RU2356508C1 - Treatment of ununited fractures, false joints and bone defects of cortical bones - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to traumatology and orthopaedics and covers treatment of ununited fractures, false joints and bone defects of cortical bones. Wobenzym is prescribed in a dose 3-5 tab. a day, 2-3 days prior to operation and 7-8 tab. three times a day within 3-4 days after operation. A bone defect is filled with mixed Kollapan and platelet rich plasma in ratio 1:1-2.

EFFECT: method provides elimination of autologous bone graft, reduced extent of surgical procedure, reduced injuries and treatment time.

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Description

The invention relates to medicine, in particular traumatology and orthopedics.

A known method of bone grafting, used in traumatology and orthopedics, which consists in the fact that in order to replenish a bone defect, bone autoplasty obtained from donor sites such as the iliac crest is used. (Sawin P.D., Trayneleis V.C. - A Comperative analysis of fusion rates and donor-site morbility for autogenic rib and iliac bone grafts in posterior cervical fusions. J. Neurosurg. 1998; 886: 255-2650).

The disadvantages of the method are its low efficiency and high morbidity associated with the use of bone autoplasty.

Closest to the proposed method for the treatment of accrete fractures, false joints and bone defects of the tubular bones is a method of treating defects of the tubular bones, when the defects of the tubular bones are filled with a graft. In this case, an autologous platelet-rich plasma (800000-850000 platelets in 1 μl) with the addition of an autologous cancellous bone is used as a graft, after which fixation is performed (RF Patent No. 2283043, 2006).

The disadvantages of the method are the duration of treatment, the use of an autologous graft - spongy bone and additional invasiveness associated with the creation of surgical access for graft collection.

The disadvantages of autoplasty include the invasiveness of operations, since they are associated with the fence of the autograft, the expansion of operational access to the area of an unassembled fracture or false joint, the need to skeleton the ends of bone fragments for the introduction and adaptation of the autograft into the formed bed with subsequent osteosynthesis; often arising need to take autografts from several donor areas; associated cosmetic defects and the risk of infectious complications; age restrictions; poor volume and shape of the grafts; the death of most osteogenic cells during transplantation of material in the very near future due to hypoxia.

The aim of the invention is a method for the treatment of non-overgrown fractures, false joints and defects of tubular bones, which allows to reduce treatment time, to exclude the use of an autologous bone graft and to reduce the amount of surgical intervention associated with its collection.

The problem is solved by the method consisting in the fact that 2-3 days before the operation, Wobenzym is prescribed for 3-5 tablets. 3 times a day and 7-8 tablets. within 3-4 days 3 times a day after surgery and fill the cavity of the bone defect with a mixture of a valve and platelet-rich plasma in a ratio of 1: 1-2.

A combination of wobenzym, a valve mixture, and a platelet-rich plasma with a ratio of the latter 1: 1-2, as previously described in the prior art, has not been previously treated for the treatment of non-consolidated fractures, false joints and tubular bone defects with a combination of the valve and the mixture, which allows us to conclude that the applicant’s proposal meets the criterion of “novelty” ".

Experimental data.

To obtain a platelet-rich plasma, silver-blue Chinchilla rabbits weighing 4500-5000 g are used. Under intramuscular anesthesia (ketamine preparations of 5% -0.5 ml and rametard 2% -0.5 ml are used), the animal is fixed on the operating table. When fixing the rabbit on the abdomen, the pelvic limbs are pulled back, and the thoracic limbs forward and tied to the operating table.

Blood is drawn using intracardiac puncture (40 ml with a syringe in an amount of 20-40 ml from the animal’s heart), which is placed in a 5 ml tube with heparin (0.3 ml heparin). After that, a double centrifugation of blood is performed in the apparatus ZUHL 4.2 (production of Russia).

The first stage of the test tube with blood is placed in a centrifuge for 20 minutes with a number of 1000 revolutions per minute. A supernatant is selected containing a mixture of platelets and white blood cells in an amount of 10 ml and placed in a sterile tube.

In the second stage, a tube with a thromboleukocyte mass in the amount of 10 ml is centrifuged for 20 minutes at 3000 rpm.

Then a supernatant of approximately 6 ml containing white blood cells is collected. Sediment liquid (4 ml) - platelet rich plasma (800000-850000 platelets in 1 μl).

