RU2463986C2 - Method of stimulating reparative processes in treatment of intraarticular fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to traumatology, and deals with elaboration of problems of treating traumatic affection of joints. Results, carried out in experiment, make it possible to suggest the following method of treating intraarticular fractures. Immobilisation of joint with recovery of anatomically correct interrelationship, stabilisation and further training movements in joint by means of apparatus of external fixation are performed. After recovery of anatomically correct interrelationship, not later than 3 days after trauma, joint surfaces are brought apart for the width which up to 50% exceeds the width of joint space of unaffected joint. During 4-5 days 24-hour drop-by-drop introduction of 0.9% sodium chloride solution into joint cavity is performed. Simultaneously one time per day freshly prepared solution consisting of 40% glucose solution, 5% ascorbic acid solution and autologic blood plasma, taken in volume ratio 1:2:7.

EFFECT: method ensures considerable reduction of fracture treatment terms in comparison with such treated by method of tranosseous osteosynthesis with application of apparatuses of external fixation due to enhancement of reparative regeneration processes.

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Description

The invention relates to medicine and can be used in the treatment of traumatic injuries of joints.

A known method of stimulating reparative chondrogenesis in case of intraarticular bone-cartilage injuries, comprising introducing into the joint cavity, into the disturbance zone of the integumentary cartilage and subchondral bone of a fibrin clot obtained from autologous blood (Application No. 98114560/14, publ. 07.27.1998).

The disadvantage of this method is its complexity and complexity of controlling the position of the fibrin clot after it is placed in the area of damage.

A known method of treating joint pathology in animals, which involves immobilizing a joint with restoring anatomically correct relationships using an external fixation apparatus, evacuating the contents of the joint cavity, injecting medications into the joint zone, stable fixation and subsequent development of joint movements (Application No. 2008152874/21, publ. . 07/10/2010).

However, drug therapy in the known method is aimed at sequentially eliminating the effects of traumatic lesions of bone and cartilage. This increases the duration of treatment due to both the duration of restoration of the integrity of damaged anatomical structures and the associated need for immobilization of the joint, and due to the increase in the timing of the subsequent restoration of its function.

The objective of the invention is to reduce the treatment time.

This problem is solved by the fact that in the method of stimulating reparative processes in the treatment of intraarticular fractures, including immobilization of the joint with the restoration of anatomically correct relationships, the introduction of medications into the joint cavity, stabilization and subsequent development of movements in the joint using an external fixation apparatus, after restoration of the anatomically correct relationships , no later than 3 days after the injury, dilute the articular surfaces to a width of up to 50% greater than the width of the su of the intact joint gap, and within 4-5 days, a round-the-clock drip is introduced into the joint cavity of a 0.9% sodium chloride solution and, at the same time, once a day, a freshly prepared solution consisting of 40% glucose solution, 5% solution ascorbic acid and autologous blood plasma taken in a volume ratio of 1: 2: 7.

The invention is illustrated by a description, an example of experimental use and illustrative material, which shows:

figure 1 - x-ray of the left hip joint before dismantling the apparatus for 14 days after surgery;

figure 2 - microphoto histological section of the acetabulum in the area of fusion of fragments obtained on the 14th day after the operation, stained with hematoxylin and eosin, vol. 10, approx. 10;

figure 3 - microphotological histological section of the articular lining of the acetabulum in the area of damage received on the 14th day after surgery, stained with hematoxylin and eosin, about. 10, approx. 10.

The method is as follows.

In the operating room, after anesthesia and treatment of the surgical field, osteosynthesis of the affected joint is performed with an external fixation device. When it is performed by known methods, the fixing elements - knitting needles and / or screw rods - are carried out (or cantilevered) at several levels in adjacent adjacent bone segments adjacent to the affected joint. The free ends of the clamps are mounted on the supports of the apparatus, which are connected with each other with the help of threaded rods and hinged nodes with the possibility of a dosed multi-plane movement and rotation.

If necessary, by displacing the supports of the apparatus and, accordingly, fixed segments of the limbs or their fragments, the anatomically correct relationships of the components of the joint are restored. After the restoration of the anatomically correct relationship of the affected joint, its articular surfaces are bred by an amount no more than half the normal width of the joint space. In this case, the criterion is to choose the width of a healthy paired joint or focus on the average dimensions of the joint gap.

