SU1690719A1 - Method for surgical treatment of chronic osteomyelitis of tubular bones - Google Patents

Abstract

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the surgical treatment of chronic osteomyelitis of the tubular bones. The aim of the invention is to reduce the recurrence of the disease. This is achieved by rehabilitating the osteomyelitis focus, including the removal of the necrosis and sclerosis zones, the connection of the formed channel with the normal bone marrow canal, as well as plastics of only the defect of the cortical layer of the operated bone.

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the surgical treatment of chronic osteomyelitis of the tubular bones.

The purpose of the invention is to reduce the recurrence of the disease.

The method is carried out as follows.

The osteomyelitis center is opened and reorganized. Necrotic tissues, granulations, sequesters, and pus are removed from the osteomyelitis cavity. Then the trepanation opening is expanded throughout the sclerotic bone fragment. A chisel and a frezya form a bone canal by a longitudinal internal resection. The formed canal is connected to a normal fragment of the medullary canal. Then, plasticization of the trepanation defect of the cortical layer is carried out by performing various types of plastic surgery: bone plastic, plastic with biocompatible materials.

Example. A 24-year-old patient, diagnosed with chronic hematogenous osteomyelitis of the left hip. Suffering from osteomyelitis in the subject 15 years, repeatedly operated. In the lower third of the thigh multiple scars from wound e operations and fistulas. On the radiograph, sclerosis of the middle and lower thirds, the cerebrospinal canal is traced only in the upper third of the thigh, there are no degradation sites, the peri erence of the other layers are absent. An operation was performed. On the operating table, before opening the zone of sclerosis by puncture, the content of the medullary canal in the upper third of the thigh was taken for seeding on the flora. A wide (incisionless surgery) incision along the front-outer surface of the thigh exposes the bone. The periosteum in the form of cicatricial tissue is tightly bonded to the bone, it is peeled as far as possible from the cortical layer. A paired saw during the middle and lower thirds in the zone of sclerosis, followed by a longitudinal internal resection, formed a channel of 20 cm.

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In the middle third of the thigh, a cavity is removed up to 1 cm in diameter, filled with thick pus (taken for seeding). During the resection, in the lower third of the femur, small cavities up to 1-2 cm in diameter were filled, filled with Poultry's serous fluid. Pooid-fom1 uplash and sanation of the cavity created by the proposed method with smzchoy operative bel carried out the river and cerebrospinal caiap, additional osrr sowing of the formed gailea and ep VI its connection with the ceremonial i-symbol. upper third edra. An insignificant amount of geo-organl was released from the DC-bone marrow pump. icic fluid. Romyt channel with 3% hydrogen peroxide Rosgzor. The bone defect throughout the trepamatsiomypny, zLekt) is closed with the fascia taken from the right thigh: the fascia was stitched around the edge of the defect t, with the periosteum nodular catgut / sutures, the wound was sutured tightly with stitches on the skin along the Dochati.

The drains were drained through two cuts: one of the canals of the canal was drained and another was wounded with soft tissues. After the operation, an aspirrhia of the wound was active. The drains were removed on the 5th day. In the pelvicooperative peoiod (as before the operation), no antibiotics were conducted. After the operation, 500 ml of one-group crumb and 150 ml of erythromass are transferred. Stitches are taken July 9, wound healing by primary tension. Results of sowing: a culture of Staphylococcus aureus was isolated from the bone-marrow channel of the upper third of the thigh; from the osteommellitic cavity in the zone of the bone cell division, the culture of Staphylococcus aureus was not cultured from the formed bone cavity after rehabilitation. The patient was discharged in satisfactory condition on the 25th

day after surgery. The patient was examined for 5 years after surgery, there is no relapse.

The proposed method provides for the recanalization of the medullary canal, the restoration of the bone or the organ as a whole,

Recanalization of the bone with plastic of the cortical defect after reconstruction of the canal reproduces the bone as a tubular organ, which reduces the percentage of disease recurrence.

According to the proposed method, 42 people were operated on, recurrence of the disease was noted in two cases (4.7%). According to the method of the prototype excluding plastic surgery of the cortical defect, 39 patients were operated on, recurrences of the disease were noted in 7 cases (18%).

Studies (from 1 month to 3 lay down after surgery) showed the preservation

the anuricular canal and its isolation from the soft tissues surrounding the bone in patients operated on with the proposed method,

Claims (1)

Invention Formula The method of chemical treatment of chronic osteomyelitis of the tubular bones, including the opening and sanation of the osteomyelitis focus with removal of necrotic tissue and the zone of sclerosis, connection formed bone canal with a normal bone marrow canal, the closure of a defect in the bone, characterized in that, in order to reduce the recurrence of the disease, only a defect is plastic cortical bone.