RU2230510C1 - Method for treating osseous cysts - Google Patents

Abstract

FIELD: medicine, orthopedics.

SUBSTANCE: one should affect osseous cyst with UHF electromagnetic field in destruction mode at 10-1000 MHz frequency, 41-45 C, for 1-10 min. The method enables to keep the integrity of affected area and stimulate reparative processes.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine and can be used in traumatology and orthopedics for the treatment of cystic skeletal lesions in children.

Along with surgical treatment of bone cysts, their conservative treatment has recently become widespread.

There is a method of conservative treatment of bone cysts, which consists in the fact that at the first stage of intensive inactivation of the cyst and its “transfer” to a less active degree, 2-4 puncture lesions are performed with the introduction of aminocaproic acid and the addition of contracal with an interval of 1-2 weeks, and then 3-4 punctures with the introduction of aminocaproic acid with Kenalog with an interval of 3-4 weeks. This period lasts from 2 to 7-8 months. At the 2nd stage - the stage of reducing activity to complete repair, 2-3 punctures are performed with the introduction of aminocaproic acid with a canalogy interval from 5 weeks to 3 months for 12-18 months (Abstract by L. Burkova “Outpatient treatment of bone cysts in children ”).

There is a method of treating bone cysts, which consists in continuous flow drainage into the pathological cavity of medicines with bone meal from demineralized matrix (US Pat. RF 2069995).

The disadvantages of known methods for treating bone cysts include: a negative effect on the growing child’s body of the trauma of traditional surgical interventions, lack of control over the state of the regenerative process, as well as the discrete nature of the effect, prolonged drainage of the cyst cavity can cause infectious complications.

A known method of treating bone cysts using a graft (US Pat. RF 2160060).

The disadvantage of this method is the use of technically complex, special and expensive devices for implementing the method.

The closest technical solution to the claimed is a method of treating bone cysts by removing contents from the cavity of the cyst, followed by the introduction of drugs into the cavity, peeling the periosteum along the perimeter of the bone (US Pat. RF 2160061).

The disadvantage of this method is the performance of a classic, extensive and heavy surgical operation, accompanied by blood loss. The timing of immobilization of the operated limb is 8-12 weeks, and the load on the limb is possible after 6-12 months. Thus, there is a variant of prolonged bone regeneration with long immobilization after surgery, which is not beneficial for the patient.

The aim of the present invention is to provide a method of treating bone cysts with controlled regeneration of bone tissue with devitalization of the affected area of the bone while maintaining its continuity for use in the treatment of cystic skeletal lesions.

This goal is achieved through the use of a method for treating bone cysts by exposing a bone to a bone in a destruction mode (microwave destruction) at a temperature of 41-45 ° C at a frequency of 10 MHz to 1000 MHz and a time of 1 to 10 minutes.

The influence of microwave EMF is possible in two versions: option 1 - intraosseous microwave destruction using a probe inserted into the cyst cavity through the hole, option 2 - application microwave destruction of the affected area of the bone after cutting the skin and muscles and detecting the affected area.

Under the influence of microwave EMF in the destruction mode, a given volume of tissue is destroyed, i.e. this effect is well controlled. In the area of exposure, coagulation of the walls of the vessels of the bone marrow canal and the contents of the cystic cavity is noted. In the wall of bone cysts, coagulation of the walls of viciously developed vessels occurs, blood clots form, in the cortical layer of the bone, the death of osteocytes and viciously developed vessels located in the central channels of osteons and perforating channels is determined. It is fundamentally important to maintain the integrity of the bone during the development of necrosis in the affected area. In the future, there is a restructuring of the dead bone area from the adjacent adjacent unchanged areas. In contrast to repair after classical resection, the process of restoring the bone structure is characterized by the formation of cutting and closing cones, which are observed under physiological conditions of regeneration. In addition, the dead area of the bone serves as the basis for the growth of periosteal and endosteal regenerate. The dead bone itself is slowly undergoing resorption, being essentially an autograft. Due to these processes, the destroyed area is replaced by coarse-fibered bone tissue, which is then converted into lamellar. The necrotic area of the bone acts as a skeleton for the formation of a regenerate, a stimulator of repair, and a source of plate material. Healing occurs by primary intention, which can be associated with the preservation of bone continuity after microwave destruction.

At the same time, it is possible to avoid severe traumatic surgery, bleeding associated with bone resection or curettage, to reduce the patient’s stay in bed and to reduce immobilization time by 2-3 times, and also to guarantee the absence of transmission of bacterial and viral infections associated with the transplant.

