RU2411015C1 - Method for cotyloid cavity transfer during double pelvic osteotomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics. It involves osteotomy of a pubic bone, and then an iliac body between an anterosuperior and anteroinferior iliac spine close to a wing of ilium. It is followed with rotation an acetabular fragment of the pelvis. Shortening of a hip bone is enabled by resection of the acetabular fragment to be displaced in the cranial direction. The provided position of the cotyloid cavity is fixed with K-wires.

EFFECT: method provides elimination of muscular compression of a repaired joint, enabled more complete reconstruction of a whirlbone and ensured reposition thereof in higher dislocations.

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Description

The invention relates to medicine, namely to orthopedics, and can be used in the surgical treatment of children with pathology of the hip joint.

A known method of performing transposition of the acetabulum during a double pelvic osteotomy according to Yu.I. Pozdnikinu (Pozdnikin Yu.I. Reconstructive surgery for congenital dislocation of the thigh in children: Dis ... Dr. med. Sciences. - L., 1983. - 510 p.), In which the supraclavicular osteotomy of the ilium is performed in a straight line or slightly arcuate line close to the acetabulum, osteotomy of the upper branch of the pubic bone and osteotomy of the intertrochanteric region of the femur, after which the acetabular fragment of the pelvis retards anteriorly - downward - outward and is fixed in the position of the achieved correction using an autograft taken from di Talnoe fragment femur and placed in diastasis ilium and spokes Kirchner and fragments held together angularly femoral plate with screws.

The disadvantage of this method is the significant reduction of the acetabular fragment of the pelvis during rotation and, therefore, the reduction of the hip joint as a whole. The reduction of the reconstructed joint is accompanied by a pronounced tension of the muscles starting on the spinal column and pelvic bone and attached to the femur and tibia (i.e., thrown over the hip joint), which in turn leads to intraarticular compression of the femoral head with the acetabulum. In this regard, surgical intervention includes a shortening of the femur and is supplemented by the performance of tenomyotomy of the lumbosacrospinalis and subspinal muscles. Meanwhile, the listed decompression measures cannot completely exclude the occurring muscle compression - a significant compressive effect of the unsexed muscle groups, and especially the gluteal muscles, remains.

The inevitable reduction of the acetabular fragment of the pelvis during rotation and its compressive effect on the femoral head during the classical operation of Yu.I. Pozdnikin limit the use of this surgical intervention for the treatment of children with Perthes disease and a high (nadiacetabular and iliac) congenital dislocation of the hip. In Perthes disease, compression of the femoral head by the articular cavity does not allow achieving the maximum possible restoration of the height of the pineal gland during the reparative process in the focus of necrosis and, therefore, restoring the normal shape of the femoral head. With a high dislocation of the thigh (in cases of the disease when, in order to achieve stability of the reduction, it is necessary to supplement the operation of open reduction of the hip with the operation of Y. I. Pozdnikin) - due to the reduction of the acetabular fragment that occurs during rotation, a much larger reduction of the femoral head is required to achieve reduction the latter into the acetabulum, which is not always possible due to the insufficient length of the gluteal muscles, therefore, reduction is often accompanied by intraarticular compression or cannot be achieved at all . In both of these diseases, the created intra-articular compression can lead to serious complications in the form of degenerative changes in the articular cartilage and the development of a vicious position of the limb. In addition, the reduction of the reconstructed hip joint relative to the opposite leads to the occurrence of biomechanical disorders that have a negative effect on gait and posture.

The objective of the invention is to increase the efficiency of surgical treatment of children with pathology of the hip joint using a double osteotomy of the pelvis by changing the level of the osteotomy of the ilium and shortening the ilium at the level of osteotomy, allowing cranial displacement of the acetabular fragment of the pelvis after normal rotation anteriorly and downward. thereby exclude its reduction and compressive effect on the femoral head.

This object is achieved by the fact that in the method of performing transposition of the acetabulum during a double pelvic osteotomy, which consists in performing an osteotomy of the ilium and the superior branch of the pubic bone with subsequent rotation of the acetabular fragment of the pelvis and fixing it with Kirschner spokes, it is proposed to perform an osteotomy of the ilium body between the anterior - the superior and anteroposterior iliac spine, close to the iliac wing, then shorten the pelvic bone by resection of the acetabular fragment from its subsequent cranial displacement.

Figure 1 presents a diagram of the pelvic bone with indicated levels of osteotomy.

Figure 2 presents the diagram of the pelvic bone after performing a high horizontal osteotomy of the ilium, osteotomy of the pubis and rotational displacement of the acetabular fragment anteriorly - downward - outward.

Figure 3 presents a diagram of the pelvic bone with the indicated level of resection of the acetabular fragment.

