RU2354322C1 - Method of mechanical stimulation of retarded osteogenesis in case of bone fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine and veterinary, and is intended for stimulation of reparative regeneration of injured bones under conditions of retarded osteogenesis. Fixation of bone fragments with apparatus for transosteal osteogenesis is performed. 3-5 days after operation dosed distraction force with 0.5 mm a day rate is applied to bone fragments during 4 days. Then fragments are fixed in attained position for 3 days, after which compression is performed with accurate matching of fragments, orienting them relative to longitudinal axis, with fixation tillconsolidation.

EFFECT: ensuring osteogenesis stimulation, enhancement of microstimulation in fracture region, reduction of treatment terms.

7 dwg, 1 ex

Description

The invention relates to medicine and veterinary medicine, can be used to stimulate the reparative processes of damaged bones in conditions of delayed osteogenesis, namely, with a significant degree of trauma to osteogenic tissues (bone marrow, periosteum) and damage to the vessels feeding the bone.

A known method of modeling delayed osteogenesis, including violation of the integrity of bone tissue, fixation of bone fragments by a transosseous osteosynthesis apparatus, in which soft tissues adjacent to the bone are prepared. An osteotomy of the tibia of the experimental animal is carried out, the ends of the fragments are removed from the wound. The contents of the bone marrow cavity and the area of the nutrient artery are removed from each. Then the ends of the fragments are compared and fixed to fusion (Patent No. 2301457, Russian Federation. IPC ⁷ G09B 23/28, A61D, A61B 17/56. Modeling method of delayed osteogenesis / Kononovich N.A. (RF), Dyuryagin E.V. (RF ), Dyachkov A.N. (RF), Federal State Institution Scientific and Research Center “WTO” named after Academician G.A. Ilizarov of Roszdrav (RF); - Declared February 18, 2005; published July 27, 2006).

A known method of stimulating osteogenesis, including intramuscular administration of a suspension of allogeneic hydroxylappatite in an isotonic sodium chloride solution and providing acceleration of bone tissue formation at the site of demineralized bone matrix in the experiment (RF Patent No. 2219933, IPC АКК 33/00. Osteogenesis / Volov L.T. stimulation method. , Podkovkin V.G., Vlasov M.Yu. - No. 2002119768/14; claimed 22.07.2002, publ. 12.27.2003).

There is a method of stimulating reparative processes in bone tissue after osteosynthesis, during which animals in the postoperative period are injected with sel-plex at a dose of 5 mg per 1 kg of live weight 1 time per day for 14 days (RF Patent No. 2295962 C1, IPC A61K 33 / 04, А61Р 19/00. Method of stimulation of reparative processes in bone tissue after osteosynthesis / Sakhno NV, Sadovnikov NV, Papazyan TT, Sadovnikova N.Yu., Chervanev VA, Troyanovskaya L .P., Federal State Educational Establishment of Higher Professional Education "Oryol osudarstvenny Agricultural University "(Russian Federation) - №2005128000 / 14;. appl 07.09.2005, published on 27.03.2007; Bull №9)....

However, the known methods do not have a direct stimulating effect on reparative processes in the damage zone, and in particular with delayed osteogenesis. In addition, both the individual components that make up the pharmacological substances, and in general the preparations used in carrying out the known methods, can cause various allergic manifestations. Also known methods provide additional costs for their implementation.

Known casting composition for stimulating bone formation and bone fusion, containing calcium sulfate and viscous biopolymers, preventing the growth of unwanted connective tissues, as well as inducing the growth of blood vessels and the development of bone osteoblasts at an early stage (RF Patent No. 2296588 C2, IPC A61L 27/40, 27/44, 27/00, А61Р 19/00 Filling composition for stimulating bone formation and bone fusion, containing calcium sulfate and viscous biopolymers / KIM In-San, 40 Byung Tea., REGEN BYOTEK, INC. (KR). - No. 2005113276/15; claimed 30.09.2002, published 10.04.2007; BU . №10).

However, the known composition is used to fill the cavities of bone defects, and is also introduced into the cavity of the diastasis in order to stimulate osteogenesis after stretching of the bones, in particular the jaw, and was not used to stimulate delayed osteogenesis during the healing of fractures of long bones.

