RU2669461C1 - Method for treatment of paraprosthetic infection - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely, operative traumatology and orthopedics. Method for treating a paraprosthetic infection, comprising firstly rinsing the wound by inserting an antiseptic or antibacterial drug through a supply drainage tube and removing wound fluid through the outflow drainage tube into the external environment. In this case, the initial washing of the wound is performed automatically after a predetermined time after the initial wound washing, which is necessary for the formation of physical and chemical parameters of the environment under the influence of the microflora of the wound. Before removing wound fluid, the following actions are also automatically performed: filtration of the wound fluid, measurement of its physicochemical parameters: pH, oxygen concentration, temperature, pressure, potential, the corresponding sensors, and analysis of these parameters. Wash the wound with saline by inserting it through the supply drainage tube and remove wound fluid through the drainage tube. Simultaneously, administer drug with a physiological solution at a concentration sufficient for the manifestation of the effect of the drug to the wound, after a predetermined time, sufficient for the manifestation of the effect of the drug after its administration with physiological solution into the wound – the filtration of the wound fluid. Its physical and chemical parameters are measured by the corresponding sensors. In the absence of a characteristic of the antibacterial effect of the drug, changes in one or more physicochemical parameters of the wound fluid relative to the previous value of the corresponding parameter, wound is washed with saline by inserting it through the supply drainage tube and removing wound fluid through the drainage tube. Administration of another drug with physiological solution at a concentration sufficient for the manifestation of the effect of the drug is carried out until the next drug is detected with corresponding changes in the parameters of the wound fluid. When changes are detected, the same drug is continued simultaneously with the physiological solution until the wound is healed, and it is clinically determined. In this case, during treatment, the values of the parameters of wound fluid are automatically recorded in order to allow the doctor to control the result of the treatment.EFFECT: method makes it possible to increase the efficiency of treatment of paraprosthetic infection.1 cl, 1 dwg

Description

The invention relates to medicine, namely to operative traumatology and orthopedics, and can be used in the treatment of paraprosthetic infection, in particular infectious complications arising after arthroplasty of large joints, for example, knee or hip, as well as other infectious complications and processes, including . gunshot wounds.

Currently, the following methods for treating a prosthetic infection are known.

The methods described in the Guide to hip replacement / ed. P.M. Tikhilova, V.M. Shapovalova. - SPb .: RNIITO named after P.P. Vredena, 2008 .-- p. 277-286) suggest surgical treatment of the infection. When determining surgical tactics in the case of the established fact of a paraendoprosthetic infection, the main thing is to decide on the possibility of maintaining or reinstalling the endoprosthesis. There are four main groups of surgical interventions:

I - revision with preservation of the endoprosthesis;

II - with one-stage, two-stage or three-stage endoprosthetics.

III - other procedures: revision with removal of the endoprosthesis and resection arthroplasty; with the removal of the endoprosthesis and the use of VCT; removal of the endoprosthesis and non-free musculoskeletal or muscle plasty.

IV - exarticulation.

The disadvantage of these methods is the high frequency of relapses of infection after treatment, for example, during revisions with single-stage endoprosthetics, up to 42% (Hanssen, AD Evolution of a staging system for infected hip arthroplasty / AD Hanssen, DR Osmon // Clin. Orthop. - 2002. - N 403. - P. 16-22.). The frequency of patients curing during the audit with preservation of the endoprosthesis is from 35 to 70%, and favorable outcomes in most cases are observed during the audit on average during the first 7 days, and

adverse - 23 days after installation of the endoprosthesis (Widmer, AF. Antimicrobial treatment of orthopedic implant-related infections with rifampin combinations / AF. Widmer [et al.] // Clin. Infect. Dis. - 1990. - Vol. 1 62. - P. 96-1 02.).

A drawback of surgical methods for treating patients with a para-prosthetic infection is the need to perform a traumatic surgical intervention, which contributes to the subsequent formation of numerous scars in the area of the operation and to an increase in the frequency of dislocations in the artificial joint.

The disadvantage of the above methods is the need for long-term systemic suppressive antibiotic therapy in the postoperative period, leading to a number of complications, for example, antibiotic-associated colitis.

The closest known method for treating a para-prosthetic infection is the method of active permanent drainage of a wound described in Wounds and wound infection / a Guide for doctors edited by M.I. Cousin and B.M. Kostyuchenok. - M. Medicine. - 1990. From 256-263. The method consists in the fact that 2 drains are installed in the wound: an antiseptic solution (or some other solution) is fed into the wound through the first, and the discharge from the wound is removed from the second. Any suction device may be connected to the second drainage.

