RU2286735C1 - Method for treating aseptic necrosis of caput femoris and perthes disease - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: it is necessary to decrease intraosseous pressure by 15% against the norm twice daily for 10 d through a needle pre-applied intraosseously that enables to avoid postoperational complications and improve circulation in caput femoris.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to orthopedics and traumatology, and can be used to treat aseptic necrosis of the femoral head (ANGBC) and Perthes disease (PD)

There are various methods of treating aseptic necrosis of the femoral head and Perthes disease: intertrochanteric detorsion-variating osteotomy, biostimulation of the femoral neck with cortical auto- and allografts (Vavilova BC Decompressive myotomy for osteochondropathy of the femoral head, T # 1, Orthopathology and Orthopaedia, 1980 // Orthopaedia. .18-19; Skleronko ET Surgical tactics for degenerative-dystrophic lesions of the hip joint // Materials of the 8th Congress of Orthopedic Traumatologists of the Ukrainian SSR, 1980, pp. 63-67; Lantabion Hozi G. Cavitalisierung des o steonekrotischen Hiistkopfes durch Cafassbiin doltraep-Orthppade // 1980, No. 9. P.255-259; Judet J., Judet H. Osteotomic de rotation en avant du col et de la tete femorale // - Acta orthop. Belg., 1981, No. 7, P.301-302).

In turn, the known methods have several disadvantages:

1) high morbidity and volume of surgical intervention;

2) performed in the later stages of the disease at stage III;

3) a large percentage of disability.

Closest to the technical solution is a method of tunneling the femoral neck with subsequent perforation of the growth plate and pineal gland with a Kirschner spoke (Gafarov Kh.Z., Yusupov RF On the surgical treatment of Perthes disease // Orthopedics and Traumatology, 1986, No. 11, p. 9 -13).

However, it also has several disadvantages:

1) this method does not adequately carry out postoperative hip pressure revascularization;

2) multiple damage to the sprout plate leads to impaired bone growth;

3) leads to coxarthrosis and does not always stop osteonecrosis due to an inadequate reduction in tissue pressure and thrombosis of the femoral neck tunnel.

The objective of the invention is the organ-sparing stimulation of revascularization and repair of bone tissue with angiopathic and angioplasty.

The task is achieved due to the fact that during treatment a reduction of 15% of the initial value of intraosseous pressure is carried out twice a day for 10 days through a previously placed intraosseous needle.

The method is as follows:

1) in outbred dogs at the age of 4 months, air ethereal anesthesia gives access to the head and neck of the femur;

2) intraosseous pressure in the femoral head (according to A.K. Makarov), which is normally 983.7 ± 11.0 Pa;

3) make access to the middle third of the femur, impose a sterile clamp on the pineal gland and clamp until insignificant penetration into the periosteum;

4) the operation is completed by layering suturing of the surgical wound;

5) on the 60th day after the operation, a pressure measurement and sampling for the study of morphological material are carried out, the clamp is removed;

6) then, using the osteoperforator, the revascularization needle is inserted into the neck of the femoral head using the puncture-hand method;

7) using the sensor measure intraosseous pressure and reduce by 15% from the indicators of the I control group (norm) using a syringe;

8) the procedure is performed 2 times a day for 10 days with a control reduction of 15% below normal;

9) on days 20 and 60 and on day 90, pressure is measured and morphological material is taken.

A specific application example:

In dog No. 11 under colipsol anesthesia, access to the femoral head is made in layers, and the intraosseous pressure was measured, which amounted to 983.7 Pa. After that, a sterile clamp was applied to the pineal gland and a pressure increase of 30% from the initial to 1291 Pa was made. The surgical wound is stitched tightly. After 60 days, the animal was taken into the operating room, the clamp was removed under calypsol anesthesia, and a manual osteoperforator carries out a revascularization needle into the neck of the femoral head under visual control. Measure intraosseous pressure, which amounted to 1225 PA. After removing the clamp, the pressure decreased arbitrarily by 64 Pa. Using a syringe, intraosseous pressure is reduced to 832.5 Pa. An aseptic dressing is applied to the skin. Within 10 days, pressure is monitored 2 times a day and reduced using a syringe through an installed needle. On the 20th day, during the third operation, the measurement of intraosseous pressure was made, which amounted to 838.4 Pa, the tissue sampling of the femoral head for morphological examination. The animal is removed from the experiment. In a subsequent morphological study of the preparations, a pronounced regression of osteoporosis is determined with an increase in the thickness of cortical plates and bone beams of 149.1 μm and 337.6 μm, and the volume of the vascular bed up to 16.4%.

