RU2489980C1 - Method of reconstructing metacarpal bones - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to reconstructive surgery of hand and can be applied in case of different in size stumps of metacarpal bones, whose length reduces approaching to radial or elbow edge of hand. In accordance with the method at the first stage short stumps in carpal-metacarpal joints are exposed with preservation of dorsal and palmar intermetacarpal ligaments. Synchronic gradual destruction of stumps is carried out in one block in apparatus of external fixation. At the second stage block from destructed third and fourth metacarpal bones is moved towards radial side with preservation of formed destruction regenerate and intermetacarpal ligaments. Osteosynthesis of stump of third metacarpal bone with stump of second metacarpal bone is carried out. Cortical allograft in form of spindle-shaped rod is installed between stump of fourth metacarpal bone and wrist bones, and osteosynthesis of allograft is performed with introduction of its ends into wrist bones and stump of metacarpal bone.

EFFECT: method makes it possible to extend possibilities of recovering grip function of short hand stump, preserve intermetacarpal ligaments and vessels, providing blood supply.

1 ex, 3 dwg

Description

The present invention relates to medicine, namely to reconstructive surgery of the hand, and can be used in the presence of different-sized stumps of the metacarpal bones, the length of which decreases as you approach the radial or ulnar edge of the hand.

There is a method of reconstruction of the metacarpal bones, which consists in moving the second metacarpal bone to the third, the intersection of the capitate bone and placing diastasis between its fragments of the polygonal bone (see A. A. Koryukov “Possibilities of modern methods of rehabilitation of patients with hand defects”, in g. " Orthopedics, traumatology and prosthetics ”, 1993, No. 3, p.29).

However, the method does not allow the formation of the metacarpal bone of the required length.

Closest to the proposed invention is a method consisting in the formation of the feeding legs of the stump of the metacarpal bone, the isolation of the stump in the wrist and metacarpal joint, its axial distraction using an external fixation device, moving the stump to the stump of the other metacarpal bone using an avascular bone graft located between them (RF patent No. 2120246, 1998).

However, the known method makes it possible to restore only one metacarpal bone, which limits the coverage function of the short stump of the hand and leads to difficulties in holding large objects. The method involves the intersection of the metacarpal ligaments and blood vessels on the back and palmar surfaces of the hand, which leads to impaired blood circulation of the transferred stump of the metacarpal bone and long periods of consolidation and reconstruction of the graft. The method does not ensure the preservation of bone regenerate and stimulate its consolidation.

The task of the invention is to improve the method.

The technical result is the expansion of the possibilities of restoring the function of coverage of the short stump of the hand, preserving the metacarpal ligaments and blood vessels, providing blood supply to the stump of the metacarpal bones, reducing the time of consolidation and reconstruction of the graft.

The technical result is achieved in that in a method comprising isolating a short stump of the metacarpal bone, applying an external fixation apparatus to the wrist and forearm, followed by distraction of the stump, moving it to the stump of the other metacarpal bone with the introduction of an avascular bone graft located between the stumps, and osteosynthesis of the metacarpal bones and transplant, at the first stage, hardware distraction of the stumps of two metacarpal bones is carried out with preservation of the back and palmar metacarpal ligaments, at the second stage, distracted the stumps are moved in a single block to the radial side, preserving the resulting distraction regenerate, the stump of the third metacarpal bone is moved to the stump of the second metacarpal bone, the stump of the fourth is placed in the position of the third metacarpal bone, a bone allotransplant graft is inserted between the fourth metacarpal stump and the bones of the wrist forms and perform osteosynthesis, introducing an allograft at one end into the bones of the wrist, and the other into the stump of the third metacarpal bone.

The essence of the method is illustrated by drawings, where figure 1 shows the stump of the brush; figure 2 - the stump of the third and fourth metacarpal bones after distraction in the external fixation apparatus and the resulting distraction regenerate; figure 3 - the stump of the third metacarpal bone, moved to the stump of the second metacarpal bone, the stump of the fourth metacarpal bone, moved to the position of the third, and the bone allograft in the form of a cortical spindle-shaped rod.

The method is as follows.

