RESTORATION OF THE DIAPHYSIS OF LONG BONES BY CELLULAR TECHNOLOGY APPLYING A METHOD FOR AUTOTRANSPLANTATION OF A VESSEL Russian patent published in 2021 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, regenerative medicine, microsurgery, vascular surgery, and can be used for autotransplantation of a vessel into the area of a bone defect, the size whereof exceeds the critical size. A transplant vessel of an applicable size is taken from a limb of the subject without a defect. Surgical access to the bone with a defect is executed. The artery providing blood supply to this segment of the limb is isolated. Two holes are made on the bone in the cortex to introduce the transplant vessel, at an angle to the anterior surface of the bone and facing the artery providing blood supply to this segment of the limb with the hole size exceeding the diameter of the transplant vessel. Two guide wires are passed towards each other from the hole made in the bone cortex to the hole of the medullary canal on the side of the bone defect through the medullary canal on each side. The transplant vessel is tied to the first and second guide wires by the ends and stretched, passing along the entire bone defect in the centre and entering the medullary canal, and then two ends of the vein are extracted through the holes in the bone together with the guide wires; two anastomoses are applied between the ends of the transplant vessel and the artery providing blood supply to this segment of the limb, at two points at the ends to the side. The adventitia of the transplant vessel is sutured to the periosteum at the entrance to the first and the second holes in the bone wall. The vessel therein constitutes a vein, the bone with a defect constitutes the tibia, the artery providing blood supply to this segment of the limb constitutes a main vessel available for creating anastomoses, and the artery providing blood supply to this segment of the limb constitutes the cranial tibial artery or an artery in the lower leg area. Also proposed is a method for restoring a bone defect, spontaneous fusion whereof is impossible, including performing autotransplantation of the vessel, installing a membrane with holes on the fragment of the tibia, filling platelet-rich autologous plasma or alginate gel in the space between the membrane and the transplant vessel using a syringe in order to displace air and fill the free space, fixing the bone fragments with an external fixation apparatus or an osteogenesis plate, suturing the wound layer by layer. After 4 days, a suspension of cellular spheroids from the periosteum, spheroids from multipotent mesenchymal stem cells and hydroxyapatite granules in a ratio of 1:1:1 is injected into the space defined by the membrane under pressure, using a needle. After 6 days, 2 million cells of a culture of multipotent mesenchymal stromal cells of the bone marrow per 1 cm³ of the bone defect are additionally injected in 1 ml of F12. After another 6 days, 2 million cells of the culture of multipotent mesenchymal stromal cells of the bone marrow per 1 cm³ of the bone defect are re-injected in 0.5 ml of F12.

EFFECT: method ensures restoration of the blood supply to the newly formed bone tissue and maintenance of partial oxygen pressure sufficient for regenerative osteogenesis in the area of the bone defect by directing the transplant vessel along the bone defect of the regenerative potential of the transplanted cell products replacing the bone defects.

6 cl, 1 dwg, 5 ex