Then, a catheter is inserted into the joint cavity expanded in this way, orienting and immersing its working end to the site with the most pronounced pathological changes. To visualize the process of installing a catheter, a mandrel made of radiopaque material is used. The free end of the catheter is fixed on one of the supports of the apparatus adjacent to the joint zone. Simultaneously with the catheter, a drainage system is installed and, in the presence of pathological contents in the articular cavity (blood, exudate, transudate, gases, etc.), it is partially or completely evacuated.

Further, if osteosynthesis is performed no later than 3 days after the injury, then within 4-5 days, a 0.9% solution of sodium chloride is injected 24 hours a day into the joint cavity and, at the same time, once a day, a freshly prepared solution of 40 % glucose solution, 5% solution of ascorbic acid and autologous blood plasma, taken in a volume ratio of 1: 2: 7.

Upon completion of the course of the introduction of these solutions, the catheter is removed under sterile conditions and the width of the joint gap is normalized by the approach of the apparatus supports. In the future, a stable fixation of the joint is carried out until the integrity of its components is restored. At the same time, active-passive movements with a gradually increasing amplitude can be developed in it. At the end of treatment, the apparatus is dismantled.

The practical use of the method is illustrated by the following experimental observation.

In sterile conditions, after preparing the surgical field for the dog, a model of the transverse fracture of the acetabulum of the left hip joint was obtained.

To restore the integrity and function of the joint, the animal underwent closed osteosynthesis with an external fixation apparatus. By displacement of the apparatus supports, a simultaneous reposition of fragments of the left acetabulum and centering of the femoral head were performed. After that, the articular surfaces were bred by 0.7 mm, which was approximately 50% greater than the width of the joint gap of the right hip joint.

Then a catheter was inserted into the articular cavity, bringing its working end to the acetabular fracture zone. When a catheter was installed, the presence of blood was revealed, which was pumped out, and the joint cavity was washed with a 0.9% sterile solution of sodium chloride. To visualize the catheter installation process, a mandrin made of radiopaque material was used. The free end of the catheter was fixed on one of the supports of the apparatus adjacent to the joint zone. The operation was completed by performing control radiography and stabilization of the apparatus systems.

Immediately after the operation, within 5 days, round-the-clock drip was introduced into the joint cavity of 0.9% sodium chloride solution. Simultaneously, 0.5 ml of a freshly prepared solution consisting of 40% glucose solution, 5% ascorbic acid solution and autologous blood plasma, taken in a volume ratio of 1: 2: 7, was administered once a day.

At the end of the course of drug therapy, the catheter was removed under sterile conditions and the width of the joint gap was normalized by the approach of the apparatus supports. Subsequently, until the apparatus was dismantled, active-passive movements in the left hip joint were developed in the range of flexion-extension, abduction-reduction, external and internal rotation with a gradual increase in the amplitude of movements.

Radiologically and clinically, on the 14th day after the operation, consolidation of fragments of the acetabulum was noted, which served as the basis for the dismantling of the apparatus (Fig. 1). The histological studies confirmed the achievement of complete bone fusion of the fragments (figure 2) and restoration of the articular lining of the acetabulum in the damage zone (figure 3).

The method was used in the treatment of 43 experimental animals with intraarticular injuries (17 knee and 26 hip joints), the age of which ranged from 1 year to 3 years, body weight ranged from 5.5 to 28 kg. The terms of their anatomical and functional recovery amounted to 14-21 days, which is on average 30-50% less than when treating similar injuries by transosseous osteosynthesis using external fixation devices.

Using the proposed method in the RRC "WTO" them. Acad. G.A. Ilizarova showed that its use provides a significant reduction in the treatment time for intraarticular fractures, as well as the duration of experimental work on the study of tissue regeneration in conditions of transosseous osteosynthesis.

Claims (1)

A method of stimulating reparative processes in the treatment of intraarticular fractures, including immobilization of the joint with the restoration of anatomically correct relationships, the introduction of medications into the joint cavity, stabilization and subsequent development of movements in the joint using an external fixation device, characterized in that after restoration of the anatomically correct relationships, no later than 3 days after the injury, the joint surfaces are diluted to a width up to 50% greater than the width of the joint space damaged joint, and for 4-5 days, round-the-clock drip is introduced into the joint cavity of a 0.9% sodium chloride solution and, at the same time, once a day, a freshly prepared solution consisting of a 40% glucose solution, 5 % solution of ascorbic acid and autologous blood plasma taken in a volume ratio of 1: 2: 7.

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