RU2190368C2 - Method for treating the cases of congenital femur dislocation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves setting femur dislocation in closed manner by means of perosseous device, repairing cotyloid cavity roof by perforating periacetabular area and performing dosed displacement and rotation of cantilever and additional wires introduced into it in sagittal plane that potentiates articulation roof development to normal level. EFFECT: enhanced effectiveness of treatment; increased depth and tilt of the roof. 5 dwg

Description

 The invention relates to the field of medicine, in particular orthopedics, and is used in the treatment of congenital dislocation of the hip with the help of transosseous fixation in children under 6 years of age.

A known method of bone tunneling, which consists in creating a channel through ischemic areas in order to provide conditions for the germination of blood vessels and the introduction of transplants on the supply connections (DG Shapurma, MS Kuvin, VA Shulga. Revascularization in coxarthrosis / Clinic and experiment in traumatology and orthopedics. - Abstract. Report of the Jubilee Scientific Conference of the Research Center "WTO". - Kazan, 1994. S. 86-87.)
There is a method of accelerating the consolidation of medial femoral neck fractures, characterized in that the neck is tunnelled through the fracture line to form new bone marrow in the tunnels with new intraspong blood vessels (Application 96113397, Russian Federation, 01.07.96, publ. 10.27.98 / Gadzhiev M .-R.G., Hasanov A.M., Dagestan State Medical Academy).

 There is a method of stimulating peripheral blood circulation by creating channels through the bone diameter, introducing pins into them, followed by excretion (Pat. 2102025, RF, IPC A 61 B 17/56, claimed 22.08.95, publ. 20.01.98, Bull. 2) .

 A known method of treating osteoarthrosis of the knee joint, including tunneling of the articular ends, which is performed in diverging directions with the capture of the entire area of pathological bone tissue reconstruction (Application 96100999, RF, IPC A 61 B 17/56, claimed January 16, 1996, published March 27, 1998 / Shevtsov V.I. (RF), Larionov A.A. (RF), Larionov S.A. (RF), Makushin V.D. (RF)).

 It is known that the correction of the roof of the acetabulum is carried out in children older than 3 years, when the potency of the hip joint for further development is lost (I.F. Akhtyamov, Kh.Z. Gafarov and other new methods of correction of the acetabulum. Kazan Medical Journal. - 1993. - 2). The best option for surgical treatment of hip dislocation in children older than 3 years is open reduction in combination with transposition of the acetabulum (Yu.I. Pozdnikin. Reconstructive and reconstructive surgery for congenital dislocation of the hip in children. - Abstract of dissertation of the Doctor of Medical Sciences. - 1983).

 A known method of surgical treatment of congenital dislocation of the thigh, including closed reduction and reduction of the femoral head into the hollows using an external fixation device or gypsum apparatus, performing a periacetabular osteotomy of the ilium, holding the spokes through the distal fragment of the pelvic bone, fixing them in the node of the distraction apparatus, with the help of which metered traction is carried out for the gradual tilt of the fragment (Malakhov O.A., Salnikov P.A., Kozhevnikov O.V. Distraction method of acetabuloplasty at congenital dislocation of the hip. // Diseases and injuries of large joints in children: Collection of scientific works of LNIDOI named after G.I. Turner. - L. - 1989. - P. 58-61).

 However, the known method for the correction of the roof of the acetabulum, which involves performing an osteotomy of the ilium, is traumatic and technically difficult, accompanied by blood loss, causes ischemia of soft tissues surrounding the joint, and contributes to the progression of degenerative-dystrophic changes in the femoral head.

 The objective of the present invention is to develop a method of treating congenital dislocation of the thigh, allowing metered closed centering of the femoral head in the cavity using a transosseous device and stabilize the achieved position by correcting the roof of the acetabulum.

 The problem is solved in that in a method of treating congenital dislocation of the thigh, including dosed closed reduction of dislocation of the thigh using the transosseous device, violation of the integrity of the periacetabular area of the ilium, insertion of spokes into it, their fixation in the support of the transosseous device with subsequent movement, form at least three perforation holes in the periacetabular region near the epiphyseal plate of the ilium, then at least three cantilever spokes are inserted into it until the inner cortical plate Stinky and one or two additional needles, which have in the sagittal plane, followed by a metered rotation of cantilever spokes and extra spokes dosed tension at least twice a week.

The invention is illustrated by a description, a specific example of its implementation and the attached copies of radiographs:
FIG. 1 - a copy of the x-ray before treatment.

 FIG. 2 - a copy of the x-ray during treatment when performing osteoperforation in the periacetabular region.

 FIG. 3 is a diagram of the cantilever and additional knitting needles in the periacetabular region.

 FIG. 4 - a copy of the x-ray during treatment after cantilever and additional knitting needles in the periacetabular region.

 FIG. 5 - copy of the radiograph after treatment.

 The method is as follows.

