RU2346662C2 - Method of treatment of clubfoot associated with shin torsion in 3-year-old children - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: method involves dissection of muscle abducting hallux, plantar aponeurosis, removal of Achilles tendon, common flexor muscle and long flexor muscle of hallux, posterior tibial muscle tendon, consulotomy of talocrural, subastragalar, talonavicular, navicular cuneiform and metatarsal cuneiform joints, excision of anterior tibial muscle tendon at transition to plantar surface with its dislocation to cuneiform bone, cutting across osteotomy of fibular and shin bones within distal metaphysis, rotation thereof to anatomically correct correlation of huckle and malleolus condyles, ankle bone reposition in ankle joint fork, with shortening fibular muscle tendon and fixing shin and foot with compressive-distractive apparatus.

EFFECT: complete correction of foot deformation, removal of anteroexternal ankle bone rotation and shin torsion.

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Description

The invention relates to medicine and can be used in the surgical treatment of clubfoot with internal torsion of the leg bones in children from the age of three.

A known method of treating severe clubfoot in children, including dissection of the tendon of the muscle that takes away 1 finger, plantar aponeurosis, lengthening of the Achilles tendon, common flexor of the fingers and long flexor of 1 finger, the posterior tibial muscle, capsulotomy of the ankle and subtalar, scaphoid-navicular and navicular , metatarsal-wedge-shaped joints with subsequent fixation of the foot with a plaster cast, or with a distraction apparatus / Kuznechikhin EP, Ulrich E.V. Surgical treatment of children with diseases and deformations of the musculoskeletal system. - M.: Medicine, 2004, p. 480-483 /.

The specified method allows you to fix the equino-cavo-varus deformity of the foot, but does not eliminate the decentralization of the talus in the ankle fork, which leads to relapse of clubfoot, and torsion of the leg bones.

The objective of the invention is to achieve complete correction of equino-cavo-varus deformity of the foot of a severe degree and internal torsion of the lower leg bones with performing tendon-muscle plastic surgery in combination with the talus being inserted into the ankle forks and performing the detorsion osteotomy of the lower leg bones.

The technical result of the task is achieved by the fact that in the method of treating clubfoot with an internal torsion of the leg bones in children from the age of three, including dissection of the muscle abducting the first toe, plantar aponeurosis, lengthening of the Achilles tendon, common flexor of the fingers and long flexor of the first finger, posterior tibial muscle, capsulotomy of the ankle, subtalar, talus-navicular, scaphoid-wedge-shaped and metatarsal-wedge-shaped joints, it is proposed to cut the tendon before her tibial muscle at the transition to the plantar surface and move it to the second sphenoid bone, perform a transverse osteotomy of the fibula and tibia in the distal metaphysis, rotate them to the anatomically correct ratio of the condyles of the femur and ankles, directing the talus into the ankle of the ankle joint, muscles and fixation of the lower leg and foot with a compression-distraction apparatus.

Figure 1 presents the photo and radiograph of the limb of a child 3 years old before surgical treatment.

Figure 2 - diagram of the surgical treatment of clubfoot with internal torsion of the bones of the leg.

Pos.1 - tendon of the muscle that removes the first finger; pos.2 - incision for dissection of the plantar aponeurosis; Pos. 3 - Achilles tendon; Pos.4 - tendon of the long flexor of the first finger; Pos. 5 - capsule of the ankle joint; pos.6 - capsule of the subtalar joint; Pos.7 - line of the osteotomy of the fibula; POS.8 - tendons of the peroneal muscles; Pos. 9 - tendons of the posterior tibial muscle and common flexor of the fingers; Pos. 10 - capsule of the ankle joint; POS.11 - capsule of the subtalar joint; POS.12 - capsule of the talar-navicular joint; Pos.13 - capsule of the scaphoid-wedge-shaped joint; Pos.14 - capsule of the sphenoid-metatarsal joint; Pos.15 - tendon of the anterior tibial muscle; POS.16 - line of the osteotomy of the tibia; POS.17 - scheme of rotation of the distal leg; POS.18 - diagram of the positioning of the talus in the ankle fork; Pos.10 - distraction and compression apparatus.

Figure 3 - photo and radiographs of the limbs of a child 3 years after surgical treatment.

A method of treating clubfoot with internal torsion of the leg bones in children from the age of three is as follows / Fig.2/:

- on the inner surface of the foot in the projection of the first metatarsal bone, a tendon of 1 muscle that takes away the first finger is allocated and dissected in the transverse direction;

- from the incision along the plantar surface 2, the plantar aponeurosis is dissected transversely at the site of attachment to the calcaneus;

- from the incision along the posterior surface of the lower leg, the Achilles tendon 3 in the sagittal plane is lengthened with its internal part cut off at the place of attachment to the calcaneus and the extension of the tendon of the long flexor of the first finger 4, the capsule of the ankle 5 and subtalar joints 6 is dissected;

- from an incision along the outer surface of the lower leg in the projection of the fibula in the lower third, an osteotomy of the fibula 7 and shortening of the tendons of the fibula 8 are made;

- from the incision along the anteroposterior surface of the lower leg in the lower third, passing to the rear of the foot to the middle third of the metatarsus, the tendons of the 9 posterior tibial muscle and the common flexor of the fingers are extended; dissection of the capsular-ligamentous apparatus of the ankle 10, subtalara 11, talar-scaphoid 12, scaphoid-wedge-shaped 13, sphenoid-metatarsal joints 14. The tendon of the anterior tibial muscle 15 is cut off at its transition to the plantar surface of the foot and moves to the second sphenoid bone. An osteotomy of the 16 tibia and rotation of the distal tibia 17 are performed together with the foot to the anatomically correct ratio of the femoral condyles and ankles. The talus is inserted into the ankle forks according to Scheme 18. The achieved position is fixed by the distraction and compression apparatus 19. Three knitting needles are held in the middle and lower third of the tibia and one needle is inserted through the calcaneus, talus, metatarsal bones and fixed in the rings of the Ilizarov apparatus.

Performing a set of these interventions on the foot and lower leg allows one-stage complete elimination of the deformation of the foot and torsional change in the bones of the lower leg. Patients have a normal gait, they can use ordinary shoes, improve the quality of life, expand the choice of work and active sports activities.

Claims (1)

A method for treating clubfoot with internal torsion of the leg bones in children from 3 years of age, including dissection of the muscle that removes the first toe, plantar aponeurosis, lengthening of the Achilles tendon, common flexor of the fingers and long flexor of the first finger, posterior tibial muscle, capsulotomy of the ankle, subtalar , talon-navicular, scaphoid-wedge-shaped and metatarsal-wedge-shaped joints, characterized in that the tendon of the anterior tibial muscle is cut off at the transition to the plantar surface and move it to the second sphenoid bone, perform transverse osteotomy of the fibula and tibia in the area of the distal metaphysis, rotate the distal tibia together with the foot to the anatomically correct ratio of the condyles of the thigh and ankles, push the talus into the ankle of the ankle joint, and the appendices and fix the lower leg and foot with a compression-distraction apparatus.

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