, mechanical cleaning of the wound with osteomyelitis of the lumbar vertebral bodies.

The problem is solved in that a drainage tube with a diameter of 4 to 6 mm previously perforated in the middle third is carried out using a metal conductor through a puncture of the right lateral sections of the fibrous ring along the edge of the transverse process, on the right, so that the perforated part of the tube is at the bottom of the wound.

Schematically, the method is presented in the figure, where 1 is a bottle with a washing liquid; 2 - perforated silicone drainage tube; 3 - the right side sections of the fibrous ring; 4 - holes of the drainage tube; 5 - output end of the silicone drainage tube; 6 - bottle for collecting washing liquid with an antiseptic solution.

The method is as follows.

After the implementation of surgical access (left-sided pararectal), revision, necrectomy and sanitation of the purulent focus, a wound cavity is formed. Using a metal conductor (not shown) through a puncture of the right lateral sections of the fibrous ring 3, a silicone drainage tube 2 pre-perforated in the middle third is drawn with a 2 to 4 mm diameter 6 mm towards the top of the transverse process of the vertebra so that the pointed end of the conductor extends along the edge of the transverse process, on the right. Why make an additional incision. The tube 2 is installed so that the hole 4 is at the bottom of the wound. The free end of the tube 2 is removed through a separate incision and fixed with sutures to the skin. Wounds are sutured tightly. A disposable system and a flushing fluid bottle (0.9% saline) are connected to the upper end of the tube 2. The lower end 5 is lowered into a jar 6 with an antiseptic solution. The rate of administration of 60 drops per minute is optimal for creating negative pressure in the wound. The drainage system is removed after 12-14 days (until the appearance of purified wash water).

The proposed drainage was used by us on 21 patients with chronic and acute forms of osteomyelitis at the level from LII to LIV.

Example 1. A 24-year-old patient was operated on for: Osteomyelitis LIII-LIV, discitis, pathological fracture of LIII bodies, LIV vertebrae with spinal stenosis and impaired spinal cord conduction. An operation was performed in the amount of anterior decompression of the spinal canal due to necrsecvestrectomy at the level of LIII-LIV. Indications are established and drainage is carried out by the above methods. The wound is sutured in layers tightly.

The postoperative period was uneventful. Healing by first intention. Drainage was removed on the 12th day (after the appearance of clean wash water, normalization of body temperature). The patient is activated from the first days after surgery. Discharged in satisfactory condition.

The method fully meets the basic requirement of drainage, spared the disadvantages inherent in the above methods. It is possible to achieve purulent cavity washing while creating negative pressure and aspirating purulent exudate. With a decrease in the clearance of the outlet end of the tube, increased pressure is created in the wound cavity, which can be used for excessive bleeding of tissues.

Claims (1)

A method of drainage for osteomyelitis of the lumbar vertebral bodies, including the use of a silicone perforated tube, characterized in that a drainage tube with a diameter of 4 to 6 mm previously perforated in the middle third is carried out using a metal conductor through a puncture of the right lateral sections of the fibrous ring along the edge of the transverse process, to the right, so that the perforated portion of the tube is at the bottom of the wound.

Images