TREPANOBIOPSIYa (Greek trypa-non the drill, is frayed + a biopsy) — the type of a puncture biopsy consisting in capture of pieces of marrow and bone tissue for a histologic research.
G. Ghedini in 1908 for the first time applied trepanation of an upper epiphysis of a tibial bone to receiving marrow of the person. In 1923 Seyfart (Page P. Seyfarth) suggested to make trepanation of a breast and the edges representing the spongy bones rich at adults with red marrow.
T. began to be implemented into a wedge, practice after emergence of works of Notter and Labkhart (V. of Notter, A. Labhart, 1953), and also Bart of l of a kheymer and Schmitt-Rodya (N. of Vag-telheimer, J. M of Schmitt-Rohde, 1957), to-rye suggested to make trepanation of an ileal crest since it is located far from vitals, and in it spongy substance of a bone is well developed. Further researches were conducted for clarification of value T. in diagnosis various a disease and improvements of a design of trepans.
At T. from a bone receive the site of compact and spongy bone substance together with marrow for gistol. researches. T. allows to receive data on structure of a bone tissue and very tectonics of marrow (cellular composition, a ratio of the hemopoietic and fatty tissue, a condition of a stroma and vessels).
The indication to carrying out chatter-nobiopsii is the cytopenia of not clear etiology when a sternal puncture (see) and a usual puncture of an ileal bone the needle intended for an aspiration biopsy (see) do not give information on a condition of marrow. In such cases of T. gains crucial importance in the differential diagnosis of diseases of system of blood and diseases which are followed by secondary damage of marrow (e.g., hron. infections, general diseases of connecting fabric, and also endocrine disturbances, diseases of a liver, kidneys, metastasises of tumors). T. in a complex with other clinical laboratory methods of a research widely apply in diagnosis of hemoblastoses, especially leukoses (e.g., a myelosis), aplastic anemia (see fig. 3 and 4 to St. Marrow, t. 11, Art. 438), an osteomyelofibrosis (see), for identification of metastasises in marrow of malignant lymphoma and cancer (see fig. 6 — 9 to St. Marrow, t. 11, Art. 439 — 440), and also other focal damages of marrow. This method is used also in diagnosis of tumors of bones, nek-ry defeats of bone system, by hl. obr. with poliossalny localization (see. Parathyroid osteodystrophy, Pedzheta disease, Fibrous osteodysplasia, etc.). T. make prior to treatment, but in some cases, napr, at leukoses, a multiple myeloma, metastasises of a lymphosarcoma in marrow, at aplastic anemia for scoping of defeat in different stages of a disease, carry out it repeatedly. A contraindication for T. sharply expressed hemorrhagic syndrome (pathological bleeding) is.
Trepan is arranged as a punktsion-but-tissue extractor and consists of a hollow cylindrical needle with mandrin (sometimes without it) and handles, edges connects to a mill trocar a screw thread or a nut (see fig. 23, to the Art. Eagles medical, t. 9, Art. 18). The needle is supplied with a safety guard, sometimes its function is performed by a transitional nut. Trepans differ with length of a needle (3 — 16 cm), diameter (internal 2 — 4 mm), the device of the peripheral end (the doubled cutting end, with cutting, cloves, conic sharpening, etc.). Apply hl. obr. manual trepans, exists also mechanical with the small electric motor; nek-ry trepans are entered into a bone by easy blows of a hammer on a stake pack-anvil, put on a needle. In the USSR the manual trepans developed by L. M. Ma-chulsky, M. G. Abramov, A. E. Baranov et al. are applied. In a crust, time use models, at to-rykh the internal diameter of a needle it is narrowed at the cutting end that ensures safety of biopsirovanny material at pushing out. Trepans of different designs allow to receive a column of fabric 2 — 4 mm wide, from 10 to 60 mm long.
T. make in the field of the right or left upper lobby or upper back ileal awns with observance of rules of an asepsis and antiseptics. Depending on the place of a puncture of the patient put on a back of a pla sideways, sometimes on a stomach. After anesthesia of skin, hypodermic cellulose, a periosteum of 2% solution of novocaine skin is pierced with an ophthalmic scalpel and enter trepan under a nek-eye pressure rotary progress through a plate of compact substance into spongy substance. The needle is taken, rotating it in the same direction. A number of researchers, including in the USSR, produce cross through T., at a cut trepan is entered perpendicular to the plane of an ileal bone and the crest passes through. Repeated T. it is necessary to make on the other hand or otstupya on 1 — 2 cm from the previous place of a puncture in view of a possibility of development of fibrosis. T. — safe intervention; only separate cases of formation of hematomas at disturbance of the technology of carrying out a tre-panobiopsiya are described.
