Bezrukov S.G.,
Roganov G.G., Kushnir K.G.
Crimea state
medical university named after S. I. Georgievsky, Simferopol.
The influence of etiopathogenic
justified therapy in treatment the traumatic osteomyelitis of mandible
The article assessed the efficiency of treatment of
patients with traumatic osteomyelitis
of mandible. Therapeutic complex include antioxidant (erbisol) and osteoplastic
material doped with silver (biomin GTLS)
Key words: traumatic osteomyelitis of the mandible , disorders of
redox processes, antioxidant, antimicrobial and osteoplastic local therapy.
The problem of treatment the
chronic osteomyelitis of mandible stays one of the most complicated in the
surgical stomatology.
The purpose of this
investigation is the opportunity of use
the antihypoxic and antimicrobic osteoplastic therapy in complex therapy of traumatic osteomyelitis of mandible.”Erbisol” has effect of decrease the intensity of
inflammatory reactions , has antioxidant and membrane stabilizing actions.
Materials and methods of investigation
Were selected 58 patients with traumatic
osteomyelitis of mandible. Also there were 27 healthy people as a control group. All examinated were
divided into 2 groups: 1 group(27 patients) – healthy people in age 18-25 with
no diseases. 2 group (the main) included 2 subgroups. In first (subgroup A)
patients with traumatic osteomyelitis
of mandible, received traditional complex
treatment(with preparation tocopherol ) with local use the hydroxyapatite. In
second group( subgroup B) 26 patients with traumatic osteomyelitis of mandible
also used Erbisol.
Results and discussion
The
significant changes demonstrated the indexes of general immunity: Ig A
decreased in 39 % (p<0,01), IgM - in
24,7%(p<0,05),that pointed out to disturbances in system of general
immunity.Growth of indexes of lipid peroxidation of blood S increased by
40,2 %, Imax – by 26,5 %, ST – 23,9%. More expressive changes registrated by
data of analysis of condition of lipid
peroxidation of saliva: S increased by
112 %(p<0,01). It testified about increase of number the free radicals in
blood and in mixed saliva and in general
- about intensification the processes of lipid peroxidation.
Cytochemical indexes of enzymes of
peripheral blood neutrophils
demonstrated had polar changes. SDH – activity decreased by
31,1%(p<0,01), LDH-activity
increased by 24,5 %(p<0,05), that pointed out to the the prevalence of
anaerobic glycolysis over aerobic oxidation, and also to tensions in metabolic
processes and reactions of oxygen deficiency. High proteolytic activity of the
neutrophils (+29,2 %,p<0,05) pointed out at development the general
inflammatory reactions. In this way ,
the results of examination showed the moderatly expressive local and general
inflammatory reactions, which progress against the background of increased
proteolytic activity of neutrophiles of peripheral blood, metabolic hypoxia and
chronic immunodeficiency.
The study of lipid
peroxidation was important to us because these data showed the condition of local and general hypoxia against the
background of use different medical complexes. The received data testified
about significant changes of data of lipid peroxidation indexes . It pointed
out about deep disturbances of processes of
lipid peroxidation in groups of comparation. The additional growth of
indexes observed in early postoperative period.
The character of changes of
cytochemical indexes (LDH and SDH) of neutrophils allowed to identify the initial imbalance in anaerobic glycolysis
and aerobic oxidation in patients with
traumatic osteomyelitis of mandible, caused by metabolic hypoxia. The more
expressive disturbances were fixed on 5-7
day of postoperative period.
Conclusion
The cytochemical analysis of proteolytic
activity of enzymes of peripheral blood neutrophils allowed to establish , that
the disease traumatic osteomyelitis leads to significant increase of average
value of the index.