The validity of the proposed method of treatment was confirmed in an experiment on the tibia of rats and rabbits. After 24 hours, in the area of exposure to microwave EMF, the periosteum is in a state of necrosis; in the cortical layer of the bone, the nuclei of osteocytes are hyperchromic, thromboses and cell infiltrate are revealed in the central and perforating canals; hemorrhages are noted in the bone marrow, red fibrin thrombi are observed in the vessels. After 3 days, a similar picture takes place, however, most ostecytic lacunae are empty, and the process of resorption is activated on the bone surfaces. After 14 days, the periosteum is thickened, from the side of the periosteal and endosteal surfaces of the bone there is the appearance of pronounced layers of coarse fibrous bone, numerous “cutting” and “closing” cones are found in the dead bone, which characterize its gradual replacement by newly formed bone structures. By 60 days, necrotic areas are not detected, the process of remodeling of coarse fibrous bone into lamellar is almost complete and only a small thickening of the bone is determined at the site of exposure. The formation of sequectors was not detected in any case.

In clinical trials of microwave bone destruction, intraoperative microwave destruction of the bone cyst was performed, the resulting damage pattern is similar to experimental data: coagulation of blood vessel walls, thrombosis, osteocyte necrosis.

To implement the proposed method, we used the installation for local EM-hyperthermia “Yacht-3” (TU 6BC.005.128), approved for use by Protocol No. 4 of May 16, 1986, by the Committee on New Technology of the USSR Ministry of Health. The operating frequency of the installation is up to 1000 MHz, the maximum output power is 180 watts.

The applicators are mounted in a special manipulator that allows you to quickly fix the desired emitter in the working position on the patient's body.

The installation is an electromagnetic energy generator operating in a manual or automatic mode for tuning power according to the received signal values from the sensors of the temperature meter. Electromagnetic energy from the generator through a non-invasive emitter, which is used as an applicator, is fed to the heated area of the body. In the heating zone, temperature sensors are located as necessary. From the temperature meter, the processed analog signal enters the automatic control unit, which, depending on the temperature in the heating zone, generates a signal to control the output power of the generator unit.

Water cooling is used in the applicators to cool the surface of biological tissues and improve the temperature distribution in depth.

The applicator size was selected depending on the size of the tumor, namely 80 × 70 mm, 130 × 100 mm, 150 × 130 mm, 160 × 160 mm.

As a temperature sensor, a small-sized small-sized diode 2D901A was used, which is placed at the end of an injection needle with a diameter of 1.2 mm.

During the treatment session, the temperature changed from 41 ° C to 45 ° C at frequencies from 10 MHz to 1000 MHz for 1-10 minutes.

The choice of treatment conditions depended on the age of the patient, the size of the bone cyst, general indications for treatment.

The inventive method is illustrated by the following clinical examples.

Example 1

Patient B., 13 years old. A bone cyst was received with a diagnosis of the lower third of the right femur in the active phase (cavity size 5.5 × 7.0 cm).

After the examination, a local microwave destruction of the bone cyst was performed. Microwave exposure parameters: applicator size 70 × 70 mm. Temperature 45 ° С, frequency 1000 MHz, exposure 10 min.

8 days after microwave destruction, the patient was discharged for outpatient treatment. On examination, 1 year after treatment: the cyst was replaced with bone tissue. There are no complaints.

Example 2. Child M.A. Entered at the age of 10 with a diagnosis of a bone cyst on the upper third of the tibia.

After the examination, a local microwave destruction of the cyst was performed. Microwave exposure parameters: applicator size 30 × 40 mm, frequency 10 MHz. Temperature 41 ° С, exposure 1 min. 10 days after the microwave destruction, the child was discharged for outpatient treatment. On examination, 6 months after treatment, the cyst was replaced with bone tissue. There are no complaints.

Example 3. Child Z.N. He was admitted at the age of 7 with a diagnosis of a bone cyst of the humerus in the active phase. The size of the cyst is 40 × 20 mm. After the examination, a local microwave destruction of the cyst was performed. Microwave exposure parameters: applicator size 50 × 50 mm, frequency 500 MHz. Temperature 43 ° С, exposure 5 min.

Claims (1)

A method of treating bone cysts, characterized in that the impact on the bone cyst is carried out by a microwave electromagnetic field in the destruction mode at a frequency of 10-1000 MHz, a temperature of 41-45 ° C, for 1-10 minutes