RU2014024C1 - Method of treatment of chronic osteomyelitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: pathologically altered tissues are totally removed: the thin skin knitted together with the bone and the most altered parts of the periosteum and bone. The bone cut is covered by the musculus tibialis anterior. EFFECT: elimination of infection sources causing complications, cut down hospital treatment period.

Description

 The invention relates to medicine / namely to surgery.

 A number of known methods / for the treatment of chronic osteomyelitis. One of the closest is the longitudinal trepanation of the bone / removal of all its affected areas and suturing the wound tightly.

 As a prototype taken method / which is as follows. The incision is made as usual. The bone is widely trepanized. All affected tissues are removed so that only a flattened healthy or least affected area of the bone remains. As a result of this operation, the cavity does not form and the defect in the bone is filled with surrounding soft tissues / which, as it were, are “screwed” in. The wound is sutured tightly. Immobilization is performed with a plaster cast.

 Healing / usually / takes place by primary intention. The bone is restored over time. Recovery occurs in almost 90% of those operated.

The prototype method has the following disadvantages:
thinned / scarred bone-welded skin / as a focal point of a chronic / dormant infection is not excised;
pathologically changed sections of the periosteum are not removed;
longitudinal osteotomy is performed using a conventional bit / which is very traumatic / lengthens the duration of the operation and the possibility of a pathological fracture is not excluded. There is no indication of the closure of a wound defect with healthy skin / which is important for wound healing.

 The purpose of the invention is the prevention of relapse of the disease / reduction of treatment time.

 The method is as follows. Two converging incisions along the entire leg are excised with scarred / thinned and soldered skin. The periosteum is exfoliated from the anterior and lateral surfaces of the tibia and its most changed sections are economically excised. A chisel / just below the tibial tubercle / a notch is made. The Jigley saw cuts the front of the tibia to be removed. Thoroughly opened small cavities and fistulous passages are thoroughly sanitized. The periosteum is stitched without tension / and the anterior tibial muscle is easily shifted to sawdust / thereby eliminating the resulting deepening.

 The wound is sutured tightly by connecting constant skin edges.

The proposed method has the following advantages:
the scar-altered bone-welded skin is completely excised / as a source of chronic dormant infection;
sparingly removed the most changed areas of the periosteum. Longitudinal bone resection is performed by a Jigley wire saw without major trauma within a few minutes;
bone sawdust is freely covered by the periosteum and displaced anterior tibial muscle / correcting / thereby / forming a deepening in the bone;
the wound surface is closed by healthy skin without tension.

 PRI me R. Extract from the medical history N 6694/887. Patient K., 26 years old / was admitted 06.12.90 with a diagnosis of chronic recurrent hematogenous osteomyelitis of the right tibia.

 Ill at the age of ten. 3 months after the accident, a swelling appeared in the right lower leg / pain area and high fever. In the same year he was operated on - a sequestrectomy was performed. Over the next time, he was repeatedly operated on for exacerbation of tibia osteomyelitis. Last exacerbation in November 1990

 Objectively. General condition is satisfactory. From the internal organs pathology is not detected. The right tibia in the middle third is deformed and bent anteriorly. The skin along the crest of the tibia is thinned / hyperemic and tightly soldered to the bone. In the upper third of the leg, pronounced soreness is determined.

 P-graphy - a tibia in the middle third is curved anteriorly. Plots of osteosclerosis over a large extent alternate with areas of osteoporesis. Against this background, individual small cavities are determined. In the upper third of the tibia, a large cavity of 5x2 cm is determined.

 01/04/91. Operation - longitudinal resection of the right tibia. Endotracheal narcosis. Two converging incisions for almost the entire length of the tibia excised fixed to the bone / scar-modified / refined skin.

 Produced mobilization of soft tissues. The periosteum is excised and exfoliated throughout the wound. Its most altered areas are excised. In the upper third of the tibia in a slanting direction from top to bottom, a notch with a depth of 1/0 cm was made with a chisel / after which the changed bone sections with a thickness of 1 to 1/5 cm were sawn with a Dzhigli wire saw. In this case, a 5x2 cm cavity was found in the upper third of the bone / containing granulation tissue and small sequestra / the same / but small cavities are found in other parts of the tibia. The cavities are thoroughly sanitized. The wound surface is repeatedly washed with furacilin. The periosteum is freely stitched with separate interrupted catgut sutures. The front tibial muscle is moved to the sawdust. The skin is sewn along the entire length of the leg without tension. The wound healed by primary intention.

 Discharged after 26 days in satisfactory condition.

 According to this technique, 6 patients were operated on. The immediate and long-term results are good. Not a single case of relapse of the disease or change of profession after surgery was observed.

 The positive effect of using the invention is as follows: all sources of infection / contributing to the complication of the disease and relapse (affected skin / periosteum and bone) are eliminated.

 The wound heals by first intention / the length of hospital stay is reduced / patients can begin active work after a few months.

Claims (1)

 METHOD FOR TREATING CHRONIC OSTEOMYELITIS by removing altered soft tissues, longitudinal resection of the altered bone, closing the wound defect with local soft tissues, characterized in that, in order to prevent recurrence of the disease, shortening the treatment period, the altered skin welded to the bone, periosteum, and longitudinal resection are additionally removed with a wire saw, bone sawdust is closed with the periosteum, anterior tibial muscle is placed on the sawdust.