RU2306110C2 - Method for complex treatment of gunshot fractures - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: the present innovation deals with treating osseous gunshot fractures due to fixing osseous fragments with the help of the apparatus of extrafocal osteosynthesis followed by their reposition and surgical treatment of the wound. After surgical treatment on the 1^st d after operation a patient should be intravenously injected with mexidol by drops at the dosage of 300 mg once daily, and during the next 2 d - intramuscularly twice daily at the dosage of 200 mg, moreover during 10 d after surgical treatment a patient should be perorally introduced with ADP-37 at the dosage of 6 capsules daily and during 5 d it is necessary to affect the wound with impulse magnetic filed of 0.5-1.0 Tl intensity through Dalcex-trypsin filter cloth impregnated with 0.01%-serotonin solution in physiological solution once daily. The innovation enables to accelerate the terms for wounds healing, avoid complications due to complex pathogenetic approach during therapy conducted.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, specifically to surgery for the treatment of gunshot bone fractures.

The morphology and pathogenesis of a gunshot wound are fundamentally different from wounds of a different genesis, namely the formation of a tissue defect along the wound channel, the nature of which depends on the caliber and speed of the bullet and the site of the wound, and the presence of a zone of non-viable tissue around the wound channel; violation of microcirculation in tissues bordering the wound zone, contamination of the wound by various microorganisms and foreign bodies.

In case of gunshot bone fractures with high-speed bullets, small fragments are formed, resulting in additional damage and a bone defect.

In the treatment of gunshot fractures, extrafocal osteosynthesis (CHO) is predominantly used using external fixation devices of various designs. The advantage of extracortical osteosynthesis is the stable fixation of almost any type of fracture (L.N. Ankin et al. “Modern methods of treating fractures”, Kiev, 1994, p. 250). The disadvantages of this method of treating gunshot fractures include a large number of complications.

The course of the wound process in a wound with a gunshot fracture is determined by many factors, but the nature and volume of damaged and devitalized tissues are the leading ones, the fate of which, ceteris paribus, determines the clinical outcome of the wound. Existing experience shows that after surgical treatment of a gunshot fracture, further treatment of the wound must be supplemented by a wide range of drug treatment.

Known closest to the claimed method for the treatment of gunshot fractures (long bones of the extremities), including the fixation of bone fragments by the extrafocal transosseous compression-distraction osteosynthesis apparatus before reposition, gentle surgical treatment and antibiotic therapy (Pat. RF No. 2185792, MKI A61B 17/00, publ. 2000).

The disadvantages of this method include the insufficiently high intensity of subsequent therapy, which includes all the disadvantages of using antibiotics: the risk of allergies, unwanted side effects and complications in the form of toxic effects.

The invention solves the problem of increasing the effectiveness of the treatment of gunshot bone fractures.

The problem is solved due to the fact that in the method of treating gunshot bone fractures, including fixation of bone fragments by an extrafocal osteosynthesis apparatus, their reposition, surgical treatment of the wound, after surgical treatment on the first day after surgery, the patient is injected with mexidol intravenously at a dose of 300 mg once a time day, and the next two days - intramuscularly 2 times a day at a dose of 200 mg, while for 10 days after the operation, the patient is dosed ADF-37 orally in a dose of 6 capsules per day and for 5 days in they act on the wound with a pulsed magnetic field with an intensity of 0.5-1.0 T through a Dalcex-trypsin napkin impregnated with a 0.01% solution of serotonin in physiological saline 1 time per day for 30 sec.

The technical result of the invention is the high efficiency of the proposed method for the treatment of gunshot fractures of the extremities: the healing time is reduced from 31-35 to 8-10 days, in addition, the use of the proposed therapy eliminates the complications inherent in antibiotic therapy.

ADF-37 is a biologically active food supplement, including spirulina, containing selenium, copper and zinc, obtained by special cultivation, bioflavonoid complexes from natural raw materials, concentrated dry extracts of ginseng, echinacea, green tea, vitamins B, C. E , beta-carotene, manufacturer Veta-Grand, Russia, is available in capsules of 504.6 mg. Registration No. 77.99.20.919B.000312.10.03.

Napkins Dalcex-trypsin - therapeutic napkins based on dialdehyde cellulose containing immobilized trypsin - FS 42-3008-99, per. No. 89/85/6.

The method is as follows.

Upon admission to the hospital, patients with gunshot wounds undergo surgical treatment of the wound. Under general anesthesia, the primary surgical treatment of a gunshot fracture is performed with the removal of blood clots, scraps of clothing, loose bone fragments that are not associated with the periosteum. Whenever possible, necrotic soft tissues are radically excised taking into account topographic and anatomical features. Reposition of fragments and extracortical osteosynthesis with AO plates are performed. In the presence of a bone defect, bone autoplasty and primary extracortial osteosynthesis are performed. A bone autograft is taken from the iliac crest according to the shape and size of the bone defect.

After abundant washing of the wound with antiseptic solutions, a perforated drainage tube for flow-through washing in the postoperative period is carried out through the contraceptive and the wound is sutured in layers tightly. If necessary, produce plastic with local tissues.

Clinical trials of the proposed method were carried out on 50 wounded, of whom 35 were the main group and 15 - the control. All the wounded were admitted to the clinic on the first day after the wound. In the control group, after adequate surgical treatment of a gunshot fracture and drainage, external fixation devices were used for fixation. In the postoperative period, broad-spectrum antibiotics, drugs of the metronidalosis group, infusion therapy, and flow drainage were used.

