RU2005506C1 - Method of treating children suffering from perthes disease - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves the steps of: subjecting bone destruction focus to the action of a direct current of magnitude of 15-20 micro A of positive polarity after operation for first three days, changing polarity beginning from the fourth day and subjecting the bone destruction focus to the action of a current of negative polarity for 20 hours, the focus being subjected to the action of direct current of positive polarity for four hours. EFFECT: enhanced rate of ossification of necrotic portions.

Description

 The invention relates to orthopedics and traumatology and can be used to treat Perthes disease in children in a shorter time.

 The treatment of Perthes disease is reduced to timely unloading of the limb to prevent deformation of the femoral head and to general strengthening therapy, which contribute to the regeneration of osteoporized bone tissue of the femoral head.

 However, even prolonged conservative treatment does not always lead to the restoration of the shape of the femoral head. Therefore, a number of patients develop deforming arthrosis.

 Along with conservative treatment methods, surgical methods of stimulation of rarefied bone foci are also used to treat osteochondropathy of the femoral head.

 However, the advantages of these surgical interventions over conservative methods of treatment have not yet been convincingly proven.

 To accelerate the ossification of necrotic sections of the epiphysis of the femoral head, neck tunneling is performed. An allograft is inserted into the formed channel or a periosteum or muscle flap is inserted. The specified method for the treatment of Perthes disease in children is selected as a prototype.

Significant disadvantages of the prototype method are: it does not allow to suspend the pathological process in the femoral head;
does not allow to accelerate the passage of the pathological process in the femoral head;
does not prevent the development of deforming arthrosis on the affected side.

 The aim of the invention is to accelerate the processes of ossification of necrotic sites of the pineal gland of the femoral head in children with Perthes disease.

 The goal is realized by exposing the femoral head to a direct electric current of small force (15-20 μA).

 The method is as follows. In the operating room under general anesthesia in the patient’s position on the healthy side, after appropriate treatment of the surgical field, we make a linear incision along the lateral thigh in the region of the greater trochanter. The subtrovertal region is exposed in layers. With the help of an awl or Kirschner needle, tunneling of the femoral neck is performed. A current conductor is introduced into one of the channels. The latter (usually the Kirschner needle) is isolated by a polyvinyl chloride tube (catheter) with the exception of its distal end (0.5-1.0 cm), which is in direct contact with the center of destruction of the pineal gland of the femoral head. On the operating table, X-ray control is performed, on which we verify the correct standing of the electrode. If necessary, the latter is pulled up or vice versa pushed forward. The proximal end of the current conductor through a separate puncture of the skin is displayed on the lateral surface of the thigh, bypassing the wound. The last layer by layer sew up tightly. In the chamber, cuff traction is established on the side of the lesion beyond the lower leg. In the postoperative period, the child receives conventional conservative treatment.

 The electrode is connected to a constant current source. In the first three days after the operation, a positive battery charge is applied to it, and the negative one is located cutaneous in the thigh or lower leg area. This allows you to eliminate the inflammatory phenomena in the wound that accompany any operation, and are also a concomitant factor of aseptic necrosis of the femoral head of any genesis.

 Starting from the 4th day, the polarity changes. Electrical stimulation of the bone destruction site by a current of negative polarity lasts 20 hours per day and 4 hours by a current of positive polarity.

 The clinical effect is that the negative pole of the direct electric current enhances the metabolism of bone tissue (the focus of destruction), while the positive one has an anti-inflammatory effect.

 PRI me R. Child U. 5 years old (source. Bol. N 1279) was admitted to the pediatric surgery and orthopedics clinic of Aktobe State Medical Institute. 10.27.89, with complaints of pain in the right hip joint. Sick for about six months. It was examined on an outpatient and inpatient basis by pediatricians at the place of residence. He was referred for treatment to the regional children's clinical hospital with a diagnosis of Perthes disease on the right. In the hospital, the child was imposed with an unloading cuff extension on the right lower limb, and appropriate physiotherapy was prescribed. 11/15/89, an operation was performed tunneling the neck of the right femur, bringing the electrode to the femoral head. The postoperative period was uneventful. 3 hours after the operation, electrical stimulation of the head of the right femur was started according to the technique developed in the clinic. On the 4th day after surgery, a significant decrease in pain in the right hip joint was noted. Against the background of exposure to PET, the child continued physiotherapy, prescribed drugs that improve microcirculation, massage, exercise therapy. January 16, 1990, the electrode was removed. On the control x-ray from 01/20/90 g, the bone structure of the head of the right femur became denser, and the form was more correct. On 23.01.90, the child was transferred to the Chaika sanatorium for further treatment, where he received general strengthening treatment, physiotherapy, massage, exercise therapy. The child was in the sanatorium for about a year and a half.

 When viewed in August 1991, the child does not complain, does not limp, and respects the orthopedic regimen. Movement in the right hip joint in full. On the control x-ray from 08.25.91, the ratios in the right hip joint are correct, the head is centered in the acetabulum, of a normal form. Recommendations are given for further follow-up of a child. (56) Volkov M.V. Bone diseases in children. M.: 1985, p. 491.

Claims (1)

 METHOD FOR TREATING PERTHERAL DISEASE IN CHILDREN, characterized in that, in order to accelerate the processes of ossification of necrotic portions of the pineal gland of the femoral head, they are exposed to a direct electric current of 15–20 μA in the first three days after surgery with a current of positive polarity, and starting from the fourth day after the operation electrical stimulation of the bone destruction site is carried out for 20 hours with a current of negative polarity and 4 hours of positive polarity.