 In a known manner, a transosseous device is placed on the iliac wing, middle third and distal femur metaphysis. Produce a gradual closed reduction of hip dislocation. When the femoral head is centered, the integrity of the periacetabular region near the epiphyseal plate of the ilium is violated. For this, through 3-4 cuts up to 0.5 cm long along the perimeter of the acetabulum at a distance of 1 cm from the edge, perforations to a depth of 1.5-2 cm are made with a narrow chisel. Then, in the oblique plane, 0.5-1 cm from the edge of the acetabulum 3-4 console spokes are inserted into the hollows to the inner cortical plate. The free ends of the spokes are fixed using rods with hinged devices to the pelvic arch. Additionally, at the same level, 1-2 through knitting needles are carried out, which are bent outward and down and fixed with the help of articulated-distraction devices to the proximal support of the apparatus (Fig. 3). In the postoperative period, additional gradual tension of the through needles of 1 mm and the rotation of the cantilever spokes one revolution 2 times a week are carried out.

An example of the method. Patient P., 4 years old, East. bol. N 33520. Diagnosis: congenital bilateral hip dislocation leading to contracture of the hip joints. Complained of lameness, fatigue. The positive symptoms of Duchenne-Trendelenburg and Dupuytren on both sides were determined. On the radiograph, bilateral iliac dislocation of the thigh, moderate deformation of the proximal thighs with an SJD of -135 ^o and an anteversion angle of 30 ^o , acetabulums of the oval shape, thickness index of the bottom of the hollow on the right - 1.6, left - 1.7, underdevelopment of the roof of the acetabulum: acetabular the index on the right is 34 ^o , on the left - 33 ^o (Fig. 1). The patient underwent surgery. In the operating room, under intravenous anesthesia, 5 spokes were inserted through the wings of the ilium, 2 spokes through the middle third of the thigh, and 3 spokes through the distal metaphysis of the thigh. All spokes are fixed in the supports of the Ilizarov apparatus. The apparatus of six supports is mounted. After performing a gradual closed centering of the femoral heads in the hollows for 66 days, an additional surgical intervention was performed in the operating room under intravenous anesthesia. On each side, through 3 cuts of 0.5 cm on the outer surface of the hip joints 1 cm above the edge of the acetabulum, a narrow chisel made perforations to a depth of 1.5-2 cm (Fig. 2). Consistently on both sides in the oblique plane at a distance of 1 cm from the edge of the acetabulum, three cantilever spokes were drawn to the inner cortical plate (Fig. 4). The free ends of the spokes are fixed using rods with hinged devices to the pelvic arch. Additionally, at the same level in the sagittal plane, one through-spoke was drawn, which are curved outward and downward, fixed and tensioned by articulated-distraction devices in the proximal support of the apparatus. In the postoperative period, additional gradual tension of the through needles of 1 mm was made and the cantilever spokes were rotated one revolution 2 times a week for the entire period of stabilization of the hip joints in a centered state, which amounted to 84 days. After 8 months. after removing the apparatus, the patient walks with two canes, there are no pains in the operated joints, the function of the hip joints was restored by 60% of the initial range of motion. On the x-ray of the pelvis, the thigh heads are centered in the hollows, the Shanton line is not broken, the degree of coverage of the head of the roof of the hollow is 100% on both sides, the acetabular index on the right is 18 ^o (decreased by 16 ^o ), on the left is 23 ^o (decreased by 10 ^o ), the bottom thickness index depressions on the right 2.0, on the left 2.2 (figure 5).

The proposed method allows for the gradual closed centering of the femoral head in the cavity and the correction of the underdeveloped roof of the cavity in a technically simple, less traumatic way, eliminating damage to the soft tissues surrounding the joint. Perforation and prolonged spoke stimulation of the periacetabular region near the os ilium epiphyseal plate potentiates the development of the pelvic component of the joint, which manifests itself in an increase in depth (index of the thickness of the bottom of the cavity) and a decrease in the angle of inclination of the roof of the acetabulum. It is advisable to use this technology in patients under 6 years of age with the following radiological criteria for pathology: deformation of the proximal femur with an SJD up to 130 ^o and an anteversion angle up to 30 ^o ; an oval-shaped acetabulum with an AI of not more than 35, a Sharpe angle of not less than 35 ^o , a bottom thickness index of not less than 1.5, a head coverage coefficient of less than 1.0.

Claims (1)

 A method for treating congenital dislocation of the thigh, including dosed closed reduction of dislocation of the thigh using a transosseous device, violation of the integrity of the pariacetabular area of the ilium, insertion of spokes into it, their fixation in the support of the transosseous device with subsequent movement, characterized in that at least three perforation holes are formed in periacetabular region near the epiphyseal plate of the ilium, then at least three cantilever spokes are inserted into it to the inner cortical plate and one to e extra spokes, which are located in the sagittal plane, followed by a metered rotation of cantilever spokes and extra spokes dosed tension at least twice a week.

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