SU1220648A1 - Method of treatment of chronic osteomyelitis - Google Patents

Description

This invention relates to medicine, namely to surgery, traumatology and transplantology.

The purpose of the invention is the prevention of postoperative complications by economical resection of the bone pathology and its replacement with a canned allograft with perforations.

The method is carried out as follows.

Bone allotransplants are harvested from human corpses. Immediately after sampling, coarse or spongy allogeneic bones are subjected to perforation through a drill with a diameter of 2-3 mm, while the holes are applied in a staggered order at a distance of 10-15 mm from each other. Pre-application of perforations prior to preservation contributes to the rapid and uniform penetration and distribution of the preservative in the graft. In addition, fibroblasts penetrate the perforations better, transplant revascularization is performed faster and more efficiently. Graft preservation is carried out in weak formaldehyde and glutaraldehyde solutions. During the preservation process, the grafts are stored in hermetically sealed dishes in a refrigerator at a temperature of + 2-4 ° C. The duration of preservation is 6-8 days, after which the grafts become sterile, they suppress antigenic activity while maintaining the biological properties of the bone.

Immediately prior to donor transplantation, the preserved graft is checked for sterility, and then washed with sterile isotonic sodium chloride solution and saturated with antibiotics. For this, the graft is immersed in a sterile glass container filled with isotonic sodium chloride solution, lincomycin or kefzol is added thereto at the rate of 3-4 g per liter of solution at a ratio of solution and graft of 8-10: 1. 1–1.5 hours prior to transplantation, the graft is placed between two carbon electrodes and is saturated with antibiotics for 1–1.5 hours at a current density of 0.15 mA / cm, after which the grafts are used for transplantation into the donor organism.

Within 2-4 weeks before and after the operation, the patient is immunized with an auto vaccine prepared from microflora isolated from an osteomyelitis center.

For the isolation of microorganisms, the purulent detachable from the patient's wound is seeded on blood and yolk-salt agar. An auto vaccine from the isolated microorganisms is prepared on a bactericidal liquid consisting of a mixture of 250 ml of sterile isotonic sodium chloride solution and 30 ml of fish oil, aged for 6 weeks at

0

37 ° C and filtered through a sterile de-ashen filter. From the microorganisms isolated from the patient on sterile isotonic sodium chloride solution, a suspension of 1.5 billion microbial cells in 1 ml of the optical standard is suspended and mixed in equal amounts with a bactericidal liquid of 6 ml each. The vaccine density is 700-800 million microbial cells in 1 ml. After checking autovaccine for its sterility

0 is poured into 0.5-, 5 ml ampoules. Autovaccine is injected intracutaneously into the middle third of the palmar surface of the forearm in a dose of 0.1-0.4 ml, and then 0.6-1.2 ml subcutaneously with an interval of 48 hours. In total, the administration of an autovaccine is carried out by the proposed method 8-10 times before surgery and 6-8 times after surgery.

At the time of implementation of the method, an economical resection of the bone lesion is performed and replaced with a canned allograft prepared for transplantation using the proposed method. The graft is modeled according to the shape of an osteomyelitis focus. The surgical wound is closed tightly in layers. In the postoperative period, patients were prescribed necessary.

5 drug therapy.

Example 1. Patient P., 36 years old, previously received an open comminuted fracture of the bones of the left tibia in the lower third. Surgical treatment of the wound, osteosynthesis of the tibia with a metal rod. However, later the wound festered, developed posttraumatic osteomyelitis of the tibial bone with a defect in bone and soft tissue. A compression osteosynthesis with an Ili-rhazos device was used, skin plastic was performed. When the tibia was crossed, but a bone defect and a permanently functioning fistula with a purulent discharge remained, the discharge of sequesters was observed during the entire observation period. From the fistulous detached, Staphylococcus aureus, resistant to most of the antibiotics used in the clinic and sensitive to tseporin, lincomycin and kefzol. An auto-vaccine was prepared from this microorganism using the proposed method. Before the operation, the patient was autovaccinated 6 times with an interval of 48 hours.

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five

The patient under anesthesia underwent an operation according to the proposed method, as a result of which an economical resection of the pathological focus of the left tibial bone was performed, followed by plastic grafting of the defect with canned allograft with through perforations around the bone circumference.

The graft for 1 h before transplantation was saturated with lincomycin by electrophoresis at a current density of 0.1 mA / cm

the concentration of lincomycin was 34.7 ± 3.24 µg / g graft tissue. The graft before transplantation is modeled in the form of an osteomyelitis defect. The wound was sutured in layers. The postoperative course is smooth. Temperature response to 37.6 ° C for the first three days, followed by normalization. Blood serum biochemical parameters on the 3-7th day after surgery: ACT -

After surgery for 2 weeks, the patient was immunized with auto vaccine (6 injections in total). Stitches are removed on the 12th day after the operation. The wound has healed. Regional lymph nodes of the former sizes. 5 After 2 and 3 months. after the operation, a control examination was carried out. The patient does not make complaints, walks freely, does not limp, and proceeds with his previous work.

On control radiographs of osteo0, 2 mmol / l; ALT - 0.9 mmol / l; common IQ myelitis center of the left tibial

protein - 74 g / l; albumin - 44%; Globe-bones fully substituted allograsplanlin - 30%. Leukocytes - 6.7X U / l, formate of 10X16 cm. Occurs

blood mule is not changed, ESR - 17 mm / h. Assimilation and restructuring of the graft.

Compiled by M. Pozn to

Tehred I. Veres Corrector A. Zimokosov

Circulation 659 Subscription

VNIIPI USSR State Committee

for inventions and discoveries

113035, Moscow, Zh-35, Raushsk nab. 4/5

Branch PPP "Patent, Uzhgorod, st. Project, 4

After surgery for 2 weeks, the patient was immunized with auto-vaccine (6 injections in total). Stitches are removed on the 12th day after the operation. The wound has healed. Regional lymph nodes of the former sizes. After 2 and 3 months. after the operation, a control examination was carried out. The patient does not make complaints, walks freely, does not limp, and proceeds with his previous work.

On control radiographs osteomyelitic focus of the left most tibial

Claims (2)

METHOD FOR TREATING CHRONIC OSTEOMYELITIS, including surgical removal of the affected area of the bone with subsequent replacement with an allograft, characterized in that, in order to prevent postoperative complications, before and after surgery during For 2–4 weeks, the patient is given an auto-vaccine prepared from a purulent discharge wound; electrophoresis of an allograft with antibiotics is carried out 1–1.5 hours before transplantation. oh oh oh OO