There is a method of stimulating reparative regeneration of bone tissue consisting in the simultaneous exposure to high-frequency fields and irradiation with low-intensity quasi-monochromatic radiation of the visible and near infrared ranges with a small spectral width (Patent RF 2259216 C2, IPC A61N 2/00, 5/06. Method for stimulating reparative regeneration of bone tissue and device for its implementation / Ryabokon D.S., Federal State Unitary Enterprise Omsk Research Institute of Instrument Engineering (RF) - No. 2002121816/14; application L. 07.08.2002, publ. 08.27.2005; Bull. No. 24).

A known method of stimulating osteoreparation in dogs after osteosynthesis, including exposure to biologically active points with an electric current of a certain parameter (RF Patent 2280431 C1, IPC A61H 39/00, A61N 1/32, A61D 99/00. Method for stimulating osteoreparation in dogs after osteosynthesis / Sakhno N.V., Federal State Educational Establishment of Higher Professional Education "Oryol State Agrarian University" (RF). - No. 2004136521/14; stated. December 14, 2004, published July 27, 2006; Bull. No. 21).

A known method of stimulating reparative osteogenesis in animals and humans, including the use of a surgical laser emitting in the near infrared in a pulse-periodic mode with an average power of 20-40 W, while osteoperforation is carried out for 3-10 s at the fracture site in at least five points and through holes are formed in the area of bone fracture in the planes perpendicular to the bone (Patent No. 2255700 RU, MKI A61B 18/22. Method for stimulating reparative osteogenesis in animals and humans / VA Molokanov, VA Privalov ., Krochek I.K., Tsiulina E.P., Lappa A.V., Shumilin I.I. (RU) - No. 2003120791/14; claimed 07.07.2003; publ. 10.07.2005; Bull. No. 19. - 7 p.).

However, the known methods include the availability of special devices, and therefore additional costs for implementation.

A known method of modeling stimulation of bone tissue regeneration, which consists in delimiting the region of a circular defect of a long tubular bone from the penetration of surrounding tissues by a film of dinitrocellulose, which is applied circularly with overlapping edges of the defect by 5-7 mm and tightly fixed with nylon threads, previously removing the periosteum from the ends of bone fragments (RF Application 2005100265/14. Method for modeling bone tissue regeneration stimulation / Shevtsov V.I., Dyachkov A.N., Ruchkina I.V., Russian State Institution The 1st Scientific Center “Reconstructive Traumatology and Orthopedics” named after Academician G. A. Ilizarov (RF); declared on January 11, 2005, published on June 20, 2006; Bull. No. 17).

However, the known method is used to stimulate the reparative regeneration of bone tissue when replacing circular defects.

There is a method of stimulating the reparative process of the bone, which consists in the fact that after the end of the distraction period, the distal and proximal parts of the bone reagent are brought together while compressing the connective tissue layer of the regenerate (Patent 2071740 RF, MKI 6 A61B 17/56. Method for stimulating the reparative process of bone / B. I. Shevtsov (RF), A.V. Popkov (RF) - No. 94013185/14; claimed on 04/13/94; publ. 01/20/97; Bull. 2).

However, the known method is intended to stimulate the formation of bone regenerate during distraction osteogenesis.

The objective of the present invention is to develop a method that allows you to provide a direct stimulating effect on the processes of osteoreparation in case of bone damage by local mechanical stress applied to the fracture region during the fixation period, under physiological conditions unfavorable for adhesion.

The problem is solved in that in the method of mechanical stimulation of delayed osteogenesis during bone fractures, including fixing bone fragments by the device for transosseous osteosynthesis, 3-5 days after the operation, metered distraction efforts are applied to the bone fragments at a rate of 0.5 mm per day for 4 days, then the fragments are fixed in the reached position for 3 days, after which compression is carried out, precisely matching the fragments, orienting them relative to the longitudinal axis, and fixing them to fusion.

The present invention is illustrated by a detailed description, the attached photo, radiographs and histotopograms, on which:

Figure 1 - view of the legs of the dog after applying the apparatus for external fixation.

Figure 2 is a copy of the x-ray of the leg bones after an open transverse osteotomy and removal of the contents of the bone marrow cavities of the fragments to a depth of 1 cm

Figure 3 - copy of the x-ray of the bones of the leg according to the invention, the end of distraction.

