RU2266071C1 - Method for treating osseous cyst complicated with pathological fracture - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should create an inter-fragmentary diastasis initially in area of pathological fracture to maintain it till normalization of intra-osseous pressure. Dosed compression should be fulfilled under conditions of centering the fragments till mashing thinned parts of cortical plates of pathologically altered bone. Stable fixation should be performed to consolidate the fracture. In peculiar case, one should additionally perform lengthening osteotomy of affected segment. The method enables to develop the conditions for complete organotypical focal reconstruction.

EFFECT: higher efficiency of therapy.

1 cl, 4 dwg, 1 ex

Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with bone cysts complicated by a pathological fracture.

A known method of treating patients with pathological fractures in bone cysts, involving circular or edge resection of the destruction site, replacing the defect with a transplant, followed by fixing the affected segment until its integrity is restored. The method is traumatic, associated with the possibility of relapse of the underlying disease and the development of postoperative complications (Demichev NP Surgical correction of pathological fractures with a solitary bone cyst. / Demichev NP, Tarasov AN - Rehabilitation of patients with injuries and diseases of the musculoskeletal systems. Prospects for development. Collection of scientific papers, book 4. - Ivanovo, 2000, p.185-189).

A known method of treating patients with bone cysts complicated by a pathological fracture, including performing osteosynthesis of the affected segment using a compression-distraction apparatus, creating dressing conditions at the junction of the fragments by compression and / or distraction, followed by stable fixation until the fracture is consolidated. However, this method does not guarantee the inactivation of the destructive process and does not create conditions for a complete organotypic reconstruction of the outbreak. If there is an “active” cyst and its significant size, this method is also associated with the possibility of relapse of the underlying disease and the associated pathological bone fracture (Kuftyrev L.M. Results of treatment of patients with tubular bone cysts complicated by a pathological fracture. / Kuftyrev L.M. ., Shakhmatov DI, Pozharishchensky KE - Modern aspects of traumatology and orthopedics. Abstracts of the final scientific-practical conference of the SRTC).

The objective of the invention is to develop a method for the treatment of bone cysts complicated by a pathological fracture, which prevents the recurrence of the disease and secondary violation of the integrity of the bone in the treatment of patients with active forms of cystic lesions of limb segments.

The problem is solved in that in a method of treating patients with bone cysts complicated by a pathological fracture, including osteosynthesis of the affected segment using an external fixation apparatus, creating stress conditions therein by compression and / or distraction of bone fragments with their subsequent stable fixation before fracture consolidation , initially, in the area of the pathological fracture, create inter-fragment diastasis and maintain it until the intraosseous pressure normalizes, and then, under conditions of centering, MCUs, they are dosed by compression until the thinned sections of the cortical plates of the area of the pathologically changed bone are crushed.

It is advisable, with a significant extent of the area of thinning of the cortical plates in the area of the pathologically changed bone, to additionally perform an extension-correcting osteotomy of the affected segment.

The invention is illustrated by a detailed description, an example of the practical use of the method, as well as illustrative material, which shows:

Figure 1 - radiograph of patient K. before treatment;

Figure 2 - radiograph of patient K. during the period of creation and maintenance of inter-fragment diastasis until normalization of intraosseous pressure;

Figure 3 - x-ray during the implementation of metered compression and crushing of thinned cortical plates in the area of pathologically altered bones with centering of bone fragments.

Figure 4 - radiograph of patient K. after removal of the apparatus, consolidation of the fracture with a pronounced normalization of the bone structure in the area of its cystic lesion.

The method is as follows.

In the operating room, after anesthesia and treatment of the surgical field, osteosynthesis of the affected segment with fixation of bone fragments with transcutaneous needles is performed by known methods. In the tensioned state, the spokes are mounted on the supports of the external fixation apparatus that are installed at the appropriate level, which are connected by threaded rods and, if necessary, by hinged assemblies, providing their multi-plane displacement relative to each other. Having completed the installation of the apparatus, a partial reposition of fragments is carried out until their angular displacements are eliminated and the segment axis is restored under conditions of centering of the bone fragments. After that, maintaining the mutual centering of the fragments, they are longitudinally bred until the formation of inter-fragment diastasis of 0.5-1.0 cm.

The creation of such a diastasis contributes to the outflow of cyst contents with normalization of intraosseous pressure and inactivation of the contents.