The received material from a cavity of trepan is pushed out mandrin with a blunt end. It is recommended to prepare smears before immersion of material in the fixing liquid. Gistol. processing includes fixing (tsenker-formol, Kar-nua liquid, alcohols, etc.), decalcification (during 48 hours in 25% solution of Trilonum In), carrying out through alcohols with the subsequent paraffin embedding or paraffin-photoxylin. Various processing conditions is recommended. Cuts paint hematoxylin-eosine, azur-eosine (see. Histologic methods of a research). For identification of reticulin and collagenic fibers carry out impregnation (see) silver according to Foote (see Silverings methods), Guo-exhaust, coloring according to Van-Gizona (see Van-Gizona a method), to Gayden-Gayden; for identification of mucopolysaccharides carry out CHIC reaction (see), coloring toluidine blue; nucleinic to - you define by Brashe's reaction, Feylge-na. The methods of filling of the taken marrow in plastic which are not demanding decalcification allow to conduct various fermento-
the II immunogistokhgshichesky researches (see. Histochemical methods of a research). Results, researches treat taking into account a wedge, pictures and others a lab. data. The qualified capture of material and quality section cutting is important. At superficial capture of material of marrow, a bruise, disturbance of its processing in drugs compact substance, abundance of bone fragments and
blood, the sites which are badly perceiving coloring (artifacts) can prevail respectively.
At microscopic examination define features of a structure of a bone tissue — signs of a rassasyvaniye or a new growth, availability of osteoid, osteoblasts, osteoclasts, swelling of cells of an endosteum; a condition of fibers and cells of a stroma — destruction or growth of fibers (see the Osteomyelofibrosis), the phenomena of phagocytosis; a ratio of the hemopoietic and fatty tissue taking into account age of the patient; cellular structure of red marrow with its detailed characteristic; condition of vessels, signs of disturbance of blood circulation. Pay attention to existence of atypical cells (a structure and character of an arrangement), granulomas (structure), necroses, deposits of a pigment. In cases, difficult for interpretation, it is necessary to draw the conclusion only in a descriptive form.
See also Biopsy, Marrow, the Bone.
Bibliography: Abramov M. G. Clinical cytology, M., 1962; Bar
A. E., Smirnov A. N. and Suvorova is new JI. And. Technique it is frayed - biopsies of an ileal bone and a breast and its value in diagnosis of focal and generalized damages of marrow, Probl. gematol. and modulation, blood, t., 18, No. 3, page 55, 1973; Vinogradova T. P. Diagnosis of bone and joint pathology on biopsies, M., 1964; M and - chulsky JI. M. K to a technique of biopsies of marrow of ileal bones at diseases of system of blood, Owls., medical, No. 8, page 76, 1955; H e m e N about -
in and N. M., Protasov T. G. and Voronin V. M. A biopsy of marrow in diagnosis of diseases of system of blood, Arkh. patol., t. 33, No. 3, page 3, 1971; Teodorovich V. P. and And-dulkadyrov K. M. Trepanobiop-siya of marrow at some hematologic diseases, L., 1977;
Bartelheimer H. u. Schmitt-Rohde J. M of Die Biopsie des Knochens ais differentialdiagnostische klinische Methode, Klin. Wschr., S. 429, 1957; In ur k-bardt R. Farbatlas der klinischen His-topathologie von Knochenmark und Kno-chen, B. — N. Y., 1971; Duhamel G, Histopathologie clinique de la moelle osseu-se, P., 1974; Landys K, A new trephine for closed bone marrow biopsy, Acta haemat. (Basel), v. 64, p.> 216, 1980; Not-ter B. u. Labhart A. Die Knochen-biopsie, Schweiz, med. Wschr., S. 1263, 1953; Seyfarth C. Die Sternumtrepa-nation, eine einfache Methode zur diagno-stischen Entnahme von Knochenmark bei Lebenden, Dtsch. med. Wschr., S. 180, 1923. M. P. Khokhlova.