RU2599202C1 - Method of treating osgood-schlatter syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to orthopedics, and can be used for the treatment of an Osgood-Shlatter disease. To do this, in the area of the affected apophis from medial, lateral, distal and proximal sides of the tibial tuberosity, as well as from front to back in the region of maximum pain, by injection administer platelet rich autoplasma. Thus autoplasma is obtained in 10-15 minutes before the procedure and is administered in equal portions in a total dose from 2 to 3 ml.

EFFECT: method provides a low-trauma intervention, reducing the period of pain relief, acceleration of time of clinical and radiological recovery with no recurrence of the disease due to the effective stimulation of bone tissue regeneration in the knee joint as a result of revascularization, improvement of microcirculation and acceleration of metabolism of the tissues.

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Description

The invention relates to the field of clinical medicine and can be used to treat osteochondropathy of the tibial tuberosity - Osgood-Schlatter disease.

Osteochondropathy is a group of diseases characterized by a peculiar change in the apophyses of the short and epiphyses of the long tubular bones, enchondral ossification of the bones of the hand and foot, spine, less often than other growing bone structures, accompanied in most cases by a successive change in necrosis, resorption or rejection of the damaged bone parts and subsequent restoration of bone structure and subsequent restoration . Involvement in the pathological process of articular cartilage leads to impaired joint function. Osteochondropathy occurs mainly in childhood and adolescence (Nekachalov V.V. Pathology of bones and joints / St. Petersburg, 2000. P. 158; Volkov M.V., Gorbunova R.L. Osgood-Schlatter disease // Medical sister. - 1966. - No. 25 (2). - S. 7-9; Volkov M.V., Ter-Egiazarov T.M. Orthopedics and traumatology of childhood. M., 1983. P. 273). One of the most common osteochondropathies in children is Osgood-Schlatter’s disease (synonyms: aseptic necrosis of the tibial tuberosity, osteochondropathy of the tibial tuberosity) (Abalmasova EA Osteochondropathy // Children's arthrology. M., 1981. P. 284-294 ; Isakov Yu.F. Surgical diseases of childhood. M: Geoetar-Med, 2004, - T. 2. - S. 264-265).

The current methods of surgical treatment of Osgood-Schlatter disease are traumatic, insufficiently substantiated from the point of view of the pathogenesis of the disease and do not significantly reduce the treatment and rehabilitation time compared to conservative therapy in patients with this pathology. This disease is relatively well amenable to conservative treatment, has a benign course and a favorable prognosis (Volkov M.V., Ter-Egiazarov T.M. Orthopedics and traumatology of childhood. M., 1983. P. 273; Isakov Yu.F. Surgical diseases childhood), M .: Geeotar-Med, 2004, - T. 2. - S. 264-265). However, the main problem for both the patient and the doctor is the duration of the course of the disease, ranging from several months (at least six) to several years (in some cases up to two years). The long course of the disease necessitates the limitation of physical activity for a long period of time (from 6 to 24 months) (Lekishvili M.V., Tarasov N.I., Vasiliev M.G. et al. Results of the clinical use of demineralized lyophilized bone implants in cases of treatment skeleton defects in children // Pediatric Surgery, 2002, No. 4. P. 17-21). This fact is of particular importance given the fact that Osgood-Schlatter disease occurs in 12.9% of adolescents who are actively involved in sports (V.G. Klimovitsky et al. Experience in the conservative treatment of Osgood-Schlatter disease in adolescent athletes // Sports Medicine, 2013. No. 1. P. 78-80; Lazerte GD, Rapp HH: Pathogenesis of Osgood-Schaltter's Disease // Am J Pathol. 2000, No. 34. P. 803-815). For this category of patients, the question of the need to reduce treatment time is most relevant, which forces us to constantly look for new, more effective treatment methods. The use of traditional methods of treatment in some cases does not significantly reduce the time of treatment and rehabilitation.

A search in the medical, scientific and patent literature found various methods for treating Osgood-Schlatter disease.

Known methods for treating Osgood-Schlatter disease by perforation of the tuberosity and adjacent areas of the tibia (application No. 20022132772, publ. 05.12.2002), as well as applying osteoperforation by radiation of a diode infrared laser (RF patent No. 2280417, publ. 04.20.2006 )

However, these methods are also quite traumatic, require immobilization, and the mechanical creation of channels in the bone is an ineffective means of stimulating bone tissue regeneration.

Also known is a puncture method for the treatment of osteochondropathy of the apophyses with the introduction of a polymer composite implant containing calcium gluconate, orotic acid and lyophilisate of embryonic bones into the pathological focus (application No. 2001127281, published June 27, 2003). However, this method is complicated due to the need to obtain a demineralized bone graft, as well as a lyophilisate of embryonic tissues, and carries a known risk of developing allergic reactions and infection of the patient due to the need to introduce foreign biological material. It should also be noted the significant morbidity of interventions, the need for general anesthesia to perform surgical intervention, the use of osteotropic antibiotics in the postoperative period.