The disadvantage of this method in the treatment of prosthetic infection is that it does not allow to evaluate the effectiveness of the drug substance that is fed into the wound. You can evaluate the results using microbiological cultures of the wound, which takes several days to complete. Thus, using this method, it is possible to introduce solutions that do not affect the microflora covering the components of the endoprosthesis. Accordingly, it is possible to change the drug only after receiving the results of the crops. Another disadvantage of this method is that the patient must always be on bed rest, due to the fact that tubes from

drainage system. This significantly reduces the quality of life, since washing occurs within a few days or weeks, and also due to the lack of mobility of the operated joint, microcirculation and wound healing are disrupted.

The objective of the invention is to increase the effectiveness of the treatment of a prosthetic infection.

To solve the problem in a method for treating a prosthetic infection, which consists in washing the wound by introducing an antiseptic or antibacterial drug through the inlet drainage tube and removing the detachable from the wound through the outlet drainage tube into the external environment, the wound is first washed in addition, measurement is carried out using appropriate sensors physico-chemical parameters of the wound discharge, such as: pH, oxygen concentration, temperature, pressure and potential p nevoe discharge, and after their change, corresponding to the impact of the microflora of the wound, analyze them again, remove the discharge from the wound, wash the wound with physiological saline, for which it is introduced through a conductive tube and removed through a drainage tube, after which the drug is administered on physiological saline in bactericidal or bacteriostatic concentration, then, under the control of changes in the mentioned physicochemical parameters of the wound medium, the discharge from the wound is filtered and in the absence and changes in at least one of them relative to the previous value - they wash the wound with physiological saline, then administer another drug on physiological saline in a bactericidal or bacteriostatic concentration, continue the selection of drugs until a change in at least one drug is detected of the parameters of the wound to be separated, upon detection of such a change, the administration of this drug in physiological saline continues until zhivleniya wounds, as determined clinically.

In the study of other well-known technical solutions in this field of medicine, the specified set of features that distinguish the invention from the prototype has not been identified.

The proposed method for the treatment of prosthetic infection is as follows.

The wound is washed automatically by introducing an antiseptic or antibacterial drug through the supply drainage tube installed in the wound and removing the discharge from the wound through the discharge drainage tube into the external environment. The discharge and supply of liquids is carried out under the control of the analysis and control unit, which controls the respective pumps.

After some time, necessary for the formation of physico-chemical parameters of the medium under the influence of the microflora of the wound, before removing the discharge from the wound, the following are also automatically performed: filtering the discharge from the wound, measuring its physicochemical parameters: pH, oxygen concentration, temperature, pressure, potential with the corresponding sensors and analysis of these parameters by the analysis and control unit. With the development of infection in the wound, the microorganisms that cause it, during their life, change the state of the liquid medium in the wound (wound contents). For example, with the development of a para-prosthetic infection, an increase in pressure in the wound occurs, in connection with which there is an exit of the discharge through the fistulous passage to the outside. With the development of inflammation due to pathogenic microflora, an increase in the temperature of the discharge from the wound and body of the patient occurs. Depending on the pathogen, such parameters as pH, oxygen concentration, and potential also change.

Thus, the measurement of physico-chemical parameters allows you to evaluate and store in the memory of the analysis and control unit environmental parameters (wound discharge), which are caused by this particular infection.

Next, the wound is washed with physiological saline by introducing it through the inlet drainage tube and removing detachable from the wound through the outlet drainage tube. This is done for the mechanical removal of microorganisms, as well as the toxic substances that they secrete in the process of their life. After that, one of the drugs is administered simultaneously with saline into the wound. The drug is administered with saline to ensure a more uniform distribution of the drug in the wound, since the dose of the drug administered into the wound (in a limited cavity) is significantly less than the dose with traditional methods of administration (oral, intravenous or intramuscular). with these methods of administration, the drug is distributed throughout the body, so its dose exceeds the dose that is injected directly into the wound. After a predetermined (programmed) time, sufficient for the manifestation of the effect of the drug, after it is injected with saline into the wound, the discharge from the wound is filtered, its physicochemical parameters are measured: pH, oxygen concentration, temperature, pressure, potential with appropriate sensors and these parameters of the analysis and control unit.

In the absence of changes in one or more physicochemical parameters of the wound discharged from the previous value of the corresponding parameter, the wound is washed with physiological saline by introducing it through the inlet drainage tube and removing the wound from the wound through the outlet drainage tube. The absence of changes in these parameters suggests that the drug administered does not have a bactericidal effect on the pathogenic flora in the wound and, under the influence of infectious agents, these parameters return to their previous values.

