Purpose: To improve effectiveness of the application of intraosteal laser radiation (LR) in the surgical treatment of patients with distal occlusions of lower extremity arteries

Materials and method: In the complex surgical treatment of 34 patients with developed critical ischemia of extremities against the obliterating thrombagite intraosteal laser radiation was applied. Average age of patients 39,7 years, average duration of the disease 4,8 years, time passed from the development of the critical ischemia till the admission to the clinic 2,9 months. In 18 patients both shin artieries, in 12 patients femoral- popliteal arterial segment, and in 4 patients popliteal-shin arterial segment occluded. In all the patients there was performed ROT of cane bone. Therefore, on the anterio-medial and anteriolateral surface of the shin, there were 3 and 4 osteoperforation on the both sides of 0,5 cm diameter of the cane bone located at 6-7 cm intervals from each other. To stimulate the intra-bone marrow blood circulation laser radiation guide was inserted and fixed from two proximal holes (KIVL-01), and LR is carried out in postoperative period. LR was carried out in the following parameter: wavelength – 0.63 mlm, for laser radiation at the end of laser guide - 1,5-2 mVt., exposition 10 min., course – 7-10 session. In 27 patients there was performed BSE in addition to intravenous laser radiation, and laser radiation was carried out in all the patients. The effectiveness of the operation was assessed based on clinical observations, as well as dopplerographic, reovasographic examinations, biochemical, coagulologic and immunological investigations of blood. The control group included 52 patients treated by traditional method in the department.

Result: In the of result of the applied treatment, indicators of the regional blood circulation, biochemical, coagulologic and immunologic indicators of blood significantly improve as compared to the comparative group. In 22 (64,7%) of the patients of the main group, necrotic wound on the foot and fingers healed, in 6(17,7%) patients amputation or exarticulation, in 3(8,8%) patients transmetatarsal amputation, in 3(8,8%) patients amputation of shin and thigh was performed. In the comparison group in 22 (42.3%) necrotic wound of foot healed, in 10 (19,2%)- amputation or exarticulation of fingers, in 12 (23.1%)- transmetatarsal amputation of foot, in 8(15,4%) patients amputation of shin and thigh was performed.

Conclusion: The application of intraosteal laser radiation (LR) in the surgical treatment of patients with distal occlusions of lower extremity arteries improves regional blood circulation, corrects biochemical, mehostatic and immunological indicators, allows to preserve supporting function of lower extremities in 91,2% of patients.

Date: 2014-12-28; view: 754