At the first stage, a skin incision is made on the palmar surface of the hand between the moved stumps, a capsule of the carpal-metacarpal joints of the third, fourth metacarpal bones is dissected, and short stumps in the carpal-metacarpal joints are dissected, while maintaining the back and palmar metacarpal ligaments. An external fixation device is placed on the wrist and forearm. Through the stump of the metacarpal bones, axial distracting spokes 1 are intramedullary. The proximal ends are bent in the form of a hook, and the distal ends are fixed to the screw rod of the external fixation apparatus. Simultaneous synchronous and gradual distraction of the stumps is carried out in one block, without separating them from each other. After distraction is completed by the required amount, an incision is made along the scar after the first stage of the operation. A block of distracted third and fourth metacarpal bones is moved to the radial side, while maintaining the resulting distraction regenerate 2 and the metacarpal ligaments. The end face of the stump of the second metacarpal bone is isolated. After that, the stump of the third metacarpal bone is installed in the position of the second metacarpal bone, and the stump of the fourth metacarpal bone is placed in the position of the third metacarpal bone. Osteosynthesis of the stump of the third metacarpal bone is performed with the stump of the second metacarpal bone spokes. Between the fourth metacarpal stump and the bones of the wrist, an intramedullary cortical allograft 3 is installed in the form of a spindle-shaped rod and osteosynthesis of the allograft is carried out by introducing its ends into the wrist bones and the metacarpal stump with additional knitting after the maximum axial traction of the fourth and fourth stump. At the same time, the junction of the formed distraction regenerate 2 with bone fragments is preserved. After the operation, the hand and forearm are immobilized with a plaster cast for 2 months. If there is a longer stump of the fifth metacarpal bone on the wrist, the stump of the fourth metacarpal bone is moved in the same way to the fifth stump, and the third to the fourth position with bone grafting of the distraction defect with a cortical allograft.

Clinical example. B-th Penins D.S., 21 years old, and.b. No. 245659, was treated at the Nizhny Novgorod NIIITO for a stump of the first metacarpal bone at the level of the head, a stump of the second metacarpal bone at the level of the distal third, a stump of the third, fourth metacarpal bone at the level of the middle third, fifth metacarpal bone at the level of the proximal third on the left hand. On the right hand were the stumps of the first, second metacarpal bones at the level of the distal third, the stump of the third metacarpal bone at the level of the middle third, the stump of the fourth, fifth metacarpal bones at the level of the distal third. In 2009, the patient received frostbite of the fingers of both hands, for which they were performed necrectomy and formed stumps of the hand. Previously, the patient on the left hand was excised scars on the end surface with plastic surgery of the resulting tissue defect with a skin-fat flap. The first stage of reconstruction of the second, third metacarpal bones was performed on 03.03.11. At the same time, an external fixation apparatus was applied to the wrist and forearm, axial distracting spokes fixed to the screw rods of the apparatus were drawn through the stumps of the third and fourth metacarpal bones. After stump distraction was completed on April 12, 11, the second stage of the operation was performed - moving the third metacarpal stump to the second metacarpal stump, the fourth metacarpal stump to the position of the third metacarpal bone using a cortical allograft, preserving the resulting distraction regenerate. The postoperative period was uneventful, the wounds healed by primary intention. The next stage was the phalangization of the first metacarpal bone (06/22/11). When studying the long-term result of treatment, it was noted that the depth of the first intercarpal gap is 4 cm, the distance between the tips of the second and first metacarpal bones when the last is equal to 6 cm, it is possible to completely close the first and second metacarpal bones, the patient confidently holds the hand stump like small objects, so and medium size. On radiographs, the complete consolidation of stumps and transplant is determined, including due to the formation of periosteal bridges.

Thus, the method makes it possible to restore two metacarpal bones, which form a wide elbow anti-resistant jaw, which makes it easier for a patient to grab and hold small and medium objects.

The use of a cortical allograft in the form of a spindle-shaped rod to replace a distraction defect and the proposed method of osteosynthesis ensures the preservation of the distraction regenerate formed between the bone fragments and attached to them.

Preservation of the distraction regenerate, formed after the first stage of the operation, stimulates the consolidation of the bone graft with the bones of the wrist and stump of the metacarpal bone, contributes to the formation of a single autoallocostal block, forming an ulnar antitumor jaw.

Preservation of the intercarpal ligaments ensures the preservation of blood vessels that supply blood to the stumps of the metacarpal bones, improves the fusion of bones and increases their resistance to resorption.

Faster consolidation of fragments of the second metacarpal bone improves the conditions for the allograft to grow together with the stump of the adjacent metacarpal bone and with the bones of the wrist.

Claims (1)

The method of reconstruction of the metacarpal bones, which consists in isolating the short stump of the metacarpal bone, applying an external fixation apparatus to the wrist and forearm, followed by distraction of the stump, moving it to the stump of the other metacarpal bone with the introduction of an avascular bone graft located between the stumps, and osteosynthesis of the metacarpal bones, transplant and characterized in that at the first stage synchronous distraction of the stumps of two metacarpal bones is carried out with preservation of the back and palmar metacarpal ligaments, at the second stage The cultured stumps are moved in a single block to the radial side, preserving the resulting distraction regenerate, the stump of the third metacarpal bone is moved to the stump of the second metacarpal bone, the stump of the fourth is placed in the position of the third metacarpal bone, and the medullary transplant bone is inserted into the coronal transplant between the fourth metacarpal stump and the bones of the wrist. spindle-shaped and perform osteosynthesis, introducing an allograft at one end into the bones of the wrist, and the other into the stump of the third metacarpal bone.

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