RU2702604C1 - Method of surgical treatment of children with legg-calvé-perthes disease - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics and can be used for surgical treatment of children with Legg–Calvé–Perthes disease. Lenticular-iliac tenotomy is performed at the level of the anterior-lower surface of the articular capsule and the anterior-lower capsulotomy. Osteotomy of an upper branch of a pubic bone, a body of an ischial bone and an iliac bone body with subsequent rotation and inclination of the acetabular fragment of a pelvis is performed. Reached position of the displaced fragment is fixed with screws.

EFFECT: method provides creating conditions for recovering the shape (remodeling) of the femoral head and congruence of the articular surfaces.

1 cl, 7 dwg

Description

The invention relates to medicine, namely to orthopedics, and can be used in the surgical treatment of children with Legg-Calve-Perthes disease.

A known method of performing a triple pelvic osteotomy according to H. Carlioz (Carlioz N. Osteotomietriplejuxta-cotyloidienne. / H. Carlioz, N. Khouri, P. Hulin // Rev. Chir. Orthop. - 1982. - No. 68. - P. 497- 501), in which periarticular osteotomies of the ileum, upper branches of the pubic bone and sciatic bone are performed, after which the acetabular fragment of the pelvis rotates anteriorly downward and tilts outward-downward, and then is fixed in the position of the achieved correction using an autograft placed in diastasis ilium, and threaded rods.

The disadvantage of this method is the lack of possibility of its use in Legg-Calvet-Perthes disease with severe deformity of the femoral head, when there is a symptom of "high abduction" (Schulitz KP, Dustmann N.O. Morbus Perthes. 1991. - S. 271 . Abb. 3) The symptom of "high abduction" is that when the hip abducts, instead of centering ("immersing") the deformed femoral head in the acetabulum, it is repelled from the outer edge of the cavity with lateralization of the lower pole. Performing a triple pelvic osteotomy according to well-known methods in a similar anatomical situation cannot provide centering of the femoral head, and, therefore, create conditions for restoring the shape (remodeling) of the latter. Therefore, such patients often undergo hip abduction osteotomy, which is a palliative intervention that can only increase the amplitude of hip abduction and compensate for shortening of the lower limb.

(Schulitz KP, Dustmann HO. Morbus Perthes. 1991. - S 293.) At the same time, pronounced deformation of the femoral head is preserved, which leads to the development of coxarthrosis in the early stages.

The objective of the invention is to increase the effectiveness of surgical treatment of children with Legg-Calvet-Perthes disease, which manifests itself as a pain symptom, restriction of movement in the hip joint, shortening of the lower limb, in particular in the presence of the symptom of "high abduction".

The technical result of the task is achieved by the fact that in the proposed method of surgical treatment of children with Legg-Calvet-Perthes disease, periarticular osteotomies of the ilium, upper pubic bone and sciatic bone are performed, followed by rotation and tilt of the acetabular fragment of the pelvis and fixing it in position correction with screws, it is proposed to rotate and tilt the acetabular fragment of the pelvis to perform a tenotomy of the lumbar iliac muscle at the level of the anterior-lower surface of the articular Capsules and lower anterior capsulotomy.

In FIG. 1 is a diagram of a hip joint with a designated tendon section of the lumbar iliac muscle. Pos. 1 - level line and the direction of the cross section of the tendon of the lumbar iliac muscle. Pos. 2 - articular capsule.

In FIG. 2 shows a diagram of the hip joint with the indicated section of the joint capsule. Pos. 2 - articular capsule. Pos. 3 - muscle of the lumbar iliac muscle. Pos. 4 - level line and sectional direction of the joint capsule.

In FIG. 3 shows a diagram of the pelvic bone with indicated levels of osteotomy. Pos. 5 is a line of the level of implementation of the osteotomy of the pubis. Pos. 6 is a line of the level of implementation of the osteotomy of the ischium. Pos. 7 is a line of the level of implementation of the osteotomy of the ilium.

In FIG. 4 shows a diagram of the pelvic bone after osteotomy, rotation and tilt of the acetabular fragment and its fixation in the position of correction with screws. Pos. 8 - a fragment of the pelvic bone acetabular, moved to the correction position. Pos. 9 - fixing screws. Pos. 10 - proximal fragment of the pelvic bone.

In FIG. Figure 5 presents a radiograph of the hip joints of patient C., 12 years old, with Legg-Calve-Perthes disease before surgical treatment in the anteroposterior projection.

In FIG. Figure 6 shows a radiograph of the hip joints of patient C., 12 years old, with Legg-Calve-Perthes disease before surgical treatment, performed in the functional position of the abduction and internal rotation, on which the symptom of "high abduction" is visualized. Pos. 11 - the point of pathological contact of the femoral head with the outer edge of the acetabulum. Pos. 12 - lateroposition of the lower pole of the femoral head.

In FIG. 7 presents a radiograph of the hip joints of patient C., 12 years old, with Legg-Calve-Perthes disease after surgical treatment with the proposed method for the surgical treatment of Legg-Calve-Perthes disease. Pos. 13 - centering of the femoral head (SKP = 1). There is no lateration of the lower pole of the femoral head.

A method of surgical treatment of children with Legg-Calve-Perthes disease is as follows.

The position of the patient on the operating table on the back. Under conditions of general anesthesia with skeletal muscle relaxation, an X-ray of the hip joints is performed in the anteroposterior projection with maximum abduction of the hips to confirm the presence of the symptom of “high abduction”. The position of the patient on the operating table on the "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. The tendon of the lumbar iliac muscle 1 is exposed in layers and obliquely dissected at the level of the anteroposterior surface of the articular capsule 1. The capsule of the joint 2 is transversely dissected along the anteroposterior surface 4 for 1.5-2.0 cm. The cartilaginous apophysis of the ilium crest is longitudinally dissected to 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 large sciatic notch, into which Gigli saw is brought. The upper branch of the pubic bone is exposed subperiosteally to the obturator foramen, into which Buyalsky's curved shoulder blades are placed. A narrow chisel is performed oblique osteotomy 5 of the upper branches of the pubic bone directly at the acetabulum. Anesthesia is performed n. isciadicus novocaine solution. The body of the sciatic bone is exposed subperiosteally to the large sciatic notch, into which Buyalsky's curved shoulder blades are installed. A wide chisel is performed oblique osteotomy 6 of the body of the sciatic bone directly at the acetabulum. Performed by a saw Gigli performed a semicircular osteotomy 7 of the ilium directly at the acetabulum. Using one of the transposing devices, the acetabular fragment of the pelvis 8 is rotated anteriorly-downward and an outward-downward inclination. The achieved position of the acetabulum is fixed by three or four screws 9 with a diameter of 4.0 mm, drawn from the proximal fragment of the pelvic bone 8 into the acetabular fragment. The wound is sutured in layers leaving the drainage of Redon. An aseptic dressing is applied. Control radiography of the hip joints in the anteroposterior projection and the immobilization of the operated limb with a derotation plaster “boot” and an abduction pillow are performed.

The positive effect of the invention is to increase the effectiveness of surgical treatment, by eliminating the pain syndrome and increasing the amplitude of movement in the hip joint.

Claims (1)

A method of surgical treatment of children with Legg-Calve-Perthes disease, which consists in performing periarticular osteotomies of the ilium, upper pubic bone and sciatic body, followed by rotation and tilt of the acetabular fragment of the pelvis and fixing it in the position of correction with screws, characterized in that before rotation and tilt of the acetabular fragment of the pelvis performs a tenotomy of the lumbar iliac muscle at the level of the antero-lower surface of the articular capsule and antero-inferior capsulotomy.

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