At the same time, in the case of an extensive cyst, with the presence of a significant thinning of the cortical plates over a large - over 2-3 cm - extension, an extension-correcting osteotomy of the affected bone segment can be additionally performed, which is performed through a soft tissue incision, usually distal to the existing cyst.

The operation is completed by performing control x-ray, stabilization of the apparatus - limb system and the application of aseptic dressings.

In the postoperative period, until intraosseous pressure normalizes, which is usually observed during the first 6-8 days, and is controlled by known methods, for example, by puncture, the fragments are stably kept in the position attached during the operation while maintaining the existing diastasis.

After that, they carry out their metered approximation, and then mutual compression, which is performed at a rate of 0.5-1.0 mm per day and is maintained until the most thinned sections of cortical plastic bone in the area of the cystic cavity are crushed. At the same time, in cases where an extension-correcting osteotomy is performed, the dosed distraction of the selected fragments is performed at the level of the latter, compensating for the shortening of the segment existing or resulting from compression at the junction of the fragments in the area of the pathological fracture and, if necessary, correcting its axis. The rate of distraction is also set in the range of 0.5-1.0 mm per day.

The creation of interfragmental diastasis contributes to the outflow of cyst contents with normalization of intraosseous pressure and inactivation of the contents. The stress conditions created in the bone segment during compression at the junction of the fragments (including when combined with simultaneous distraction), along with the consolidation of the fracture, have a stimulating effect on the normalization of bone structure in the area of the pathological focus, crushing of destructive bone structures reduces the volume of destruction bone substance, increases the mechanical strength of the fusion, which prevents the development of relapse of the disease.

In the future, until a reliable picture of consolidation is obtained, and in cases of extending-correcting osteotomy, and the reconstruction of the site of the formed distraction regenerate into mature bone tissue, the segment is stably fixed. Additional immobilization of the limb after dismantling the apparatus is not required.

The practical implementation of the method is illustrated by the following clinical observation.

Patient K., 29 years old, was admitted to the hospital with a diagnosis of: a solitary cyst of the left humerus up to 13 cm in size; pathological fracture at the level of the proximal pole of the cystic cavity (figure 1).

To eliminate the cyst and restore bone integrity, the patient underwent surgery: closed osteosynthesis of the left shoulder with an external fixation device - such as Ilizarov's apparatus.

During the operation, fragments of the affected segment were fixed with precision spokes and their simultaneous reposition with centering relative to each other, as well as dilution along the segment axis with the creation of 1.0 cm inter-fragment diastasis.

In the postoperative period, during the first 8 days, the fragments were stably kept in the attached position, which facilitated the outflow of hemorrhagic contents of the bone cyst into the area of inter-fragment diastasis and, thereby, normalized intracavitary pressure (figure 2).

Starting from day 9, at a rate of 1 mm per day, a metered approach and then compression of the opposing ends of the fragments were carried out. The duration of the compression period was 18 days, which led to the crushing of the most thinned part of the cortical plates by up to 1.5 cm (Fig. 3). The duration of the subsequent period of stable fixation in the apparatus was 56 days (figure 4).

The proposed method allows to restore the integrity of the affected segment, to normalize the structure of bone tissue by increasing the area of the end contact of the fused ends of the fragments, and in the area with less pronounced destructive changes in bone tissue, which increases the mechanical strength of the fusion. At the follow-up examination after one year, the achieved treatment result is preserved, there are no signs of relapse of the disease.

In addition, the use of the proposed method for the treatment of bone cysts complicated by a pathological fracture provides the prevention of relapse of the disease and secondary violation of bone integrity in the treatment of patients with active forms of cystic lesion of limb segments.

Claims (2)

1. A method of treating bone cysts complicated by a pathological fracture, including performing osteosynthesis of the affected segment using an external fixation apparatus, creating stress conditions in it by compressing and distracting bone fragments with their subsequent stable fixation until the fracture is consolidated, characterized in that it is initially in the pathological zone the fracture creates inter-fragment diastasis and maintain it until the intraosseous pressure normalizes, and then, under the conditions of centering of the fragments, they are dosed com pressing before crushing of the thinned sections of the cortical plates of the area of the pathologically changed bone. 2. The method according to claim 1, characterized in that it additionally perform an extension osteotomy of the affected segment.

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