RU2458646C2 - Method of treating hip dislocation in children and teenagers with flaccid paralysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Proximal resection of femoral bone is performed. Canal in femoral bone near lesser trochanter is formed. Previously isolated own ligament of femoral bone head is brought through canal and fixed on lateral surface of femoral bone with transosseal sutures. Lesser trochanter is introduced into acetabulum.

EFFECT: method ensures elimination of adducting contracture, reduction of pain syndrome, preservation of hip workability and movements in hip joint.

3 dwg

Description

The invention relates to medicine, namely to orthopedics and traumatology.

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 paralysis, 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). 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 adductor contracture, relieving pain, as well as maintaining the supportive ability of the hip and movements in the hip joint.

The technical result of the task is achieved due to the fact that after the osteotomy of the femur directly above the level of the small trochanter and cutting off the trochanteric troxus, the proximal femur is removed and the small trochanter is sent to the acetabulum. Plastic surgery of the own ligament of the femoral head is performed by forming a canal in the femur near the trochanter, is carried out through the channel of the own ligament of the femoral head and is fixed on transverse sutures on the lateral surface of the femur. The greater trochanter is also fixed by transossal sutures to the lateral semicircle of the femur when the middle gluteal muscle is pulled.

Figure 1 shows the relationship diagram in the hip joint before surgery:

1 - line of the osteotomy of the femur;

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

Figure 2 shows the relationship diagram in the hip joint after surgery.

3 - small skewer, set into the acetabulum;

4 - own ligament of the femoral head;

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

Fig. 3 is a clinical example (before and after surgery).

A method of treating hip dislocation in children and adolescents with flaccid paralysis is carried out in the following way: 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. An osteotomy 2 is made with the dissection of the greater trochanter along with the area of attachment of the gluteal muscles from the femur. Dissection of the overstretched capsule of the hip joint is performed. Allocate their own ligament of the femoral head and take on the holders. After separation of the periosteum and soft tissues with a wire saw, an osteotomy of the femur 1 is performed directly above the small trochanter. The proximal femur, including the head and neck of the thigh, is removed. Small skewer skeletonizes. A revision of the acetabulum is performed with the removal of interponates (fat "pillow" and the transverse ligament). With a drill, a canal is formed in the femur next to the small trochanter, into which the own ligament of the femoral head 4 is drawn and fixed on the lateral surface of the femur with transossal sutures. The lesser trochanter 3 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 pulled.

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 supportiveness of the hip, the range of motion in the hip joint.

Claims (1)

A method of treating hip dislocation in children and adolescents with flaccid paralysis, characterized in that they perform proximal resection of the femur with the introduction of a small trochanter into the cavity and plastic surgery of the own ligament of the femoral head, by forming a canal in the femur near the trochanter, passing through the canal own ligament of the femoral head and fixing it on the lateral surface of the femur with transossal sutures.

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