RU2264184C1 - Method for treating defects of long tubular bones - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: the present innovation deals with substituting the defects of long bones. For this purpose on should perform osteotomy of tibial fragment followed by additional osteotomy of opposite tibial fragment, replace simultaneously osteotomized tibial fragments up to their junction, perform fibular osteotomy at junction level of tibial fragments, replace gradually fibular ends up to the contact of the junction of the ends of replaced tibial fragments. The method enables to substitute vast defect, prevent relapse of failed symphysis and development of angular deformation.

EFFECT: higher efficiency of therapy.

2 dwg, 1 ex

Description

The invention relates to medicine, in particular to orthopedics, and in particular to methods for replacing subtotal defects of the tibia with atrophy and thinning of the ends of the fragments and can be used in clinical departments that use external fixation devices for the treatment of orthopedic diseases.

A known method of replacing a tubular bone defect with thinned fragments ends, including osteotomy and dosed movement of the selected fragment in the defect before contact with the end of the opposite fragment, followed by fixation using a compression-distraction apparatus, in which, after reaching the contact of the opposing ends of the fragments, they are fragmented and dosed compression of the fragmentation zone to normalize the thickness of the bone (RF Patent No. 2150905. Publ. 20.06. 2000, Bull. No. 17).

However, the known method does not provide for the substitution of a subtotal defect of the tibia in conditions of common skin scars in the contact area of the ends of the fragments and leads to great trauma when duplicating them.

There is a method of treating false joints using a compression-distraction apparatus, in which a transverse osteotomy of the end of one of the fragments is performed and the end of another fragment is inserted into it, and then the junction of the fragments in the form of a bridge is closed with a cut-off fragment (AS USSR No. 835421. Publ. June 7, 81, Bull. No. 21)

However, the known method does not include dissection of soft tissues in the junction of the fragments, operative fitting of the end sections of the fragments, which, when mobilized and the formation of bone fragments, is associated with additional tissue trauma in the junction of the fragments, an increase in anatomical shortening, segment, corrugation of soft tissues, and deterioration of tissue trophism and cosmetic appearance of the damaged segment.

The present invention is to develop a method for replacing a subtotal defect of the tibia with thinned, atrophic ends of the fragments, when during the reconstruction of the joined fragments, the fusion strength is increased by increasing the newly formed bone mass using an osteotomized fibula.

The problem is solved in that in the method for replacing subtotal defects of long bones, including osteotomy of a fragment of the tibia, moving the fragment to their contact with the opposite fragment, fixation by the transosseous device, additional osteotomy of the opposite fragment of the tibia, simultaneous movement of the osteotomy bone fragments , then perform the osteotomy of the fibula at the junction of fragments of the tibia and dosed shift the ends of the fibula to contact with the junction of the ends of the displaced fragments of the tibia.

The present invention is illustrated by a detailed description, an example of a method, a surgical procedure and copies of radiographs, on which:

Figure 1 - scheme of osteosynthesis;

Figure 2 - photo and radiographs of patient T .: a - before treatment; b - in the process of osteosynthesis; c - the result of treatment.

The method is as follows.

After epidural anesthesia after treatment of the surgical field with antiseptic solutions, 2-3 spokes are cross-linked through the proximal and distal metaphyses of the tibia taking into account the existing angular deformations of the fragments. One spoke is passed through both tibia, fixing the distal and proximal tibia syndesmoses. Installation of the external transosseous fixation apparatus (hereinafter referred to as the apparatus) is performed from 4 ring supports. Knitting needles drawn through the tibia metaphyses in a taut state are fixed in the base supports of the apparatus. Through the end sections of the fragments spend 2 pairs of distraction-guide spokes with thrust pads or "twists". The spokes are fixed in traction units mounted on the base supports of the apparatus. In the metadiaphysis of the fragments, osteotomy (corticotomy) is performed. The movement of the formed fragments towards each other begins on the 5-7th day after the operation of 1 mm by means of the dosed tension of the distraction guide spokes in the traction units.

After reaching the contact of the elongated fragments, the distraction guide spokes are removed. Through the end sections of the fragments, 2 pairs of intersecting spokes are carried, which, when tensioned, are fixed in the middle annular supports of the apparatus.

At the junction of the fragments, oblique osteotomy of the fibula is performed in the oblique sagittal plane. Taking into account the line of osteotomy, in the oblique sagittal plane, a spoke with a thrust pad is drawn through one of the fragments of the fibula proximal or distal to the osteotomy with the possibility of moving the fragments to the junction of fragments of the tibia by pulling a spoke with a thrust pad through the traction site. The movement of fragments of the fibula is carried out 0.25 mm 2-3 times a day. After reaching the fragments of the fibula into contact with fragments of the tibia and immersing the junction of fragments of the tibia in the formed sphenoid distraction regenerate, the fibula is kept in compression by tensioning this spoke 1 mm every 10-14 days until the formation of the tibia synostosis and bone fusion junction of fragments.

Clinical example.

Patient T., East. bol. No. 18266, 19 years old. Diagnosis: post-traumatic defect - tibial diastasis; shortening of the left tibia 4 cm.

Prior to admission to the Center, the patient used crutches to move, and the limb was fixed with a splint. The soft tissues of the left tibia were scarred, intimately soldered with the opposite fragments of the tibia. On radiographs: the ends of the fragments were thinned, the end plates were formed. The end section of the distal fragment was sclerotized throughout. Inter-fragment diastasis was 6.0 cm.

To perform the method, the arrangement of the external transosseous fixation apparatus from the Ilizarov apparatus parts was used.

Inter-fragment diastasis was replaced by lengthening of opposite fragments of the tibia. The fibula was osteotomized at the junction of the fragments and in the lower third of the tibia. Tibialization of the fibula was carried out by a metered traction of a knitting needle with a “twist” drawn through the end section of the proximal fragment and fixed through the traction unit to the middle support of the apparatus. The junction of fragments of the tibia was immersed in the formed sphenoid distraction regenerate of the tibia. The segment length was equalized by lengthening the distal fragment of the tibia and fibula in the lower third. The total duration of distraction was 147 days. The anatomical integrity of the lower leg bones with the formation of the tibiofibular synostosis was restored on the 382th day of fixation. 2 months after removal of the apparatus, the patient fully loaded the operated limb.

The proposed method allows to replace an extensive defect of the tibia with the formation of a large mass of bone tissue at the junction of the thinned ends of the fragments and to prevent a relapse of nonunion and the development of angular deformation. In addition, the application of the proposed method allows to restore the anatomical length of the leg.

The proposed method is used in the orthopedic department of the State Research Center "WTO".

Claims (1)

A method for replacing defects of long bones, including an osteotomy of a fragment of the tibia, moving fragments to their contact, fixing with a transosseous device, characterized in that they perform additional osteotomy of the opposite fragment of the tibia, simultaneously moving the osteotomy fragments of the tibia to their junction, then perform osteotomy on the fibula the level of the junction of fragments of the tibia and metered out the ends of the fibula to contact with the junction of the ends of the per substituted fragments of the tibia.

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