Also known is a method comprising chiseling with a chisel tuberosity bit, applying several perforations to it, fixing the tuberosity with a screw or driving bone autografts into it (application No.2010135722, publ. 10.03.2012). At the first stage of treatment, transcutaneous perforation of the tuberosity is performed, and in the absence of effect, they cut off their own ligament of the knee, curettage of the dystrophic lesion in the tuberosity and suture their own ligament of the patella with a transossal suture to the tibial crest just below the previous attachment site.

The disadvantages of the above methods of treatment include trauma and the need for prolonged immobilization.

An interesting method is the conservative treatment of Osgood-Schlatter disease, which consists in the introduction of naturopathic drugs (Cel-T, Traumel-S) to the most painful points, combining the parenteral administration of drugs with physiotherapy and massage courses (V.G. Klimovitsky and others. Experience of conservative treatment of the disease Osgood-Schlatter among adolescent athletes // Sports Medicine, 2013, No. 1. P. 78-80).

The closest in technical essence and the achieved effect to the claimed method is the prototype method of surgical treatment of aseptic necrosis of the tibial tuberosity (Osgood-Schlatter disease), protected by RF patent №2338477. The essence of the method consists in the fact that after performing local anesthesia under the damaged apophysis, from the medial and lateral side of the tibial tuberosity, the patient is injected with a composite implant - CollapAn-G gel in a volume of 0.5-1.0 ml on each side. Local anesthesia is performed by administering a 1% solution of novocaine. Patients under the age of 10-12 years old are injected with 0.5 ml of the implant on each side, and at the age of 12-16 years - 1 ml of the implant on each side. Patients are limited physical activity for 2-4 months under radiological control. According to the authors of the patent, this method allows you to stop the pain syndrome within 7-15 days, note positive radiological dynamics after 1 month, and the patient's clinical recovery is noted after 4 months.

The disadvantages of this method of treating Osgood-Schlatter disease are the duration of treatment, the complexity of the procedure, the need for local anesthesia with 1% novocaine, which can cause an allergic reaction, the duration of the pain syndrome after the procedure, and the possibility of developing an allergic reaction to the drug CollapAn-G itself.

The objective of the present invention is to improve the quality and effectiveness of the treatment of Osgood-Schlatter disease by providing low invasiveness of the intervention and effectively stimulating the bone tissue regeneration process due to revascularization and improving microcirculation, accelerating the metabolism and regenerative processes in the knee joint, reducing the period of relief of pain and accelerating the duration of the clinic X-ray recovery, as well as the absence of relapse of the disease.

The technical result, objectively manifested in the application of the proposed method for the treatment of Osgood-Schlatter disease, is to reduce the time to relieve pain, reduce the time of clinical and radiological recovery and the absence of relapse of the disease.

The technical result is achieved by the fact that in the region of the tibial tuberosity, the patient is once injected with autologous material that stimulates osteogenesis. As such material, platelet-rich blood plasma stimulating osteogenesis can be used (Deikalo V.P., Mastykov A.N., Boloboshko K.B. Platelet-rich plasma in the treatment of diseases and injuries of the musculoskeletal system // Bulletin of the Vitebsk State Medical University, 2011, volume 10, No. 4, p. 7).

The method is as follows.

To obtain platelet-rich autoplasma, 15.5–14 ml of blood are taken from a vein 15–14 min before manipulation into a disposable syringe with a capacity of 20 ml containing 1.5 ml of sodium citrate anticoagulant. Then the blood is placed in a test tube and centrifuged on a rotary centrifuge for 4 minutes at 3600 rpm. The autoplasma obtained in the supernatant is subjected to a second centrifugation for 2-4 minutes at 3600 rpm. After this, a platelet-rich autoplasma in the amount of 2-3 ml is removed with a 5 ml disposable syringe. After treating the surgical field with an antiseptic and determining the point of maximum pain, the patient is injected with platelet-rich autoplasma by injection into the area of the affected apophysis from the medial, lateral, distal and proximal sides, as well as from front to back in the area of maximum pain. The introduction is carried out once, in a volume of 0.4-0.6 ml on each side. The injection sites are treated with an antiseptic and closed for a day with an aseptic sticker. Anesthesia and immobilization of the limb in the postoperative period is not required.

Patent studies have not revealed methods of treating Osgood-Schlatter disease characterized by the claimed combination of features, therefore, it can be assumed that this method meets the criterion of "novelty."

The use of a combination of distinctive features is also unknown, which indicates compliance with the criterion of "inventive step".

