RU2155548C2 - Method for treating benign cystic tumors and dysplasia of bones in children - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying one corticotomy on the boundary separating the healthy bone near the distal tumor pole from the tumor. The other corticotomy is carried out in the diaphysis zone. The so created segment is introduced into the focus substituting it for the length equal to the tumor extent without making its resection. Conditions are created under gradual compression promoting the tumor restructuring in more short time. EFFECT: retained motor activity and supporting function of the extremity. 6 dwg

Description

 The invention relates to medicine, namely to traumatology, and can be used in the treatment of children with benign cystic tumors and dysplasias.

 A known method for the treatment of cystic tumors and dysplasia / M.V. Volkov, 1985 /. Incision over the tumor. A cystic tumor is secreted subperiosteally and resected within a healthy tissue. The resulting defect is kneaded using alloplasty using the brushwood technique. The segment is immobilized with a plaster cast or other external fixation method.

The operation proposed by M.V. Volkov, in our opinion, has the following disadvantages:
- firstly, the operational allowance provides for extensive access with trauma to a significant muscle mass. The resection site is not always possible to completely close the periosteum. It is known that the area of bone grafting, even partially devoid of the periosteum, is in worse conditions of blood circulation;
- secondly, the technique involves the preliminary preparation and conservation of osteoplastic material;
- thirdly, the operation technique involves the introduction of an axial bone pin into the proximal and distal sections of the medullary canal. It is known that the introduction of a bone pin injures the bone marrow and disrupts the processes of bone formation. This circumstance contributes to the occurrence of axial deformations and shortening of the segment;
- fourthly, the operation is technically complicated and involves "resection of the bone from within the cystic focus, tamponade of bleeding vessels with bone chips and non-compliance with these measures leads to relapse," the author M.V. Volkov.

 The aim of the invention is to reduce the morbidity and reduction of treatment time while restoring the normal structure, axis and length of the affected segment.

 This goal is achieved by conducting corticotomy along the border of the distal pole of the tumor and in the dialysis zone. Gradually mix the segment into the pathological focus / tumor /, replacing it. Moved to a length equal to the extent of the tumor without resecting it. At the same time, the segment is lengthened to a predetermined length.

 The implementation of the method is illustrated by a description of the operation, illustrated by a graphic image, radiographs.

 In FIG. 1 and FIG. 2 schematically shows an operation.

 Operation description. Spoke three spokes through the proximal segment / zone of the femoral neck /. Distal cysts spend two spokes, and through the distal metaphysis three. Installation of the Ilizarov apparatus, consisting of two arcs and a ring. Roentgenography. From the incisions along the outer surface of the thigh up to 1.5 cm, two corticotomies are performed, one at the distal pole of the tumor, the other in the diaphysis zone. From the fifth day they begin the compression of the tumor zone by promoting the healthy segment into the tumor. When eliminating shortening, the device is stabilized. The formation of a complete regenerate serves as the basis for the removal of the apparatus. The drawing shows a diagram illustrating the method. Positions 1, 2, 3 indicate the level and location of the needles. Position 4, 5 indicates the level of hip corticotomy. In FIG. 2, 6 indicates the replacement of the tumor, 7 regenerates the compensating shortening.

Thus, the proposed method for the treatment of bone tumors and dysplasia in children compared with the known has the following advantages:
- the treatment time is reduced, the motor activity of the child and the supporting function of the limb remain;
- the operation is less traumatic, since extensive access, tissue trauma, resection and prolonged immobilization are excluded;
- the tumor is mixed with its own healthy bone;
- the technique allows to reduce the risk of surgery in the treatment of tumors in complex anatomical areas, to prevent orthopedic consequences.

 Example: Patient S., 13 years old, N case history 1963/225, was admitted to the clinic 03/27/90 g with complaints of pain in the upper third of the left thigh. Pain appeared after falling to the left side.

 Objectively: a boy of the right physique. From the internal organs there is no pathology. Locally: the left thigh in the external rotation position. On palpation, the upper third of the thigh is painful. Active movements are not possible due to pain. On the roentgenogram of the left thigh, a bone cyst is identified, occupying the neck region and the intertrochanteric region. The fracture line is traced. The length of the cyst is from 4.5 to 5.0 cm. In FIG. 3 presents a radiograph of patient C at admission.

 Operation 03/29/90. Three spokes were drawn through the femoral neck, which are fixed in an arc. Farther into the diaphysis region and in the metaphysical zone of the thigh, three spokes were made. Installation of the Ilizarov apparatus, consisting of two arcs and a ring. X-ray control. Taking into account radiographs from accesses 1.5-2.0 cm long, each performed corticotomy at the base of the cyst and distal. In FIG. Figure 4 shows the X-ray of the left thigh at the stage of treatment / the thigh segment is introduced into the cystic cavity /, compression of 0.25 turns four times a day. Maintenance compression at one revolution per week for the entire stabilization period. The thigh is extended by 5.0 cm for 83 days. In FIG. 5 x-ray of the left thigh on the 90th day after the operation / cyst is filled, partially the tumor tissue is pushed to the periphery /. On the 124th day after the operation, the device was removed and the development of movements in the joint began.

 Inspected after a year. There are no complaints. Gait is not broken, active. A tomography of the left thigh was performed. In FIG. Figure 6 shows a tomography, 11 cm section. There are no signs of a tumor. The outcome is recovery.

Claims (1)

 A method of treating benign cystic tumors and dysplasias by means of bone grafting and external fixation, characterized in that they use an external fixation apparatus, the spokes of which are passed through the proximal segment distal to the cyst or dysplasia and through the distal metaphysis, one corticotomy is performed at the distal pole of the cyst or dysplasia, the other in the diaphysis zone, the resulting segment is gradually introduced into the pathological focus for a length equal to its length, without resecting it with simultaneous extension of the segment to a predetermined value s.

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