Patent RU-2699742-C1 (RU)
Title: Method of integrated treatment of primary chronic recurrent osteomyelitis in children with background somatic status
Inventor: OCHKURENKO ALEKSANDR ALEKSEEVICH
IPC: A61L27/24
Filed: 2018-05-21
Granted: 2019-09-09
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used for complex treatment of primary chronic recurrent osteomyelitis in children on a background of somatic status. In preoperative period before radical removal of inflammatory focus is determined by multilayer spiral computed tomography spatial visualization of chronic osteomyelitis affected patient's bone structures. Magnetic resonance tomography is used to assess the extent of their damage, as well as the state of surrounding soft tissues, including the state of their vascular network, which are not visualized when performing multilayer spiral computed tomography. Then, in any sequence, presence or absence of chronic bacterial infection of upper respiratory tract in patient is determined by performing cultures of separated nose and oropharynx on nutrient mediums to detect monocultures and associations of bacteria of genus Staphylococcus, genus Streptococcus and Haemophilus in units of CFU/ml. Patient is diagnosed with the presence or absence of chronic persistent viral herpes infection by the content of specific IgG and IgG antibodies in U/ml in blood for detection of one or association of herpes viruses. Patient is diagnosed with the nature of chronic bacterial and viral infections accompanying somatic diseases of the digestive apparatus with determining the severity of intestinal dysbiosis and excessive bacterial growth of the colonic contents of the patient by sowing feces on nutrient media to detect presence of pathogenic flora in the form of haemolytic E.coli, lactose-negative E.coli and Staphylococcus aureus in CFU/g units. Presence of a secondary immunodeficient state of the patient is detected by the level of IgG, IgM, IgG in IgG and classes IgE in U/ml in blood serum for the severity of the primary chronic multifocal recurrent osteomyelitis. Patient's calcium-calcium metabolism disorders are detected by the level of total calcium, ionised ion and phosphorus in mmol/l, alkaline phosphatase in U/l, parathyroid hormone in pmol/l and vitamin D in ng/ml, as well as content of daily urine calcium and phosphorus in mmol/day. That is followed by the radical removal of the patient's bone structures affected by the primary chronic recurrent osteomyelitis. That is followed by postoperative antibacterial therapy and immunocorrection, in which the presence of pathogenic Staphylococcus bacteria in an amount greater than 10 4  CFU/ml in the separated nasal and oral pharynx cefuroxime is administered in dose of 15 mg/kg intramuscularly, intravenously or orally every 12 hours for 10-11 days. If observing the presence of Streptococcus pathogenic bacteria in the amount of more than 10 2  CFU/ml in the separated nose and oropharynx of the patient is prescribed for clindamycin 25 mg/kg/day intramuscularly, intravenously or intravenously divided into 4 doses every 6 hours for 10-11 days. If observing the fact that Haemophilus pathogenic bacteria in the amount of more than 10 2  CFU/ml are kept in the separated nose and oropharynx of the patient is prescribed cefixime in dose of 4 mg/kg every 12 hours inside for 10-11 days. If observing the presence of specific IgG antibodies and specific IgG antibodies to herpes viruses in amount of 40 U/ml and more in the patient's venous blood, the patient is prescribed valaciclovir 20 mg/kg every 6 hours for 11-12 days. If observing the presence of haemolytic E. coli, lactose-negative E. coli and Staphylococcus aureus in an amount of more than 10 1  CFU/g is prescribed in pyobacteriofag 20 ml 3 times a day on an empty stomach for 13-14 days. If observing the patient's blood serum content of immunoglobulin of class IgA in amount of less than 0.45 g/l or more than 2.5 g/l, immunoglobulin of class IgM in amount of less than 0.6 g/l or more than 2.5 g/l, immunoglobulin of class Ig G in amount of less than 8 g/l or more than 18 g/l and immunoglobulin of class IgE in amount of more than 100 U/ml Galavit is administered intramuscularly in amount of 5 injections 50–100 mg every other day once a day at night. If observing the content of total calcium in the venous blood of the patient in an amount of less than 2.5 mmol/l, calcium ionized in an amount less than 1.03 mmol/l, phosphorus in an amount less than 0.87 mmol/l, alkaline phosphatase in an amount of less than 40 U/l or more than 150 U/l, parathyroid hormone less than 1.6 pmol/l or more than 6.9 pmol/l and vitamin D less than 30 ng/ml, as well as when determining content in daily urine of calcium patient less than 2.5 mmol/day and phosphorus in amount of less than 12.9 mmol/day prescribed patient receiving alfacalcidol in amount 0.25–0.5 mcg once a day at night for 90–120 days and intake of calcium carbonate in amount of 250–500 mg twice a day after meals in the morning and during lunch for 90–120 days. Cavity formed after radical removal of the inflammatory focus can be filled with "CollapAn" in the form of granules or in the form of "CollapAn"-gel with antibiotic. 
     EFFECT: method provides postoperative prevention of recurrences with due allowance for etiopathogenetic factors, determination of patient's polymorphism and subsequent conservative treatment taking into account patient's respiratory and digestive system diseases, reliable determination of patient's calcium-calcium metabolism state, as well as bone tissue restoration taking into account the state of calcium-phosphate metabolism of the patient as a result of detecting etiopathogenetic factors of the patient's disease involved in the recurrent chronic osteomyelitis. 
     1 cl, 3 ex