The inventive method can be carried out in any medical institution, therefore, it meets the criterion of "industrial applicability".

The use of this method for the treatment of Osgood-Schlatter disease is illustrated by examples from clinical practice.

Example 1. Patient M., 13 years old, played football for 4 years. In 2011, pain appeared after physical exertion in the upper third of the left tibia. Over time, he noted an increase in the nature of pain, the pain appeared with little physical exertion - flexion and extension in the knee joint, intensified during physical exercises and walking up the stairs, as well as when resting on the knee joint. Outpatient in the clinic at the place of residence conservative treatment was carried out, without effect. Upon admission to the Department of Traumatology of the Children's General Hospital of Taganrog, a dense, painful swelling was revealed below the patellar ligament above the tuberosity of the left tibia, painful on palpation and percussion. Pain was noted when moving in the left knee joint (90 mm on the VAS scale). The functions of the knee joint were impaired (Leken index - 12 points).

The patient underwent a puncture method of treatment with the introduction of a platelet-rich autoplasma into the lesion site as described above.

After the surgical field was treated with an antiseptic and the maximum pain area was determined, the patient was injected with platelet-rich autoplasma by injection into the area of the affected apophysis from the medial, lateral, distal and proximal sides, as well as from front to back in the area of maximum pain. A platelet-rich autoplasma was injected once in a volume of 0.4-0.6 ml on each side. The injection sites were treated with an antiseptic and closed for a day with an aseptic sticker. Anesthesia and immobilization of the limb in the postoperative period was not required. 30 minutes after the injection, the patient was released home for further treatment on an outpatient basis.

In the early period after the injection of platelet-rich autoplasma, the patient complained of mild pain, stopped after a few hours, analgesic drugs were not used. There were no allergic reactions. The night was calm. There were no manifestations of hyperthermia. Within 3 days after the injection, the swelling in the upper third of the left leg decreased significantly, the intensity of the pain syndrome decreased on the second day (from 90 mm to 10 mm on the VAS scale). Knee function recovered 7 days after the injection (Leken index changed from 12 to 3 points in 7 days). During the follow-up examination after 1 month of edema in the apophysis, there was no tuberosity of the left tibia, palpation and percussion of this area were painless. Movement in the left knee joint without pain and in full. Indications for further limitation of physical activity were not identified.

Example 2. Patient G., 10 years old. In 2013, pain appeared after physical exertion in the upper third of the left tibia. The pain intensified during physical exertion. Outpatient in the clinic at the place of residence conservative treatment was carried out, without effect. Upon admission to the Department of Traumatology of the Children's General Hospital of Taganrog, a dense, painful swelling was revealed below the patellar ligament above the tuberosity of the left tibia, painful on palpation and percussion. Pain was noted when moving in the left knee joint (80 mm on the VAS scale). The functions of the knee joint are impaired (Leken index - 10 points).

The patient underwent a puncture method of treatment with the introduction of a platelet-rich autoplasma into the lesion by the claimed method. After the surgical field was treated with an antiseptic, the patient was injected with platelet-rich autoplasma by injection into the area of the affected apophysis from the medial, lateral, distal, proximal sides of the tibial tuberosity, as well as from front to back in the area of maximum pain. A platelet-rich autoplasma was injected once in a volume of 0.4-0.6 ml on each side. The injection sites were treated with an antiseptic and closed for a day with an aseptic sticker. Anesthesia and immobilization of the limb in the postoperative period was not performed. After the injection, the intensity of the pain syndrome decreased on the second day (from 80 mm to 0 mm on the VAS scale). Knee function recovered 5 days after injection (Leken index changed from 10 to 0 points in 5 days). During the control examination 1 month after the treatment carried out by the proposed method, there is no edema in the apophysis of the tuberosity of the left tibia, palpation and percussion of this area are painless. Movement in the left knee joint without pain and in full. Indications for further limitation of physical activity were not identified.

Thus, the claimed method for the treatment of Osgood-Schlatter’s disease with the use of platelet-rich autoplasma stimulating reparative osteogenesis allows for low invasiveness of the intervention, reduces the time to relieve pain, helps to quickly restore the structure of the affected area of the bone, does not require the patient to be hospitalized, can significantly improve the results treating patients with this pathology, reduce rehabilitation time and improve the quality of life. Clinical trials indicate the effectiveness of this method of treatment.

Claims (1)

A method of treating Osgood-Schlatter disease, including the introduction of platelet-rich autoplasma, obtained 10-15 minutes before the procedure, by injection into the affected apophysis from the medial, lateral, distal and proximal sides of the tibial tuberosity, as well as from front to back in the area of maximum pain, autoplasma is administered in equal parts in a total dose of 2 to 3 ml.