RU2295925C2 - Method for treating severe degree of equino-cava-varus deformation of feet in case of arthrogryposis in children - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should carry out tenoligamentocapsulotomy of talocrural, subtalar and talonavicular joints; ankle bone should be removed; one should perform the modeling of heel bone at resetting it into talocrural fork and creating anatomically acceptable, correct ratios in talocrural joint. Then comes wedge resection of navicular, cuboid and wedge bones at wedge's bottom facing the rear and outwards, at keeping articular surfaces of the present bones. The tendon of anterior tibial muscle should be transferred onto the second wedge bone. Fixation should be fulfilled with Kirschner's needles: one needle should applied through the great toe, the 1^st metatarsal bone, the 1^st wedge and navicular bones; one more needle - through cuboid and heel bones and two needles - through metatarsal and wedge bones. The innovation provides decreased quantity of deformation relapses in older age.

EFFECT: higher efficiency of therapy.

2 dwg

Description

The invention relates to medicine, namely to orthopedics.

Known methods for the treatment of severe arthrogrypotic clubfoot, including the following main operational actions: tenoligamentocapsulotomy of the ankle, subtalar, talus-navicular joints and astrogalectomy. Moreover, sometimes, based on the severity of the deformity, a capsular-ligamentous apparatus was also dissected along the posterior surface of the ankle and subtalar joints with achilloplasty. After that, the talus was removed, and the calcaneus was inserted into the ankle joint (Steindler 1949, Kazantseva ND 1953, Zatsepin TS 1956, Gibson and Urs 1970; book "Arthrogryposis", authors L.E. Rozovskaya, G. .M. Ter-Egiazarov, M .: Medicine, 1973, pp. 120-121, which is the prototype).

A common disadvantage of the considered methods is the low effectiveness of treatment due to the fact that supination and adduction of the forefoot remain, which are further aggravated and lead to relapse or multi-plane deformation.

The objective of the invention is to increase the effectiveness of surgical treatment in young children with a severe degree of equino-cava-varus deformity of the feet, reducing the number of relapses of deformities in older age, by completely eliminating all components of the deformity, improving the ratio of tarsus bones and muscle balance.

The technical result of the task is achieved by the fact that in the method of treating severe equino-cava-varus deformity of the feet with arthrogryposis in young children, including teno-ligamentocapsulotomy of the ankle, subtalar, talar-navicular joints, removal of the talus, it is proposed to simulate the calcaneus with its reduction into the fork of the ankle joint and the creation of anatomically acceptable, correct ratios in the ankle joint; wedge-shaped resection of the scaphoid, cuboid and sphenoid bones, with the base of the wedge facing the rear and the outside, leaving the articular surfaces of these bones; transplantation of the tendon of the anterior tibial muscle onto the second sphenoid bone, followed by fixation with Kirschner spokes, which are carried out: one spoke through the calcaneus and tibia; the other spoke through the first finger, the first metatarsal bone, the first sphenoid and scaphoid bones; another knitting needle through the cuboid and calcaneus and two knitting needles through the metatarsal and sphenoid bones.

Figure 1-2 presents the operational plan of the method (figure 1 is a front view of the foot; figure 2 is a side view of the foot).

1 - muscle abducting the first toe

2 - S-shaped incision along the inner surface of the foot, enveloping the inner ankle and extending to the rear of the foot

3 - back tibial muscle of the foot

4 - tendon of the long flexor of the toes

5 - talus

6 - calcaneus after modeling

7 - sphenoid bones

8 - the second sphenoid bone

9 - cuboid bone

10 - scaphoid

11 - anterior tibial muscle of the foot

12 - Kirschner knitting needles

The method is as follows.

An incision is made along the medial surface of the foot in the projection of the head of the 1st metatarsal bone. A muscle is extracted and dissected, which removes the first toe of the foot 1 (Fig. 1). From the arcuate incision along the plantar surface of the foot, the plantar aponeurosis is isolated and dissected.

An S-shaped incision is made along the inner surface of the foot, enveloping the inner ankle and extending to the rear of the foot 2 (figure 2). Tendons of the posterior tibial muscle 3 and the common flexor of the fingers 4 are distinguished and Z-shaped. Tenoligamentocapsulotomy of the ankle, subtalar, talus-navicular joints is performed. The talus 5 is allocated on the inner, outer, back surfaces and is removed. The calcaneus 6 is simulated, after which the latter is set into the ankle fork. From this section, a wedge-shaped resection of the bones of the tarsus is made: wedge-shaped 7, scaphoid 10, cuboid 9 with the base of the wedge open outward and anterior (Fig. 1). The tendon of the anterior tibial muscle 11 is transplanted from the scaphoid to the second sphenoid bone 8. Fixing with Kirschner 12 needles: one spoke - through the calcaneus and tibia; the other spoke through the first finger, the first metatarsal bone, the first sphenoid and scaphoid bones; another knitting needle through the cuboid and calcaneus and two knitting needles through the metatarsal and sphenoid bones.

The proposed method allows to increase the effectiveness of surgical treatment in young children with a severe degree of equino-cava-varus deformity of the feet, to reduce the number of relapses of deformities in older age.

Claims (1)

A method for the treatment of severe equino-cava-varus deformity of the feet with arthrogryposis in young children, including teno-ligamentocapsulotomy of the ankle, subtalar, talar-navicular joints, removal of the talus, characterized in that the calcaneus is modeled with its ankle inserted and inserted into the fork and anatomically acceptable, correct ratios in the ankle joint, conduct a wedge-shaped resection of the scaphoid, cuboid and sphenoid bones with the base of the wedge facing m to the rear and outside, leaving the articular surfaces of these bones left, the tendon of the anterior tibial muscle is transplanted onto the second sphenoid bone, fixated with Kirschner spokes: one spoke is carried through the calcaneus and tibia, the other spoke through the first finger, the first metatarsal bone, the first sphenoid and scaphoid, another spoke through the cuboid and calcaneus and two spokes through the metatarsal and sphenoid bones.

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