RU2503415C1 - Method of estimating state of bone regenerate - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular to physiology, and can be applied for estimation of bone regenerate state in case of tibia fracture in the process of treating patients in accordance with Ilizarov. Functional load on extremity is performed by means of high-frequency Dopplerography method with carrier frequency 20 MHz 20 days after tibia fracture in conditions of extrafocal transosseous osteosynthesis of fragments. Parameters of systolic blood flow rate when pressure force is 10 and 20 kgF are compared, and if blood flow rate decreases by more than 50%, patient is given recommendation not to load injured extremity, and if blood flow rate does not increase 30%, it is recommended to patient to perform functional load on extremity while walking and healing of fracture in due time.

EFFECT: improvement of estimation method.

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Description

The invention relates to medicine, in particular to physiology, and can be used to assess the state of bone regenerate during fracture of the tibia during treatment of patients according to Ilizarov.

The state of bone regenerate can be assessed by the optical density of the x-ray (Comparative evaluation of direct and indirect computer densitometry methods of bone regenerate / L.Yu. Gorbacheva, E.V. Osipova, V.A. Schurov, etc. // The problem of osteoporosis in traumatology and orthopedics : abstract of international conference - M., 2000. - P.60-61) or ultrasonographic image of emerging bone structures in the diastasis between the fragments (Ultrasound evaluation of contact and distraction tibial regenerates / T.I. Menshchikova, T. I. Dolganov a, I.I. Martel and others // Ultrasound and functional diagnostics, 2008. No. 2. - P.117).

However, the known methods of x-ray and ultrasound methods of research are not informative in the first weeks after the injury in the absence of dense radiologically and acoustically detected bone formations in the diastasis, in helical fractures with a thin fracture line and overlapping shadow fragments of the bone fragments on the image of the regenerate zone.

An object of the present invention is to determine the state of bone regenerate by evaluating the damping properties of the resulting soft tissue fusion.

This problem is achieved by the fact that in the method for assessing the state of bone regeneration of the leg, including assessing the state of microcirculation in the regenerate using high-frequency dopplerography with a carrier frequency of 20 MHz 20 days after fracture of the tibia, in conditions of extrafocal transosseous osteosynthesis of fragments, a functional load on the limb is produced , compare the readings of the systolic blood flow velocity with readings of pressure strength of 10 and 20 kG, and if

blood flow is reduced by more than 50%, then it is contraindicated for the patient to load the damaged limb;

the blood flow does not exceed 30%, the patient is recommended a functional load on the limb when walking and a timely fracture fusion is predicted.

The invention is illustrated by a detailed description, examples and illustrations, which depict:

Figure 1 - installation diagram of a limb and a sensor; 1 - external fixation apparatus; 2 - high-frequency ultrasonic sensor; 3 - floor scales;

Figure 2 - the dynamics of blood supply to the bone regenerate with increasing functional load on the limb in patients with a fracture of the tibia.

Figure 3 - dopplerography of patient L. study of systolic blood flow in bone regenerate with increasing load on the limb.

Figure 4 - Dynamics of blood flow velocity in bone regenerate with increasing load on the limb in patient B.

The method is as follows.

A patient with a fracture of the tibia and a superimposed external fixation apparatus in a standing position sets the lower leg on a floor scale with a pressure of 10 kgf (limb weight). In this case, the skin over the fracture of the tibia on the anterolateral side of the tibia is smeared with contact gel and an ultrasonic high-frequency sensor (20 MHz) is installed, connected to a computerized complex for analyzing the received signal, for example, Mini-Max (St. Petersburg) (Figure 1). Find the location of the blood flow velocity along the arterioles and fix the sensor at this point. The sensor touches the surface of the skin with pressure, sufficient to block skin blood flow (30-50 g). Blood flow velocity is recorded.

The patient increases the pressure on the balance from 10 to 20 kG. Repeated registration of blood flow velocity. With a decrease in blood flow velocity at 20 kgf by more than 30%, we conclude that the damping properties of bone marrow are insufficient and their formation is delayed (Figure 2). The systolic blood flow velocity is compared with pressure readings of 10 and 20 kG (Table 1).

Table 1 The linear velocity of blood flow through the vessels of the regenerate (cm / s) Indicators Functional limb load (kgf) 0 10 twenty thirty Blood flow rate 5.11 5.02 4.41 4.28 Standard error ± 0.58 ± 0.70 ± 0.45 ± 0.42 Percentage change one hundred% 98% 86% 84%

If the linear velocity of blood flow through the vessels of the regenerate is reduced by more than 50%, which indicates a slower healing of the fracture, then the patient is advised not to load the injured limb, and if the blood flow velocity does not exceed 30%, then the patient is recommended a functional load on the limb when walking and predict timely fracture fusion.

The method is illustrated by the following examples.

Example 1

Patient L., 38 years old. Diagnosis: closed comminuted fracture of the bones of the right leg, fixation period of 17 days. A full comparison of fragments is determined by X-ray, the patient walks from the supporting to both limbs using crutches. The maximum permissible functional load on the damaged drumstick, determined by floor scales, is 30 kg. In order to clarify the tactics of further treatment, the patient underwent a dopplerographic study, where the systolic blood flow velocity in bone regenerate with a stepwise 10 kG increase in the limb load from 1 to 30 kG was: 5.08; 4.05; 3.96; 3.44 cm / s. (Figure 3). With an increase in load from 10 to 20 kG, the blood flow rate changed within 3%. Maintaining stable blood flow velocity indicators with an increasing load on the limb indicates the formed damping abilities of the soft tissue regenerate.

The patient recommended the functional load of the damaged limb when walking.

Example 2

Patient V., 40 years old. Diagnosis: closed screw-shaped bone fracture in the lower third of the left leg with a primary displacement of the ends of bone fragments to the width of the diaphysis. Fixation for 20 days using an external fixation device. On the roentgenogram after reposition, a complete comparison of the ends of the fragments. The patient walks with support on crutches. When conducting a test with a functional load on a damaged limb, it turned out that a painless increase in load does not exceed 20 kG. When conducting a Doppler study, the systolic blood flow velocity was found at a load of 10 and 20 kG, respectively - 8.96 and 2.7 cm / s (Figure 4), that is, a decrease in blood flow velocity by 70% was detected. The patient has delayed consolidation of bone fragments due to the fact that the formation of reticulofibrotic fusion is delayed, insufficient protection of the vascular bed from compression with an increase in axial load on the limb.

At this stage of treatment, the patient is contraindicated to load the damaged limb.

The application of the proposed method in the FSBI "RRC" WTO "them. Acad. G.A. Ilizarova showed the possibility in the early stages of treatment to evaluate the damping properties of the resulting soft tissue fusion of bone fragments and to recommend the patient a functional load on the limb when walking.

Claims (1)

A method for assessing the state of bone regeneration of the lower leg, including assessing the state of microcirculation in the regenerate using high-frequency dopplerography with a carrier frequency of 20 MHz, characterized in that 20 days after the fracture of the tibia in the conditions of extrafocal transosseous osteosynthesis of fragments, a functional load on the limb is produced, and systolic readings are compared blood flow velocity with pressure readings of 10 and 20 kG, and if blood flow velocity decreases by more than 50%, then the patient is contraindicated load a damaged limb; the blood flow does not exceed 30%, the patient is recommended a functional load on the limb when walking and a timely fracture fusion is predicted.

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