Next, the following drug is administered simultaneously with saline into the wound. After a predetermined (programmed) time, sufficient for the manifestation of the effect of the drug, after it is injected with saline into the wound, the discharge from the wound is filtered, its physicochemical parameters are measured: pH, oxygen concentration, temperature, pressure, potential with appropriate sensors and these parameters of the analysis and control unit.

In the event of a change in one or more physicochemical parameters of the wound discharged from the previous value of the corresponding parameter, administration of the same drug continues along with saline until the wound heals, which is determined clinically, while during treatment the values of the parameters of the wound discharged are automatically recorded to ensure the possibilities for the doctor to control the result of treatment

A change in one or more of these parameters indicates that the drug administered has a bactericidal or bacteriostatic effect, as a result of which there is no change in environmental parameters under the influence of microorganisms.

During treatment, the results of all parameters are monitored by a physician. In the treatment process, it is possible to control the process of drug administration. For example, it is possible to introduce a certain amount of drugs and evaluate their effect on the microflora in the wound, after which you can choose the most effective ones. Accordingly, it is possible (under the supervision of a doctor) to carry out their simultaneous or sequential administration, which will enhance their antibacterial effect.

In FIG. 1 shows a diagram of a device for implementing the proposed method.

In FIG. 1 adopted the following notation:

1 - personal computer;

2 - analysis and control unit;

3.1, 3.2, 3.3, ..., 3.N, 6 - pumps;

4.1, 4.2, 4.3, ..., 4. N - drugs, incl. saline;

5 - filter;

7 - a working chamber;

8 - a wound;

A device explaining the essence of the proposed method for the treatment of a paraprotective infection contains a personal computer 1 connected wirelessly to the analysis and control unit 2. The analysis and control unit 2 is connected to the pH, oxygen concentration, temperature, pressure, potential sensors located in the working chamber 7. B the working chamber 7 enters the discharge drainage tube from the wound 8 and the tube exits into the external environment. The drainage tube includes a filter 5 and a pump 6. The pump 6 is controlled by an analysis and control unit 2. The device also contains containers with medicines 4.1, 4.2, 4.3, ..., 4. N, which are connected via tubes to the corresponding pumps 3.1 , 3.2, 3.3, ..., 3.N. Tubes coming from pumps 3.1, 3.2, 3.3, ..., 3.N are connected to the inlet drain pipe. The pumps 3.1, 3.2, 3.3, ..., 3.N are controlled by the analysis and control unit 2.

Elements used in the device implementing the proposed method can be implemented as follows.

Typical tubes included in intravenous infusion systems can be used as the outlet, lead and other tubes.

Typical syringe microdosers for intravenous infusion can be used as pumps and containers with drugs.

The analysis and control unit can be implemented on the basis of a microcontroller, for example, Arduino. Silver-zinc or Ni-Cd batteries can be used as battery pack elements.

The oxygen sensor can be implemented on the basis of the InPro 6800 polarographic oxygen sensor (Mettler Toledo).

The temperature sensor, pH and redox potential can be implemented on the basis of the combined sensor MPA - 200.010 (Measure Device).

The pressure sensor can be implemented on the basis of an electronic liquid pressure sensor PTL - 25 (Energetometry).

As filters, typical filters that are part of intravenous infusion systems can be used.

Wireless communication between the personal computer and the analysis and control unit can be implemented based on the Bluetooth radio standard using the Bluetooth module integrated in the personal computer and a similar module as part of the analysis and control unit.

Thus, the implementation of the proposed method is not in doubt, since the device for its implementation uses standard medical instruments and electronic devices.

A device that implements the proposed method works as follows.

According to the command (signal) sent by the doctor from the personal computer 1, the analysis and control unit 2 includes a pump 3.1, which delivers antiseptic or antibacterial drugs to the wound 8, and a pump 6, which removes the detachable from the wound 8 through an outlet drain pipe to the external environment, thus, the automatic primary washing of the wound 8.

Some time after the initial washing of the wound 8, necessary for the formation of physico-chemical parameters of the medium under the influence of the microflora of the wound, before removing the detachable from the wound 8, the analysis and control unit 2 includes a pump 6, which pumps out a certain volume of the wound detachment, which after filtration enters the working chamber 7, in which its physicochemical parameters are measured: pH, oxygen concentration, temperature, pressure, potential corresponding

sensors 1 ... 5 located in the working chamber 7, and the analysis of these parameters by the analysis and control unit 2.