Figure 4 is a copy of an x-ray of the lower leg bones according to the invention, 7 days of fixation after compression.

Figure 5 is a copy of an x-ray of the lower leg bones according to the invention, 30 days of fixation after compression, 42 days of experience.

6 is a copy of the x-ray of the bones of the leg according to the invention, 30 days after the termination of fixation by the apparatus.

7 is a copy of the histotopogram 30 days after the termination of fixation by the apparatus.

The method is as follows.

A diaphyseal bone fracture, accompanied by significant damage to osteogenic tissues and vessels feeding the bone, is fixed using an apparatus for transosseous osteosynthesis. 3-5 days after the operation, metered distraction efforts are applied to the fragments at a rate of 0.5 mm per day for 4 days, after which a 2.0 mm diastasis is formed between them. After three days of fixation, in the achieved position, the fragments bring together until complete contact.

The device is dismantled in the presence of clinical and radiological signs of fusion.

An example of the method.

In an experimental animal (dog), according to the known method, an open fracture of the lower leg bones is modeled, accompanied by significant damage to the periosteum, bone marrow and rupture of the vessels feeding the bone. For this, in the operating room, in an anesthetized animal, after treating the surgical field with a 5% alcohol solution of iodine, the Ilizarov apparatus was placed on the right shin, consisting of two subsystems (proximal and distal), interconnected by three threaded rods (Figure 1). An open transverse osteotomy was performed in the middle third of the tibia diaphysis using a Jigli file. In order to enhance the degree of trauma to osteogenic tissues from the bone marrow cavities of the proximal and distal fragments, the contents were removed to a depth of not less than 1 cm, after which the fragments are accurately compared (Figure 2). Knotted stitches are applied to the soft tissue. The surgical field is treated with 5% alcohol iodine solution.

5 days after osteosynthesis, distraction was started along the rods connecting the subsystems of the apparatus at a rate of 0.5 mm per day for 4 doses over four days. By the end of distraction, the diastasis between the fragments was 2 mm (Figure 3). Further, after three days of fixation, compression was performed until the fragments were in full contact.

7 days after compression, the radiological contours of the ends of the fragments are not clearly defined. The inter-fragment gap is covered by homogeneous shadows of low intensity. In the projection of the bone marrow cavities of the fragments, an endosteal reaction is detected. Periosteal - characterized by the presence on the fragments of loose shadows with a thickness of up to 2.0 mm and a length of 0.5-1.7 cm from the line of osteotomy, more pronounced on the distal fragment (Figure 4).

By 30 days after compression on the radiographs, the fracture line is blocked by dense homogeneous shadows. The endosteal reaction in the fragments fades. Periosteal strata noticeably compacted (Figure 5). In a clinical study, pathological mobility and pain in the osteotomy are not determined, which is the reason for the termination of fixation by the device.

1 month after removal of the apparatus, the x-ray of the bone axis is correct. The fracture line is not determined. Formed a single bone marrow cavity. Endosteal reaction is not visually detected. Compacted periosteal strata with a length of up to 0.6 cm have a thickness of not more than 1.0 mm (Fig.6).

By this time, bone fusion is determined on histotopograms. In the bone marrow cavity, bone trabeculae of the endosteal regenerate and periosteal layers with a thickness of up to 1.0 mm are insignificant in length. Hematopoietic bone marrow. In the cortical plate, mainly of the proximal section, small cavities with bone marrow are detected (Fig. 7).

The proposed method allows in cases of delayed osteogenesis to stimulate the processes of osteoreparation in bone fractures due to increased microcirculation in the fracture created by local mechanical effects on the fragments.

In addition, the method is easily performed, does not cause allergic reactions when it is performed, and does not require additional costs for implementation, in comparison with the known ones.

Claims (1)

A method of mechanical stimulation of delayed osteogenesis in bone fractures, including fixation of bone fragments with a transosseous osteosynthesis apparatus, characterized in that 3-5 days after surgery, metered distraction efforts are applied to bone fragments at a rate of 0.5 mm per day for 4 days, then the fragments are fixed in the reached position for 3 days, after which compression is carried out, precisely comparing the fragments, orienting them relative to the longitudinal axis, and fixing them to fusion.

Images