Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
які мають вищу або середню спеціальну медичну освіту.


Підтвердіть, що Ви є фахівцем у сфері охорони здоров'я.

"Тrauma" Том 15, №5, 2014

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Current approaches to the treatment of chronic osteomyelitis of the lower limbs

Authors: V.Shimon, V.Kovach, A.Sheregiy - State university Uzhhorod National University

Categories: Traumatology and orthopedics

Sections: Clinical researches

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Introduction.

According to the dates of World Health Organization, osteomyelitis is about 7% in structure of diseases of the musculoskeletal system [13]. Osteomyelitis complicate the course of the injuries in 5-67 %, particulary, open fractures complicated by purulent necrotic effects with frequency till 59.7 %, osteomyelitis - till 15.4 % and after osteosynthesis of closed fractures reaches 0,65-0,96%. [10]. The long bones of the limbs affected in 75,3-88,7 % of cases. In the general structure of disability from injuries of the musculoskeletal system osteomyelitis share is 13 % [1, 6, 8].

Treatment of traumatic osteomyelitisis is a significant economic and social problem, because suffer mostly patients of working age. Special attention attract, in our opinion, patients with traumatic osteomyelitis in the background of iodine deficiency.

The purpose of the study: To improve the results of treatment of traumatic osteomyelitis in patients with iodine deficiency by adding complex of therapeutic activities using a laser focus on source of destruction and impact on bloodstream.

Material and methods. Study materials covered the group of patients treated from post-traumatic osteomyelitis during the period 2008-2013 years at the clinic of traumatology- orthopaedics Transcarpathian Regional Hospital named by A. Nowak. Was performed the analysis of medical history in 70 patients. Also analyzed the results of treatment, both surgical and low-invasive with the use of high-and low-intensity laser radiation in 46 patients, which constituted the main group of studing in treatment of which standard, conventional measures were complemented by methods of own methodology, which studied in Institute "Injuries " and includes catheterization a. epigastrica inferior, followed by prolonged regional leading in of antibacterial and cardiovascular preparations using infusomats Lineomat, «ВЕДА-2», «ДШВ» and laser manipulation. Accordingly, in the complex treatment of 24 patients in the control group who received the conventional treatment, the following scope: sanitation source of purulent-necrotic process (sequestrectomy, necrosectomy), antibacterial, detoxification and vascular therapy, conducted by intravenous, intraarterial (puncture) and intramuscular mothods, intraarterial manipulation and laser techniques were not used, it was used in control group .

Sowing excretion from the wound or source inflammatory made exclusively ​​for all patients, the results shown in the diagram below. Pathogenic staphylococci sown in 61-100 % of cases as a monoculture or in association with other microorganisms. At the present time, there are many strains of microorganisms that are not sensitive to most antibacterial preparations. The nature of the microbial flora that sown from patients was typical and included staphylococci (34.3 %), E. coli (26.5 %), pseudomonas aeruginosa (18.2 %), proteus (11.6 %), streptococcus (9.4 %). In 32.7 % of cases sown mixed.

We have proposed expanding range of medicines to patients, after repeated treatment without the desired effect and with the consent of the patient, they was transferred to the main group of study.

The research results.

As a result of the treatment was observed acceleration of the dynamics of wound healing in patients of main group, that was shown by shorten terms of cleaning wounds, the appear of granulation and epithelialization beginning. Postoperative wound heal by secondary tention within 14-18 days. In order to fix bone fragments used external fixators, particulary prefer many planar external fixation device type Popsuyshapka, which, for ease of use complement by mobilizing connecter, patent certificate № u201311554, and external fixators device by own constraction, patent of Ukraine № 49002 . Radiologically ascertain accelerate bone regeneration.

Positive dynamics of endotoxemia, iodine balance wound healing, increase the body's protection power in patients on post-traumatic osteomyelitis of bones of the lower limbs led also to a reduction of patients' stay in hospital - from 38,6 ± 2,8 bed-days in the control group, where used the conventional treatment, till 22,4 ± 3,2 bed-days in the study group, where used the described method.

Conclusions.

Using the methods of treatment of post-traumatic osteomyelitis of the long bones of the lower limbs with using the regional infusion and the wide use of high-and low-intensity laser radiation makes it possible to stop the progression of purulent destructive process in bone and soft tissues or completely eliminate of injury center, can achieve rapid bone sanation, fistulas moves and source of purulent necrotic process of soft tissue, accelerate the dynamics of wound healing and regeneration of bone, reduce endotoxemia, improve immune status of the organism and normalize iodine balance, gives significantly faster treatment time, and ordering iodine preparations gives corrective trends in the treatment of traumatic osteomyelitis in patients from mountainous regions.

Our research require more in-depth and follow-up observations.



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