Modern approaches to the treatment of osteomyelitis using laser radiation

Abstract

In modern traumatology, due to the increasing intensity of traumatic agents and increase in number of surgical interventions for bone fractures, the number of septic complications remains the same, despite improvements in surgery methods. Unsatisfactory results thus make 7,8-29,3%. Biomedical and social component of the problem is particularly significant for the inhabitants of mountainous areas with iodine deficiency in the environment and in the body. The main treatment for post-traumatic osteomyelitis is radical surgery, but on the way to achieving a favorable result it is necessary to recover the hemostatic body dysfunctions, including iodine metabolism. One of the most effective non-drug methods of such correction is exposure of laser radiation directly to the lytic lesion and blood.

The objective of our study was to improve outcomes of patients from mountainous regions, suffering from posttraumatic osteomyelitis on the background of iodine deficiency by using laser radiation on the lytic lesion and bloodstream.

Materials and methods. We have performed the analysis of treatment of patients with posttraumatic osteomyelitis on a clinical site of the Department of General Surgery with the course of Traumatology and Orthopaedics of Faculty of Medicine of Uzhgorod National University for 2010-2016 years. Patients were divided into two groups. The test group consisted of 42 patients aged 19 to 70 years, 30 of which 30 were males, and 12 of which were females. In 29 patients had diagnosed with post-traumatic osteomyelitis after bone fractures of the lower leg, 24 of which had open fractures. Eight of injured patients had hip osteomyelitis, two injured patients had forearm osteomyelitis, and three patients had osteomyelitis developed after shoulder surgery.

The control group consisted of 40 patients. 33 of them had hematogenous osteomyelitis (according to Waldvogel classification), osteomyelitis associated with peripheral vascular insufficiency was reported in 4 patients, and osteomyelitis, which combines all forms was reported in 2 patients. According to classification of Cierny – Mader, medullary osteomyelitis was diagnosed in 3 patients, superficial osteomyelitis was reported in 7 patients, 10 patients had localized osteomyelitis, and 20 patients were diagnosed with diffuse osteomyelitis.

Most patients in both groups (82.2%) were living in areas, which had the status of mountain areas or endemic regions with iodine deficiency.

We analyzed the changes in levels of triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) in patients with traumatic osteomyelitis at admission and in terms of 3 months, 6 months, 12 months. In the treatment of the main group of patients, 42 patients with posttraumatic osteomyelitis of the long bones, we used a previously developed approaches, as part of which the standard, conventional measures were complemented by methods of the own development of the Department of general surgery Zhgorod

National university, the Institute of “Trauma”:

- radical surgery, aimed at eliminating of the osteomyelitis site of damage – sequestrectomy (in particular, with the help of laser radiation);

-   treatment of sequestral cavity and sinus tracts with “Lika-Surgeon” high-intensity diode laser manufactured by Cherkasy enterprise “Photonika Plus” (wavelength of 980 nm, power of 10-18 watts);

-  drainage of sequestral cavity with its postoperative treatment by ultraviolet radiation (wavelength of 270-320 nm, power of 25-30 mW) using quartz-polymeric light guide inserted through the drainage;

-  catheterization of a. epigastrica inferior followed by prolonged regional administration of antibiotics and vascular drugs via infusion pumps “Lineomat”, “VEDA-2”, “DSHV”;

-  laser therapy (endovasal and the local magnetic-laser exposure).

In the test group of patients, in contrast to the control, iodine status correction was performed by prescribing iodine drugs (potassium iodide and L-thyroxine under endocrinologist’s supervision) after surgery and for up to 6 months.

Patients of the control group, received the following conventional treatment of post-traumatic osteomyelitis: sanitation of purulonecrotic process nidus (sequestrectomy, necrectomy), sequestral cavity drainage, antibacterial, detoxification and vascular therapy was carried out by intravenous and intramuscular route. Intra-arterial laser irradiation of blood, and laser exposure of bone destruction lesion were not used in the control group.

Analyzing the treatment outcomes, we assessed the wound process dynamics, clinical and radiological picture. The level of endotoxemia, Kc intoxication rate, leukocyte and intoxication ratio, and (if applicable) laboratory parameters of iodine were taken into account.

As a result of treatment the acceleration of the wound process dynamics was observed in patients of the test group; it was evidenced by the reduction of period of wound cleansing, the appearance of granulation and initiation of epithelialization. Postoperative wounds healed by secondary intention within 14-16 days.

Conclusions. The treatment of traumatic osteomyelitis in patients, especially those from mountain areas, having the reduced iodine balance, according to our observations, gives positive results only when the iodine balance is brought up to the normal range. There were 8.4% more good results, 12.2% more satisfactory results and 5.7% less unsatisfactory results in patients who have been treated according to the proposed regimen, compared to the control group.