RU2172619C1 - Method of fixation of acetabular component of endoprosthesis with osseous defect of posterior edge of cotyloid cavity - Google Patents

Abstract

FIELD: medicine, particularly, traumatology and orthopedics; applicable in prevention of instability of acetabular component of endoprostheses after implantation of artificial joint with defect of posterior edge of cotyloid cavity. SUBSTANCE: method includes taking of osseous autograft with feeding vascularmuscular pedicle from middle part of iliac crest on side of operation. Autograft is displaced distally, laid with concave side to acetabular component to compensate deficiency of osseous cover of acetabular component of endoprosthesis, and its fixing with screw to iliac bone to provide for growing of osseous autograft into mother bed without is resolution and to ensure strong fixation of endoprosthesis acetabular component. EFFECT: higher efficiency of method. 1 dwg, 1 ex

Description

 The invention relates to medicine, namely to traumatology and orthopedics.

 A known method of total hip joint replacement according to Shaposhnikov-Sherepo and a method for autoplasty of a pronounced traumatic acetabular defect (ed. St. USSR N 1782562, class A 61 B 17/56 and Ukrainian patent N 24543 A). However, they have a number of significant drawbacks. In the first case, foreign materials are used to fix the acetabular component: bone cement, Teflon casing. In the second, a free autograft from the resected neck and femoral head is used for plastic surgery of the defects of the acetabulum (posterior edge and bottom), which is free, that is, devoid of blood supply, and therefore having a high risk of possible development of aseptic necrosis.

 Closest to the claimed solution is a method for additional fixation of the socket of the Sivash endoprosthesis in the acetabulum (Orthopedist., Traumatologist., Prosthesis., 1980, p. 56 and 57), he is also a prototype.

 However, the above method has a number of significant drawbacks, namely, the autograft serving to strengthen the acetabular component is a free bone fragment from the intertrochanteric region, deprived of blood supply, which does not exclude its resorption during static-dynamic loading and the instability of the acetabular component of the endoprosthesis.

 In addition, the introduction of a free autograft to strengthen the acetabular component of the endoprosthesis is carried out by driving into the groove above the edge of the acetabulum of the hip joint, which, on the one hand, weakens the fixation of the acetabular component, on the other hand, the creation of a groove leads to additional trauma to the surrounding tissues and is unfavorable a condition when a positive result is achieved.

 The aim of the invention is to improve the fixation of the acetabular component of the endoprosthesis with bone defects in the posterior edge of the acetabulum with an autograft on the "feeding vascular-muscular leg" and preventing its instability.

 This goal is achieved by filling the defect of the posterior edge of the acetabulum with a non-free bone autograft on the “feeding vascular-muscular leg” with fixation of the latter with spongy screws to the ilium.

The drawing illustrates a method for fixing the acetabular component of the endoprosthesis with a bone defect in the posterior edge of the acetabulum of the hip joint (rear view):
a) there is a post-traumatic defect in the posterior edge of the acetabular region;
b) after the first stage - total arthroplasty;
c) after the second stage, the bone defect of the posterior edge of the acetabulum is replenished with an autograft from the ilium rubble on the "feeding vascular-muscular leg" (1 - "feeding vascular-muscular leg" from m. gluteus medius).

 Technique of operation.

 Under anesthesia in the patient’s position on the operating table on the healthy side, an S-shaped incision is made with the beginning along the iliac crest to the projection of the posterior edge of the acetabulum. Layered through the upper and lower twin, internal obturator muscles (mm gluteus major, medius et minimus; gemellus superior et inferior; obturatorius intermus), the posterior upper edge of the acetabular region is exposed, the sciatic nerve is isolated and it is moved medially. Further, upon examination, the sizes of the defect of the posterior margin and the deficiency of the bone cover of the acetabular component of the endoprosthesis are revealed (drawing, a). Then, the inner part of the ilium wing is isolated subperiostally and an autograft of the required size is taken without cutting off the middle gluteus muscle (m. Gluteus medius) attached to it from the anterior superior spine. Part of this muscle is the "nourishing musculoskeletal leg". The cut non-free bone autograft is distally displaced and placed in place of the existing defect with adaptation of the bone surfaces using bone cutters, a rasp, thereby filling the deficiency of the bone coating of the acetabular component of the endoprosthesis. Then this autograft on the "feeding vascular-muscular leg" is fixed with two or three spongy screws to the ilium (drawing, b). Wound monitoring for hemostasis. The wound is sutured in layers, leaving 3-4 drains for active aspiration of the wound discharge. Apply an aseptic dressing. A control x-ray is taken on the operating table (drawing, c).

 B-th L., 42 years old, N 6799/99, was admitted to the orthopedic department of the Krasnodar Regional Clinical Hospital on 05/20/99 with a diagnosis of fractures of the right hip joint, fracture of the lower pole of the femoral head, fracture of the posterior edge of the acetabulum, flexor-leading contracture right hip joint.

 He was injured in a traffic accident in February 1999. He was treated at the place of residence by skeletal traction. After stabilization, he was transferred to the regional hospital.

 After examination, the patient performed surgery on 04.06.99: total hip replacement with a Phoenix implant. An operation revealed a bone defect in the posterior margin, formed after the removal of many small fragments of the posterior margin. The acetabular component is additionally fixed with 2 screws to the bottom of the acetabulum. 06/24/96, the second stage of surgical intervention was performed: fixation of the acetabular component of the endoprosthesis with a bone autograft from the iliac crest on the "feeding vascular-muscular leg".

 Examined after 8 months. There are no clinical complaints, the range of motion in the joint has increased significantly, X-ray and computed tomography indicates autograft ingrowth into the "mother bed". The position of the endoprosthesis is correct. There are no signs of instability of the acetabular component.

 This example illustrates the possibility of reconstructing the posterior edge of the acetabulum using a non-free bone autograft taken from the iliac wing on the “feeding vascular muscle leg”.

Claims (1)

 The method of fixation of the acetabular component of the endoprosthesis with a bone defect of the posterior edge of the acetabulum, characterized in that they use a bone autograft on the "feeding vascular-muscular leg" from the middle part of the iliac crest, displace distally, lay the concave side to the acetabular component of the endoprosthesis, make up for the existing bone deficit cover the acetabular component of the endoprosthesis and fix it in this position with screws to the ilium.