RU2240068C1 - Method for developing a hip joint's cement spacer - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with operation for hip joint's re-endoprosthetics. One should remove endoprosthesis, fill in cotyloid cavity with osseous cement and antibiotic, create spacer's cervix due to manual modeling to introduce there 2-4 fragments of Kirschner's needles, after cement hardening one should introduce the portion of cement into medullary canal of proximal femoral department to connect both parts with protruding part of needles in functionally efficient position of lower limb that creates optimal conditions for limb's functioning.

EFFECT: higher efficiency.

2 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in operations of endoprosthetics of the hip joint.

Hip replacement has taken a leading place in the surgical treatment of severe forms of hip joint pathology. This operation eliminates or significantly reduces pain, restores movement in the joint, provides support for the limb, improves gait and, as a result, significantly improves the quality of life of the patient.

In the coming years after surgery, good and satisfactory results were observed in 80-90% of patients. However, after performing this effective but complex operation, various complications occur. In particular, complications (from 1% to 10%) in the form of a purulent infection in both the early and late postoperative period (Imamaliev A.S. et al., 1992; Mamontov et al., 1992; Karptsov V.I. et al., 1994; N.V. Kornilov et al., 1995; Murrey et al., 1995). It is a well-known tactic for the treatment of such complications: active soft tissue fistulnecrectomy, active drainage. If this attempt to preserve the endoprosthesis in conditions of purulent infection is unsuccessful, its removal is indicated. In the future, patients move with crutches due to a significant shortening of the lower limb. In young patients, it is possible after some time (from 2 to 6 months) to perform endoprosthetics of the hip joint in case of favorable healing of the surgical wound (Dorr, 1984; Babst et al., 1989; Fitgerald, Jones, 1990). However, significant technical difficulties arise during the operation of endoprosthetics of the hip joint, which worsen the result of the operation.

1. After removal of the endoprosthesis, muscle tension causes upward displacement of the proximal femur. Attempts to prevent this by wearing an orthopedic orthosis are ineffective. And the imposition of an external fixation apparatus is fraught with a great risk of an exacerbation of the infectious process in the soft tissues of the joint or thigh. This hip displacement forces the surgeon to completely cut off the gluteal muscles from the greater trochanter to lower the femur to the required level.

2. In addition, after removal of the components of the endoprosthesis in the acetabulum, the entire space is filled with scar tissue. As a result, trauma during their removal, profuse bleeding.

A known method of replacing a defect after removal of the knee joint prosthesis with a filler (polymethylmethacrylate) (Zahar A., Vaida A., Kiss J // 13 scientific-practical conference SICOT, St. Petersburg, 2002, s.263-264). Its essence lies in the fact that gentamicin creates an insert from bone cement with the addition of an antibiotic, replacing the cavity after removal of the endoprosthesis. However, it is not applicable for the use of the hip joint in view of the large anatomical differences of these large joints.

Closest to the claimed solution, it is also a prototype, is a method of individual endoprosthetics of joints and joint ends according to A.V. Vorontsov (IV All-Russian Congress of Orthopedic Traumatologists, Kuibyshev, 1984, p.186). The essence of the method is intraoperative reconstruction from polymethylmethacrylate (bone cement) using casts of the bone department according to the sample removed. However, when the endoprosthesis is removed, it is not possible to recreate it, and the use of casts only complicates the operation.

The purpose of the proposed method: to improve the results of endoprosthetics of the hip joint after complications in the conditions of purulent infection.

The objective of the proposed method is to create the conditions for the least traumatic installation of the components of the hip joint during the endoprosthetics operation.

The essence of the proposed method is that after a fistulnecrectomy of soft tissues and removal of the components of the endoprosthesis, the resulting defect of the cervical region and the acetabulum is replaced with a spacer (insert) from bone cement with an antibiotic consisting of the acetabulum and femoral parts, interconnected by 2-4 fragments of Kirchner knitting needles.

The proposed method of creating a spacer of the hip joint from bone cement with an antibiotic is as follows.

During the operation, a soft tissue fistulnecrectomy is performed and the hip joint endoprosthesis is removed. Stage I of the creation of the spacer - the cavity of the acetabulum is densely filled with bone cement with an antibiotic (at the moment of its hardening, when it ceases to adhere to the gloves). Using the method of hand sculpting, they create the spacer neck of the same length, but slightly larger diameter (3-4 mm) of the neck of the removed femoral component of the endoprosthesis. The end face of the spacer neck is made smooth and even. Several fragments (2-4) of Kirchner spokes with a diameter of 2 mm and a length of 4-5 cm are introduced into the center of the spacer neck so that one half (2-2.5 cm) is immersed in bone cement and the other half protrudes over the neck end spacer (figa). These fragments of the spokes act as reinforcement for the durable connection of the two parts of the spacer. After the polymerization of bone cement has begun, the acetabular portion of the spacer is mixed with a second portion of bone cement with an antibiotic. Stage II of the creation of the spacer - at the time of bone cement hardening, when it ceases to adhere to the gloves, it is introduced to a depth of 5-7 cm into the bone marrow canal of the proximal femur. A smooth surface of bone cement is created in the transverse region. They give the lower limb a functionally advantageous position - 15 ° abduction, 170 ° flexion in the hip joint. Connect the two parts of the spacer (acetabular and femoral) using the protruding halves of the fragments of the Kirchner spokes in the acetabulum (Fig.1B). After the solidification of the second portion of bone cement is completely hardened, the two parts of the spacer are tightly joined (Fig. 1c). At the same time, metal fragments of Kirchner spokes are located inside the bone cement with an antibiotic and do not adversely affect the healing of the surgical wound. A postoperative wound is drained and sutured according to the classical technique.

Clinical example.

Patient Kolomiytseva T.V., 41 years old, East. b No. 9354/03, was undergoing treatment in the orthopedic department of the Krasnodar Regional Clinical Hospital No. 1 (Krasnodar). The diagnosis is bilateral stage 3 dysplastic coxarthrosis. In March 2001, an operation was performed: total replacement of the right hip joint with autoplasty of the acetabulum roof with an autograft from the iliac crest on the feeding "muscle leg". In February 2002, an operation was performed for total arthroplasty of the left hip joint. The patient's long-term result of operations is good. However, on January 7, 2003, after an acute respiratory illness, the patient developed reddening of the skin and a fistula appeared in the area of the right hip joint (2 years after the operation). On contrasting fistulography, the fistula penetrates into the joint cavity in contact with the components of the endoprosthesis (Fig. 2a). On April 18, 2003, an operation was performed in the same medical institution - fistulnecrectomy and removal of the endoprosthesis of the right hip joint and replacement of the defect with bone cement Polacris (St. Petersburg) with the addition of the antibiotic gentamicin (Fig.2b). In the postoperative period, she received antibiotic therapy (intravenous and intramuscular), taking into account sensitivity to the microbial flora (St. aureus). The intravenous laser irradiation of blood was carried out (7 sessions). The surgical wound healed by first intention. The patient began to walk on crutches in an orthopedic splint. Revision endoprosthetics are planned.

Claims (1)

A method of creating a cement spacer of the hip joint, characterized in that after removal of the endoprosthesis under conditions of purulent infection, the acetabulum is filled with bone cement with an antibiotic, spacer neck is created by manual molding, into which 2-4 fragments of Kirchner spokes are inserted, after the cement has hardened into the second portion injected into the medullary canal of the proximal femur and using the protruding part of the fragments of Kirchner spokes connect both parts of the spacer in a functionally advantageous position and lower limb.

Images