Figure 4 presents a diagram of the pelvic bone after resection of the acetabular fragment.

Figure 5 presents a diagram of the pelvic bone after the displacement of the acetabular fragment, held in the reached position of rotation of the anteriorly, upward until its sawdust is compared with the sawdust of the proximal fragment.

Figure 6 presents a diagram of the pelvic bone after fixing its fragments in the position of correction by a beam of Kirchner spokes and cutting off a small part of the acetabular fragment, standing anteriorly.

Pos. 1 - level of osteotomy of the pubis

Pos. 2 - level of osteotomy of the ilium according to the proposed method

Pos. 3 - level of osteotomy of the ilium according to the method of Yu.I. Pozdnikin

Pos. 4 - acetabular fragment of the pelvic bone

Pos. 5 - center of rotation of the acetabular fragment

Pos. 6 - level of resection of the acetabular fragment

Pos. 7 - removable triangular part of the supraclavicular region during shortening

Pos. 8 - diastasis between parallel sawdust of the proximal and distal ilium fragments

Pos. 9 - line of contact of filings of fragments of the pelvic bone

Pos. 10 - cutoff level of the front of the acetabular fragment

Pos. 11 - cut off part of the acetabular fragment, standing anteriorly

Pos. 12 - a bunch of fixing knitting needles Kirchner

The method is as follows.

The patient's position on the operating table on a healthy side. Under aseptic conditions, an angular incision is made in the skin and subcutaneous tissue along the outer thigh in the upper third - from the anteroposterior iliac spine to the apex of the greater trochanter and further down the thigh. After a cruciate dissection of the wide fascia of the thigh, the middle gluteus muscle and the muscle straining the wide fascia of the thigh are separated from the bottom-up and the antero-lower iliac spine is exposed through the resulting intermuscular gap. Layered exposed and intersected at the level of entry into the acetabulum of the lumbar-iliac muscle tendon. The cartilaginous apophysis of the iliac crest is longitudinally dissected to the anteroposterior spine, the incision extends down to the anteroposterior spine and further to the pubic bone. The body of the ilium is exposed subperiosteally to the sciatic notch into which Gigli saw is brought. The upper branch of the pubic bone is exposed subperiosteally to the obturator foramen into which Gigli saw is brought. Carried out by Gigli's saws (or an oscillatory saw), oblique osteotomy of 1 upper pubic bone is performed somewhat medial of the Y-shaped cartilage and transverse (horizontal) osteotomy of 2 ilium bodies between the anteroposterior and anterior-inferior iliac spines. Using one of the transposing devices, the distal (acetabular) pelvic fragment is rotationally shifted 4 anteriorly - downward - outward, and then, in accordance with the required shortening, a resection of the acetabular fragment level 6 is performed - cutting off the triangular part 7 from the acetabulum, which is removed . As a result, there is a diastasis of 8 fragments of the ileum and the possibility of a cranial displacement of the acetabular fragment of the pelvis, which is accompanied by the complete or partial elimination of its lateral tilt, created earlier during the rotational displacement. Acetabular fragment is displaced upward (with its constant retention in the achieved position of rotation anteriorly) until its filing comes into contact with filing 9 of the proximal fragment. Moreover, in both cases of displacement, the center of rotation 5 of the acetabular fragment of the pelvis is the pubic-sciatic synchondrosis, in which twisting deformation first occurs, and then bending deformation occurs. The achieved position of the acetabulum is fixed by a beam of three or four Kirschner spokes 12, drawn from the proximal fragment of the ilium into the distal fragment, after which Liston's nippers cut off at level 10 a small part 11 of the last one, which is anterior to the filament of the proximal fragment. The wound is sutured in layers leaving the drainage of Redon. An aseptic dressing is applied. A control x-ray and immobilization of the lower extremities with one and a half coxite gypsum dressing is performed.

The positive effect of the invention is as follows: there is no reduction of the acetabular fragment of the pelvis during rotation and, therefore, the reduction of the hip joint as a whole, therefore, muscle compression of the reconstructed joint is excluded. In this regard, it becomes possible to more fully restore the shape of the femoral head in Perthes disease and the possibility of repositioning the femoral head with higher dislocations.

Claims (1)

A method for performing transposition of the acetabulum during a double pelvic osteotomy, which consists in performing an osteotomy of the ilium and the superior branch of the pubic bone, followed by rotation of the acetabular fragment of the pelvis and fixing it with Kirschner spokes, characterized in that the osteotomy of the ilium is performed between the anteroposterior and anterior - the lower iliac spine, close to the iliac wing, then the pelvic bone is shortened by resection of the acetabular fragment with its subsequent cranial displacement iem.

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