RU2392894C1 - Method of treating hip dislocation in children and asolescents with paralyses - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely orthopaedics. After excision of the greater trochanter and osteotomy of femoral bone above the level of the lesser trochanter, proximal femur is removed. The lesser trochanter is reset into the cotyloid cavity. The greater trochanter is fixed with transosseous sutures to a lateral semicircle of the femoral bone with tension of the gluteus medius muscle.

EFFECT: method provides joint motion with preserved support.

3 dwg

Description

The invention relates to medicine, namely to orthopedics.

A known method of treating hip dislocation in children and adolescents with paralysis, consisting in resection of the proximal femur with the location of the femoral stump in the soft tissues (Kalen V., Gamble JG Resection arthroplasty of the hip in paralytic dislocation. Dev. Med. Child. Neurol. 1984; 26: 341).

This method eliminates the possibility of reliance on the limb, and the loss of function of the abducting muscles of the thigh in the absence of articulation in the joint does not exclude the possibility of a relapse of contracture.

There is also a method of treating hip dislocation in children and adolescents with cerebral palsy, which consists in performing an angulating femoral osteotomy with the support of a small trochanter on the acetabulum (Samilson RL, Tsou P., Aamouth G. et al., Dislocation and subluxation of the hip in cerebral palsy. Pathogenesis, natural history and management. J Bone Joint Surg Am. 1972; 54: 863).

However, the preservation of the proximal femur in this case can lead to the restriction of movements in the joint and the preservation of pain.

The objective of the invention is to increase the effectiveness of the treatment of hip dislocation in older children and adolescents with paralysis, eliminating adductive contracture, relieving pain, as well as maintaining hip support, movements in the hip joint and hip abduction function.

The technical result of the task is achieved due to the fact that after an osteotomy of the femur directly above the level of the small trochanter and cutting off the major trochanter, the proximal femur is removed, the small trochanter is sent to the acetabulum, and the large trochanter is fixed with transossal sutures to the lateral semicircle of the femur with medium tension gluteal muscle.

Figure 1 presents the relationship diagram in the hip joint before surgery, where

1 - line of the osteotomy of the femur;

2 - line of osteotomy of the greater trochanter of the femur.

Figure 2 presents a diagram of the relations in the hip joint after surgery, where

3 - a resected fragment of the proximal femur;

4 - a small skewer, set into the acetabulum;

5 - a large trochanter with the area of attachment of the middle gluteal muscle.

The method is as follows.

From the linear incision 12-15 cm long in the upper third of the thigh along the outer surface above the trochanteric region, the proximal femur is distinguished. An osteotomy 1 is performed with cutting off the greater trochanter together with the area of attachment of the gluteal muscles from the femur. Dissection of the overstretched capsule of the hip joint is performed. After separating the periosteum and soft tissues with a wire saw, an osteotomy of the femur 2 is directly above the small trochanter (figure 1). The proximal femur 3, including the head and neck of the thigh, is removed. Small skewer skeletonizes. The acetabulum is revised to remove interponates (circular and transverse ligaments) from it. The lesser trochanter 4 is set into the acetabulum, and the greater trochanter 5 is fixed to the diaphysis of the femur with transosseous nodal sutures when the middle gluteal muscle is tensioned (Fig. 2).

The wound is sutured in layers. Immobilization is carried out by a hip plaster cast during hip abduction up to 30-40 ° for 6-8 weeks.

The proposed method provides the simultaneous elimination of hip dislocation, leading to contracture of the hip joint, relief of pain, and also allows you to maintain the supportiveness of the hip, the amplitude of movement in the hip joint and hip abduction function (Fig. 3).

Claims (1)

A method of treating hip dislocation in children and adolescents with paralysis, including an osteotomy of the proximal femur, characterized in that after the osteotomy of the femur immediately above the level of the small trochanter and cutting off the greater trochanter, the proximal department, including the head and neck, is removed, the small trochanter is inserted into the acetabulum, a large trochanter is fixed with transossal sutures to the lateral semicircle of the femur with tension of the middle gluteal muscle.

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