RU2362496C2 - Technique for revasculised periosteal-cortical autograft bed formation - Google Patents

Abstract

FIELD: medicine; traumatology.

SUBSTANCE: formed host canal is sized after a clutch containing branched feed vessels. At the bottom of the canal, the bed is formed in size of periosteal-cortical plate. Vascular pedicle of the graft is laid on a bevel edge of the canal.

EFFECT: rational use of the graft repair properties.

1 ex, 2 dwg

Description

The invention relates to the field of reconstructive traumatology, i.e. to a method of forming a bed for a revascularizable periosteal-cortical autograft, and can be used in specialized departments of reconstructive microsurgery, traumatology and orthopedics.

In reconstructive traumatology, a method is known for forming a bed in the recipient area, respectively, of the bone part of the microsurgical autograft (Patent RU No. 2210998 of 08.27.2003).

However, the known method has significant disadvantages.

A free revascularizable periosteal-cortical autograft has properties that allow a certain degree of influence on osteoreparative processes. The implementation of these properties can be considered in the form of two main processes: the formation of the combined vascular bed of the contacting tissues - the periosteal-cortical autograft and the recipient region, and the participation of living bone cells in the formation and reconstruction of bone tissue. Obvious for large bone fragments with impaired blood supply is the remoteness of the autograft tissue from most of the bone fragment tissue at its surface location. As a result, the autograft performs its function either not fully, or with some delay, required for the formation of vascular connections with distant areas of bone tissue.

The objective of the proposed method of forming a bed for a revascularizable periosteal-cortical autograft is to increase the effectiveness of surgical treatment, reduce surgical risk, and also reduce the duration of treatment.

The problem in the method of forming a bed for a revascularized periosteal-cortical autograft is achieved by sequentially forming a channel in the recipient bone according to the size of the sleeve containing the supply vessels with their branches, on the bottom of the channel is a bed of the size of the periosteal-cortical plate and then the beveled edge of the channel for laying the vascular pedicle of an autograft.

The proposed method and features that distinguish it from those known in the medical and patent literature have not been found, which allows us to conclude that its criterion of "novelty."

The essence of the invention lies in the fact that they consistently form a channel in the recipient bone according to the size of the sleeve containing the supply vessels with their branches, at the bottom of the channel there is a bed of the size of the periosteal-cortical plate and then the beveled edge of the channel for laying the vascular leg of the autograft.

It is the sequential formation of the canal in the recipient bone according to the size of the sleeve containing the supply vessels with their branches, and then the formation of a bed of the size of the periosteal-cortical plate on the bottom of the canal allows the periosteal-cortical autograft to be immersed deep into the bone fragment with adequate contact of the autograft with the cortical plate . This makes it possible to rationally use the reparative properties of the autograft, which results in a reduction in the terms of revascularization and bone remodeling, and for avascular bone fragments, a significant reduction in the risk of volume and shape loss due to bone resorption processes. In turn, the formation of the channel in the recipient bone according to the size of the sleeve containing the supply vessels with their branches, and the beveled edge of the channel for laying the vascular pedicle of the autograft allows immersing the autograft in the formed bed and avoiding hemodynamic disturbances, loss of the autograft due to bending and compression of the supply vessels.

The combination of these factors not only reduces surgical risk, but also increases the effectiveness of surgical treatment, as well as reduces treatment time due to the full realization of the potential of a well-supplied, osteogenetically active cortical graft.

Thus, the totality of all the distinguishing features allows you to achieve your goal and get a positive result.

The implementation of the method is illustrated by drawings.

Figure 1. A channel was formed in the recipient bone according to the size of the coupling of the revascularized periosteal-cortical autograft containing the supply vessels with their branches, at the bottom of the canal there is a bed of the size of the periosteal-cortical plate and the beveled edge of the channel for laying the vascular pedicle of the autograft.

Figure 2. A revascularizable periosteal-cortical autograft is placed in the formed bed.

The method is as follows.

In a patient with a violation of osteogenesis, access to the recipient bone or bone fragments is carried out, a periosteal-cortical graft is taken, a channel is formed in the recipient zone according to the size of the sleeve containing the supply vessels with their branches. A bed is formed at the bottom of the canal according to the size of the periosteal-cortical plate and then the beveled edge of the canal for laying the vascular pedicle of the autograft.

Clinical example

Patient S., 50 years old, and / b No. 529028. Clinical diagnosis: False joint of the distal metadiaphysis of the left femur.

From the anamnesis. 5 years before admission, a femoral artery and a fracture of the lower third of the femur occurred as a result of a gunshot wound. Regarding the fracture, and subsequently the false joint, she was repeatedly operated on unsuccessfully.

The patient underwent surgery: osteosynthesis in the Ilizarov apparatus, reconstruction of the pseudoarthrosis using a radiation periosteal-cortical autograft. During the operation according to our proposed method, a channel was formed in the recipient bone according to the size of the sleeve containing the supply vessels with their branches, at the bottom of the channel there was a bed of the size of the periosteal-cortical plate and then the beveled edge of the channel for laying the vascular leg of the autograft. A revascularizable autograft is placed in the formed bed and fixed. Blood circulation in the autograft restored.

Fusion of the pseudoarthrosis occurred 3.5 months after surgery.

The proposed method is implemented in the department of reconstructive microsurgery RSCH RAMS and will be widely used in clinical practice.

Using the proposed method of forming a bed for a revascularizable periosteal-cortical autograft allows:

1. Improve the effectiveness of surgical treatment.

2. Reduce surgical risk.

3. Reduce treatment time.

Claims (1)

A method of forming a bed for a revascularizable periosteal-cortical autograft, which consists in the fact that they consistently form a channel in the recipient bone according to the size of the sleeve containing the supply vessels with their branches, at the bottom of the channel there is a bed according to the size of the periosteal-cortical plate and then the beveled edge of the canal for laying vascular pedicle of an autograft.

Images