In order to create an experimental defect, a silver-blue color Chinchilla rabbit soft tissue incision is performed (weight 4500-5000 g) in the projection of the s / s radius of the animal 1.5 cm long. The radius is exposed with a blunt and sharp path. Using the Kvant dental electric drill (made in Russia) with a nozzle for bone resection (saw), a 1 cm radius defect is formed with exposure of the bone marrow canal.

Animals are divided into 5 groups. In the 1st group (7 animals), the wound is sutured in layers (control group). In the 2nd (7 animals) plasma rich in platelets is introduced into the cavity of the bone defect. In the 3rd group (7 animals), the cavity is filled only with a valve. In the 4th group (9 animals), the bone defect is filled with a valve and autologous platelet-rich plasma in a ratio of 1: 1.5. In the 5th group, animals are administered 0.2 tablets orally two days before the operation. 3 times a day, Wobenzym, the defect cavity is filled with a valve and platelet-rich plasma in a ratio of 1: 1.5, Wobenzym is administered in 0.3 table. 3 times a day for 3 days after surgery. Animals are removed from the experiment in terms of 1, 2, 3 months.

As a comparative histological study shows, the most pronounced activation of reparative osteogenesis is observed in the 5th group. The latter is manifested in the earlier formation, maturation and remodeling of the newly formed bone.

The positive effect is explained by the fact that autologous platelet growth factors are immobilized and activated on the surface of the collapsing particles of hydroxyapatite (HAP) and collagen elements, stimulating the proliferation and differentiation of osteoblasts, accelerating the processes of osteogenesis. As follows from the data obtained, it can be assumed that wobenzym also actively stimulates osteogenesis.

Clinical example.

B-naya 3., 43 years old, was admitted to the hospital with a diagnosis of False joint of the middle third of the left femur. Condition after osteosynthesis with an intramedullary pin.

Trauma as a result of an accident. The ambulance team was taken to the hospital at the place of the injury, where a fracture of the middle third of the left femur was diagnosed and an operation was performed: osteosynthesis of a fracture of the left femur with a pin. After discharge, with an increase in physical activity, she began to notice increasing pain in the left thigh, shortening of the limb. I went to the clinic.

Upon receipt, walks with a stick. In the area of the left hip joint, an old postoperative scar 12 cm long, with no signs of inflammation. Pain, crepitus and pathological mobility during palpation in the middle third of the left thigh, moderate restriction of movements in the left hip joint.

On radiographs - the false joint of the middle third of the left femur, the condition after osteosynthesis with a pin. In the preoperative period, the patient for 3 days was orally prescribed Wobenzym 4 tablets 3 times a day.

On the eve of the operation, the patient undergoes a blood sampling in an amount of 450 ml followed by its 2-fold centrifugation in a Hettich apparatus (Germany). At the first stage, autologous blood is centrifuged at 2300 rpm. Within 5 minutes, the erythrocyte mass is separated from the plasma. In the second stage, the blood plasma is centrifuged at 4000 rpm for 5 minutes, then the supernatant is separated, in the sterile bag remains plasma rich in red blood cells, in the amount of 20-30 ml, which is mixed immediately with the valve before surgery.

The patient undergoes surgery: removal of the pin, economical resection of the pseudoarthrosis. Rheosteosynthesis of a fracture of the left femur with an AO plate with filling of the bone defect with a valve and plasma rich in platelets (obtained by the above method) at a ratio of 1: 1-1.5. In the postoperative period, the patient receives 4 tablets for 4 days. Wobenzym 3 times a day.

The postoperative period is smooth. The wound heals by first intention. Sutures were removed on day 12. Discharged for outpatient treatment. Fracture healed after 5 months. After 11 months, an operation was performed on an enlarged fracture of the left femur with full movement in the hip and knee joints: removal of the metal structure.

This method of treatment of overgrown fractures, false joints and bone defects of the tubular bones was applied in 30 patients. All patients managed to achieve fusion. There were no purulent-inflammatory complications.

In the group of patients where treatment was carried out in a known manner, purulent-inflammatory complications occurred in three patients (n = 25). The terms of femoral fusion in patients of this group amounted to 9 + 1.5 months, whereas in the group of patients treated by the proposed method they were 8 + 1.5 months.

Claims (1)

A method for the treatment of non-accrued fractures, false joints and bone defects of the tubular bones with the use of platelet-rich plasma, characterized in that 3-5 days before the operation, Wobenzym is prescribed. per day and 7-8 tablets. 3 times a day for 3-4 days after surgery and fill the bone defect with a mixture of a valve and platelet-rich plasma in a ratio of 1: 1-2.