RU2197193C2 - Method of a three-articulation arthrodesis of foot - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics. SUBSTANCE: the method deals with treating patients with instability and deformations of feet. After resection of articular surfaces of a subtalar joint and a Chopart's one the grooves should be formed perpendicular to the line of a talocalcaneonavicular joint introduced with conserved cortical allotransplants. EFFECT: higher efficiency of operation. 2 ex

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and can be used to treat patients with instability and deformities of the feet.

 In recent years, there has been a clear increase in congenital and acquired pathology of the musculoskeletal system and, in particular, the development of instability and various types of deformities of the feet 3-12% (Krisyuk A.P., Mezenina E.P., Kutsenok Y. B., 1993, Krasnov A.F., Chernov A.P., 1994). The most common diseases such as cerebral palsy, poliomyelitis, injuries of the peripheral nerve trunks, etc. can be the reasons for the development of foot deformities.

 The most characteristic picture of the development of deformities of the foot bones, leading to the appearance of its instability, can be traced on the example of paralysis.

 In patients suffering from polio, cerebral palsy, over time, there is a slower bone growth in length and thickness due to the lack of the necessary tonic effect on the bone, consisting in uniform muscle traction and its pressure on the skeleton. As a result of the abnormal development of their ossification nuclei and improper loading, skeletal deformation gradually develops; Heel and talus, scaphoid and cuboid bones undergo special changes in the foot.

 To correct deformities of the feet and to stabilize the joints, more than 40 methods of arthrodesis have been proposed. As practice shows, the most effective are intra-extraarticular arthrodesis of the subtalar and Shoparov joints.

 The literature describes a method for Dan's triple arthrodesis, in which a resection of the head of the talus bone, the entire navicular bone, articular cartilage of 1 sphenoid bone is performed. The heel-cuboid, ram-heel joint is resected with a chisel.

 P.G. Kornev suggested resection of the ankle, Shoparovsky and Lisfranc joints with subsequent extraarticular graft placement on the front surface of the foot.

 In 1933, C. Lambrinudi improved the technique of three-joint arthrodesis, after removing the articular cartilage of the subtalar joint from the head of the talus bone, formed a bone spike, which was embedded in a previously made groove in the lower part of the scaphoid. The talus should be in the maximum flexion position, and the front section in the extension position. In addition, a heel-cuboid joint resection was performed.

 For the treatment of flat valgus deformity of the foot in children, a method of extraarticular subtalar arthrodesis D.S. is known. Grice (Z.P. Lubegin, M., 1967). The technique of the operation is to mobilize the talus and set it in the correct position with respect to the calcaneus. After eliminating the equinus component of the deformity of the foot, the talacaneal joint is opened with resection and two bone grafts are introduced into sinus tarsi simultaneously, introducing them into the cortical layer of the talus and calcaneus. The best position of the grafts is achieved with a slightly oblique position, when the distal ends of the grafts in contact with the calcaneus lie in front of the proximal ends. In this position, the grafts are almost at right angles to the axis of movement of the subtalar joint and effectively interfere with the lateral displacement of the calcaneus. For the ends of the grafts in the cortical layer of the talus and calcaneus form 2 grooves, the grafts are introduced in a position of some hypercorrection. This method is taken as a prototype.

However, it has several disadvantages:
1. Resection of all articular surfaces of the talus and calcaneus bones is not performed, which does not allow the creation of durable ankylosis in the subtalar joint using only bone grafts.

 2. The introduction of bone grafts only in sinus tarsi does not eliminate instability in the ram-navicular and heel-cuboid joints.

 The aim of the invention is to create stability of the foot.

 This goal is achieved by resection of the articular surfaces of the subtalar and shopar joints, followed by fixation of the foot bones with bone allografts.

 The method is as follows.

 A skin incision is made along the inner surface of the foot below the inner ankle with a length of 8-9 cm, the soft tissues are spread apart and held by hooks. The bones and heel and bones are opened. The selected tendons are taken to the holders and taken to the side. A wide osteotome resects the articular surfaces of the lower part of the talus and upper part of the calcaneus in the form of a wedge facing the base in one direction or another, depending on the type of deformation of the foot. Next, a resection of the articular surfaces of the talon-scaphoid and calcaneo-cuboid joints is performed, also in the form of a wedge with the base outward or inward, depending on the type of deformation present. After putting the foot in the correct position and comparing the resected articular surfaces with an osteotome 2.5-3 cm wide and 2-3 mm thick perpendicular to the line of the talocental joint, 2 grooves 2-2.5 cm deep are formed in the direction from the inside to the outside, at a distance of 3 -3.5 cm from each other, into which tubular bones prepared in advance from a cortical plate of the same size as the grooves, canned allografts are implanted. After that, an osteotome 1.5-2 cm wide perpendicular to the line of the talar-navicular joint also forms a groove to a depth of 1.5-2 cm. A canned bone allograft is tightly hammered into the formed groove. Catgut sutured dissected soft tissue and skin tightly. For immobilization use a plaster boot for 3 months.

 Example 1. Patient Belova T.L., 58 years old. was in the clinic of traumatology and orthopedics with a diagnosis of Residual poliomyelitis. Right paralytic clubfoot.

 May 16, 2000, the patient underwent surgery: Closed achillotomy. Three-joint arthrodesis of the right foot.

 Example 2. Patient Sergievskaya AS, 18 years old, was in the clinic of traumatology and orthopedics with a diagnosis of Post-traumatic equinovarus deformity of the left foot.

 10.10.2000, the operation was performed: Closed achillotomy. Three-joint arthrodesis of the left foot.

 A total of 4 operations were performed for 4 patients.

 Thus, the use of the proposed method of three-joint arthrodesis of the foot will create a stable fixation of the resected joints in the postoperative period, ensure the preservation of the anatomical relationship of the talus, calcaneus, scaphoid and cuboid bones, and contribute to the more rapid formation of ankylosis in the bones-calcaneal, bones-calcaneal and calcane-navicular bones after eliminating the existing deformity of the foot, eliminate instability in the joints of the foot that developed as a result of existing congenital or acquired strain. The use of canned allografts will improve bone regeneration in the area of the resected joints.

Claims (1)

 The method of three-joint arthrodesis of the foot, including resection of the articular surfaces of the subtalar and chopar joints, the creation of a bed for transplants, their introduction into the ram-calcaneal joint with subsequent immobilization, characterized in that perpendicular to the line of the ram-calcaneal and ram-navicular joints form grooves that form canned cortical allografts.