RU2187268C2 - Method for surgical treatment of foot deltoid ligament damages - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology. SUBSTANCE: tunnels are formed in internal ankle, heel and scaphoid bones. Two tunnels are formed in soft tissues: one tunnel comes from heel bone towards internal ankle, another one - from scaphoid bone towards internal ankle. Allotransplant's end is put into the tunnel in heel bone to be blocked up with osseous allotransplant and additionally fixed to periosteum with sutures. Then allotransplant is directed step-by-step from heel bone through the tunnel in soft tissues, through internal ankle, through the tunnel in soft tissues, through scaphoid bone, along internal edge of sole aponeurosis towards heel bone. The method enables to restore the stability of talocrural joint and strengthen the foot arch. EFFECT: higher efficiency. 2 ex, 2 dwg

Description

 The invention relates to medicine and relates to methods for surgical treatment of diseases of the musculoskeletal system, in particular patients with rupture of the deltoid ligament of the foot.

 Known methods for surgical treatment of rupture of the deltoid ligament of the foot.

1. The method of V.V. Nikitina. Auth. St. 1533673
The essence of the method is the restoration of the tibial-talus ligament using an autograft with bone fragments at the ends, taken from the operated patient from the ligament of the patella.

 The disadvantage of this method is that only one of the three portions of the deltoid ligament is restored, the tibial-talus, while there are two more portions - the tibial-scaphoid, tibial-calcaneal.

 In addition, when taking an autograft an additional injury is applied to the patient in the area of the knee joint.

 2. The method of research institute them. P.P. Harmful.

 A feature of the method is the restoration of the deltoid ligament using an allograft fixed in the bone channel of the inner ankle to the calcaneus and scaphoid bones. This method is taken as a prototype.

 The purpose of the invention is to restore the stability of the ankle joint in the frontal plane by plastics of the anterior and posterior portions of the deltoid ligament with an allograft fixed intraosseously at three points, and strengthening the structures supporting the arch of the foot.

 The method is as follows.

 The first semi-oval skin incision with a bulge upward is made in the region of the inner ankle of the foot. The skin flap is separated downward. Through the inner ankle slightly above the joint gap in the horizontal plane, a bone tunnel is formed with a drill (Fig. 1). The second section is a semi-oval shape from the scaphoid-wedge-shaped joint to the middle of the calcaneus. The skin flap is separated down and held by hooks.

 In the calcaneus with a drill, a tunnel is formed to a depth of 3 cm, in the scaphoid - through the entire thickness from top to bottom. The diameter of the drill and allograft should match (figure 1). The first and second surgical wounds are connected by two tunnels in the soft tissues, one goes from the calcaneus, the second from the scaphoid to the inner ankle. The end of the graft is immersed in a tunnel of the calcaneus to a depth of 3 cm and jammed with a wedge-shaped bone allograft, additionally fixed to the periosteum with non-absorbable sutures. The graft is sequentially carried out from the calcaneus through the first tunnel, ankle, second tunnel, scaphoid, along the inner edge of the plantar aponeurosis to the calcaneus (figure 2). The foot is given a moderate-varus position with the aim of eliminating the subluxation of the talus and creating congruence of the articular surfaces. The graft is pulled so that the foot is held in a predetermined varus position.

 Wounds are sutured in layers. Conduct a control x-ray of the bones of the foot. Impose a plaster boot to the upper third of the leg for 6 weeks.

 The fundamental difference between the proposed method and the known one is that they form bone tunnels in the inner ankle, calcaneus and scaphoid bones; form two soft tissue tunnels; the end of the allograft is immersed in the calcaneus tunnel, fixed with the bone allograft and threads to the periosteum, the allograft is passed sequentially from the calcaneus through the inner ankle, through the tunnel in the soft tissues, through the scaphoid bone along the inner edge of the plantar aponeurosis to the calcaneus.

 Figure 1 shows the location of the bone tunnels in the inner ankle, calcaneus and scaphoid; figure 2 - the position of the allograft after the operation.

 The advantage of the proposed method over the known one is as follows: an allograft is carried out in such a way that two portions of the deltoid ligament are formed, repeating the position of the natural ligament; strong intraosseous fixation of the graft at three points creates favorable conditions for its physiological reconstruction; holding the graft along the inner edge of the plantar aponeurosis strengthens the arch of the foot.

 The proposed method was used in the clinic of traumatology and orthopedics of the Samara Medical University in 4 patients with traumatic rupture of the deltoid ligament of the foot.

 1. Patient K., 45 years old, was admitted to the traumatology department of the clinic of traumatology and orthopedics of the Samara Medical University on March 16, 2000 with a diagnosis of chronic rupture of the deltoid ligament of the right foot. I got injured 6 months ago. The main complaint: foot instability. When supporting the foot is shifted outwards. The last two months before admission, pain in the ankle region has bothered.

 March 19, 2000 the operation was performed according to the proposed method. The postoperative course is smooth. 1.5 months after the operation, the plaster cast was removed. Conducted postoperative rehabilitation treatment. The result is positive. Viewed on June 29, 2000. The patient is pleased with the operation, walks freely, does not limp, and pains do not bother.

 2. Patient M., 35 years old, was admitted to the traumatic department of the clinic of traumatology and orthopedics of the Samara Medical University on March 30, 2000 with complaints of instability of the left foot and limp.

 I got injured two weeks ago. Examination revealed excessive mobility of the foot in the frontal plane. An X-ray of the foot in the anteroposterior projection revealed an extension of the joint gap of the ankle joint from the inside by 5 mm. With a diagnosis of traumatic rupture of the deltoid ligament, the patient was operated on by the proposed method on April 2, 2000. The patient was examined 3 months after surgery. There are no complaints, walks without limp, pain in the foot does not bother.

 According to the proposed method, a patient Ch., 42 years old, patient P., 29 years old were also operated on with a positive result.

 The method can be recommended in practical medicine.

Claims (1)

 A method for surgical treatment of rupture of the deltoid ligament of the foot, including restoration of the ligament using an allograft and intraosseous fixation of the allograft to the inner ankle, characterized in that they form tunnels in the inner ankle, calcaneus and scaphoid bones, form two tunnels in the soft tissues, one from the calcaneus to the inner ankle, the second from the scaphoid to the inner ankle, the end of the allograft is immersed in the tunnel in the calcaneus, it is wedged with a bone allograft and an adjunct but fixed to the periosteum with threads, an allograft is carried out sequentially from the calcaneus through the tunnel in the soft tissues, through the inner ankle, through the tunnel in the soft tissues, through the scaphoid, along the inner edge of the plantar aponeurosis to the calcaneus.

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