In the complex treatment of gunshot fractures in patients of the main group after adequate surgical treatment, the antioxidant Mexidol, which after surgery on the first day, was administered to patients at a dose of 300 mg intravenously 1 time per day, for the next two days at a dose of 200 mg intramuscularly 2 times a day, at the same time, within 10 days after the operation, the patient was dosed ADF-37 orally in a dose of 6 capsules per day and for 5 days was exposed to the wound with a pulsed magnetic field of intensity 0.5-1.0 T through a Dalcex-trypsin napkin, p opitannuyu 0.01% solution of serotonin 1 times a day for 30 seconds. Thus, in the complex treatment of gunshot fractures in patients of the main group, primary extracortial osteosynthesis in combination with antioxidant therapy was used. On the second day, a decrease in perifocal edema and pain was noted. Separated by drainage was hemorrhagic in nature. Drainage was removed on the 6-7th day, depending on the course after the operation period. The proposed method of treatment made it possible to achieve wound healing by primary intention in all patients. The length of stay in the hospital was 8-10 days, while in the control group these periods were 31-35 days.

Thus, an integrated approach in the treatment of gunshot fractures, taking into account the pathogenetic features of this pathology, can achieve a significant reduction in the length of hospital stay, outpatient treatment, rehabilitation and improvement of functional results.

The invention is illustrated by examples.

Example 1

Patient K., 38 years old, was admitted to the hospital for a blind gunshot wound to the left shoulder, a gunshot comminuted fracture of the humerus at the level of lower 1/3, with displacement of fragments, 4 hours after the wound. On examination, there is an inlet in the area of the outer surface of the lower third of the shoulder 0.9 × 1.3 cm, the wound bleeds moderately. On the radiograph (before the operation), a comminuted fracture of the left humerus with displacement of fragments is noted, a foreign body of metal density (bullet core) is traced in the soft tissues.

After preoperative preparation for 2 hours under general anesthesia, primary surgical treatment of the wound was carried out, which included revision of the wound canal, careful excision of necrotic tissue, removal of foreign bodies and free bone fragments not associated with soft tissues. Large bone fragments associated with surrounding tissues are preserved. The bone fragments were repositioned and the AO plate was fixed using screws with a diameter of 3.5 mm. A through perforated drainage tube was made for flow-through washing in the postoperative period. The postoperative wound is sutured in layers tightly. In the postoperative period, the patient received mexidol on the first day after surgery intravenously in a dose of 300 mg once a day, in the next two days, mexidol was administered intramuscularly at a dose of 200 mg 2 times a day. Moreover, starting from the first day after the operation, the patient was dosed ADF-37 orally at a dose of 6 capsules per day for 10 days and for 5 days the wound was treated with a pulsed magnetic field with an intensity of 1.0 T through a Dalcex-trypsin soaked cloth 0.01% solution of serotonin, for 30 seconds 1 time per day. The patient also received infusion therapy. Drainage removed on the 5th day. Healing by first intention. Discharged 8 days after surgery. Sutures were removed on day 10 on an outpatient basis. Examined after 3 months: the postoperative scar is soft, painless with the underlying tissues not fused, complete consolidation of fragments is noted. Movement in the elbow joint restored in full.

Example 2

Patient S., 24 years old, was admitted 3 hours after being wounded with a diagnosis of a through gunshot wound to the right forearm, a gunshot comminuted fracture of the radius. On examination: at the level of the lower third of the right forearm along the velor surface of the forearm, there is an irregular-shaped wound inlet 3.0 × 3.2 cm and an outlet proximal to the dorsal surface, dimensions 3.6 × 3.3 cm, on the radiograph: comminuted fracture and defect of the radius at the level of the distal third.

After preoperative treatment of the patient after 3 hours, primary surgical treatment of the fracture was performed under general anesthesia, dissection and thorough excision of nonviable soft tissues, removal of freely lying bone fragments with preservation of bone fragments associated with soft tissues. Given the presence of a defect in bone tissue and the absence of crushing and extensive damage to soft tissues, bone autoplasty and extracortical osteosynthesis were performed. A bone autograft is taken from the iliac crest. The autograft was fixed to the radius using the type of Russian castle.

In the postoperative period, the patient received mexidol on the first day after surgery intravenously in a dose of 300 mg once a day, in the next two days, mexidol was administered intramuscularly at a dose of 200 mg 2 times a day. Moreover, starting from the first day after the operation, the patient was dosed ADF-37 orally at a dose of 6 capsules per day for 10 days and for 5 days the wound was treated with a pulsed magnetic field with an intensity of 0.5 T through a Dalcex-trypsin soaked cloth 0.01% solution of serotonin, for 30 seconds 1 time per day. The patient also received infusion therapy. Flowing drainage was carried out for 6 days.

Drainage removed on the 6th day. The postoperative course is smooth. Wound healing by primary intention. Sutures were removed on the 9th day, the patient was discharged on the 10th day.

Examined after 3 months: postoperative scars are soft, painless with underlying tissues are not fused, complete consolidation of the fracture is noted. The functions of the forearm and hand are fully restored.

Claims (1)

A method for treating gunshot bone fractures, including fixation of bone fragments with an extra focal osteosynthesis apparatus, their reposition, surgical treatment of a wound, characterized in that after surgical treatment on the first day after the operation, the patient is administered mexidol intravenously in a dose of 300 mg once a day, and on subsequent two days - intramuscularly 2 times a day at a dose of 200 mg, while for 10 days after surgical treatment, the patient is dosed ADF-37 orally at a dose of 6 capsules per day and is exposed for 5 days to the wound by a pulsed magnetic field with an intensity of 0.5-1.0 T through a Dalcex-trypsin napkin, impregnated with a 0.01% solution of serotonin in physiological saline 1 time per day.