The experiment was conducted on 11 dogs aged 5-7 months. The observation period was 20-60-90 days. No complications were observed. To assess the effectiveness of bone tissue regeneration, the morphological picture was studied under normal conditions and during experimental exposure. During the experiment, it was found that prior to placing the needle in the neck of the femoral head, a significant increase in tissue pressure to 1225 ± 18.3 Pa due to arterial-venous stasis and a decrease in the thickness of the cortical plate to 148.6 ± 2.9 μm and bone beams by 96.6 μm, which indicates pronounced osteoporosis (table 1). After the needle is installed and the intraosseous pressure is reduced by 15% from the parameters of the control group, to 836.25 ± 11.6 Pa with constant monitoring. On day 20, it was found that tissue pressure decreased by 14.86% relative to the first control group, the cortical plate thickness increased by 20.2 μm relative to the second control group, with a bone beam thickness of 335.2 ± 1.0 μm, the volume of the vascular bed increased by 2.8%. Tissue pressure is also reduced by 85 Pa. On day 60, the most pronounced significant changes in indicators were noted, an increase in the thickness of bone beams to 411.3 ± 5.0 μm and cortical plates by 1.13 times, as well as the volume of the vascular bed by 4.7% with a decrease in tissue pressure of 24 Pa from the first control group. On the 90th day, tissue pressure decreased by 85 Pa, however, an increase in the thickness of the cortical plate by 1.35 times was noted, with an increase in the thickness of the bone beam by 12.3% from the first control group, the volume of the vascular bed also increased by 17.2 times relative to the second control groups (table 1).

Table 1
The dynamics of changes in the structure of bone tissue with a decrease in intraosseous pressure at various times. I counter. group (norm) II counter. Group (Perthes Disease Model) Main group 20 days after surgery 60 days after surgery 90 days after surgery 1. Intraosseous pressure (Pa) 983.7 ± 11.0 1225 ± 18.3 837.5 ± 9.0 858 ± 12.5 898 ± 14.4 2. The thickness of the cortical plate (μm) 174.1 ± 6.0 148.6 ± 2.9 168.4 ± 4.0 198 ± 3.9 200 ± 4.0 3. The thickness of the bone beam (microns) 382.0 ± 1.0 285.4 ± 5.2 335.2 ± 1.0 411.3 ± 5.0 429 ± 5.0 4. The volume of the vascular bed (%) 14.1 ± 0.3 11.2 ± 0.3 16.9 ± 0.21 18.8 ± 0.41 19.1 ± 0.3

Thus, a morphological study determines a steady increase in the revascularization of the lesion and regenerative response of bone tissue to the experimental effect, which results in a steady increase in the thickness of cortical plates and bone beams by an average of 15% when compared with the control group.

The method allows:

- to exclude severe postoperative complications (canal thrombosis after tunneling of the femoral neck with subsequent progression of osteoporosis of the femoral head, impaired bone growth as a result of multiple osteoperforations of the thigh area of the thigh, graft rejection and metal structures);

- allows for organ-preserving surgery without postoperative femoral osteotomy, resection of autografts from the iliac wing or femoral skewers;

- allows you to operate in the early stages of the disease, since changes in tissue pressure occur in the early stages due to impaired microcirculation of the thigh;

- reduces intrafocal hemolymphostasis by increasing the volume of the vascular bed and reducing tissue pressure;

- recovery occurs at an earlier date (pronounced regeneration occurs on the 60th day);

- there is no additional trauma caused by bone autoplasty (an autograft is taken from the iliac wing or one of the trochanters on the muscle leg is used);

- has persistent signs of increased blood supply to the femoral head due to an increase in the volume of the vascular bed.

Claims (1)

A method of treating aseptic necrosis of the femoral head and Perthes disease, including perforation of the femoral neck with the introduction of a needle, characterized in that during the treatment, intraosseous pressure is reduced by 15% from the norm twice a day for 10 days through a previously set needle.