Further, the analysis and control unit 2 includes a pump 3.N, which supplies physiological saline 4.N to the wound 8 and pump 6, which removes the wound, so that the wound 8 is washed with saline by introducing it through the inlet drainage tube and removing the detachable from the wound 8 along the outlet drainage tube.

Next, the analysis and control unit 2 includes a pump 3.2, which delivers the next drug 4.2 and a pump 3.N, which delivers the physiological saline to the wound 8. In the supply drainage tube, two solutions are mixed and a solution of the drug in physiological saline is obtained. After a predetermined (programmed) time, sufficient for the manifestation of the effect of the drug, after it is injected with saline into the wound 8, the analysis and control unit 2 includes a pump 6, which pumps out a certain volume of the wound, which, after filtration, enters the working chamber 7, in which its physical and chemical parameters are measured: pH, oxygen concentration, temperature, pressure, potential with the corresponding sensors 1 ... M located in the working chamber 7, and the analysis of these parameters b Lok of analysis and management 2.

In the absence of changes in one or more physicochemical parameters: pH, oxygen concentration, temperature, pressure, potential detached from the wound 8 relative to their previous values, the analysis and control unit 2 includes a pump 3.N, which supplies physiological saline 4.N to the wound and a pump 6, which removes the wound discharge, thus washing the wound with physiological saline 4.N by introducing it through the inlet drainage tube and removing the discharge from the wound 6 through the outlet drainage tube.

Next, the analysis and control unit 2 includes a pump 3.3, which delivers the next drug 4.3 and pump 3.N, which

delivers 4.N saline into the wound. After a predetermined (programmed) time, sufficient for the manifestation of the effect of the drug, after its introduction with physiological saline 4.N into the wound 8, the analysis and control unit 2 includes a pump 6, which pumps out a certain volume of the wound, which after filtration enters the working chamber 7 , in which the measurement of its physico-chemical parameters is carried out: pH, oxygen concentration, temperature, pressure, potential by the corresponding sensors located in the working chamber 7, and the analysis of these parameters com analysis and control 2.

In the event of a change in one or more physicochemical parameters of the discharge from the wound relative to their initial values, the same drug is continued to be administered simultaneously with physiological saline 4.N, while a constant concentration of the drug in the wound is ensured by its uniform administration, which is carried out by the corresponding pumps with specified analysis and control unit 2 parameters of their performance. The duration of administration of this drug is determined clinically by the doctor for wound healing.

During treatment, the parameters of the discharge from the wound 8 are automatically recorded and transmitted to a personal computer 1 to enable the doctor to control the treatment result.

Since the inventive method can be implemented by a miniature device fixed on the patient’s body (for example, on a belt), patients have the possibility of free movement. This provides an improvement in the quality of life of patients in comparison with the use of traditional washing systems, and also promotes the distribution of drugs (in the process of movement in the artificial joint) in all sections of the wound, which contributes to a more effective effect of drugs.

The technical result is an increase in the effectiveness of treatment of a prosthetic infection.

Claims (1)

A method of treating a prosthetic infection, which consists in primary washing of the wound by introducing an antiseptic or antibacterial drug through the supplying drainage tube and removing the discharge from the wound through the discharge drainage tube into the external medium, characterized in that the primary washing of the wound is performed automatically after a predetermined time after the initial washing of the wound , necessary for the formation of physico-chemical parameters of the medium under the influence of microflora of the wound, before removal from a wound are also automatically produced: filtering the discharge from the wound, measuring its physicochemical parameters: pH, oxygen concentration, temperature, pressure, potential with the appropriate sensors and analyzing these parameters, washing the wound with saline by introducing it through the inlet drainage tube and removing the discharge from wounds along the outlet drainage tube, simultaneous administration of the drug with physiological saline in a concentration sufficient to manifest the effect of the drug and, into the wound, after a predetermined time sufficient for the effect of the drug to appear after it is injected with saline into the wound, filtering the discharge from the wound, measuring its physicochemical parameters with appropriate sensors, if there is no change in one or the characteristic antibacterial effect of the drug more physico-chemical parameters of the discharge from the wound relative to the previous value of the corresponding parameter is washing the wound with saline by introducing it through the inlet drainage tube and removal of discharge from the wound through the outlet drainage tube, the introduction of another drug with physiological saline in a concentration sufficient to manifest the effect of the drug into the wound until the next change in the parameters of the discharge is detected for the next drug , when changes are detected, the same drug continues to be administered simultaneously with saline until the wound heals, which is determined by the wedge In this case, during treatment, the values of the parameters of the discharge from the wound are automatically recorded to enable the doctor to control the treatment result.

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