SU1739979A1 - Method for treating fibrous ankylosis of a knee joint - Google Patents

Abstract

Usage: in orthopedics and reconstructive surgery. Objective: to provide movement in the joint while maintaining the length of the limb. Technical essence: arthrotomy, arthrolia, dissection of fibrous tissues, external and internal wide muscles are performed in the transverse direction to achieve the required range of motion, the allopupulin is placed at the site of tissue dissection.

Description

The invention relates to medicine, namely to orthopedics and reconstructive surgery.

The aim of the invention is to provide movements in the joint while maintaining the length of the limb.

The method is carried out as follows.

An incision is made through the skin and subcutaneous fatty tissue in front of the non-internal surface of the thigh, starting from its middle third to the tibial tuberosity of the tibial bone, through the inner edge of the patella and opening the joint capsule.

They separate the skin and subcutaneous fat to the edges of the outer and inner thigh muscles.

The right head of the quadriceps muscle of the thigh is separated from these muscles and from the middle muscle to the border of the lower and middle third of the thigh. The skin and subcutaneous tissue are detached from the patella, mobilizing the patella ligament while keeping it attached to the tibial tuberosity.

Adhesions between the patella and the articular surface of the condyles, as well as the commissures from the lower and upper torsion of the joint are removed.

The leg is gently bent at the knee joint with simultaneous application of shallow transverse incisions on the wide muscles of the thigh near their transition to tendon stretch. When the knee joint is bent, the straight muscle is sewn with wide inner and outer thigh muscles.

If it is difficult to reach during the operation, the bending angle of 90-100 ° C makes possible oblique-incisional dissection of these muscles in the same zone.

The amount of flexion of the leg in the knee joint is brought up to 90-100 °. Throughout the multiple cuts, multiple thin pads of formalized allogeneic umbilical cord are laid.

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After the layer-by-layer wound closure, the limb is placed on the Beller splint and starts with 4-5 days of movement at the knee joint and conventional rehabilitation measures.

Example. Patient N., 26 years old, chauffeur with fibrous ankylosis of the right knee joint 1.5 g in length after a closed epistemral fracture of the right femur.

The fracture treatment was initially carried out using skeletal stretching, an abnormal fusion of the fragments was noted, then a refracture was made with a plaster cast.

A front cross with the restoration of the anatomical axis of the bone 10 months after the injury, but marked stiffness in the right knee joint. The lower leg is in the extension position, because of the impossibility of flexion in the knee joint, the gait is abruptly disturbed: the patient suffered a leg that is not bending at the knee joint, its abduction is outward in the hip joint and the pelvis.

Under epidural anesthesia, advanced arthrolysis was performed. Dissection and excision of paraarticular tissues, removal of cicatricial adhesions between the patella and the femoral condyles, as well as the last and condyles of the tibia were performed. Allopupine gaskets are laid at the tissue dissection sites.

Flexion in the contracted knee on the operating table has been reduced to 90 °.

After the operation, the limb is laid on the Beller's splint. The movements in the operated joint on the splint with a gamach started on the second day after the operation and walking on the crutches is allowed.

Healing of the postoperative wound by primary tension.

Stitches are on the twelfth day. The range of motion was kept within the limits achieved during the operation.

After 2 weeks, it is allowed to walk with crutches, stepping on the operated leg. In a month c - walking without crutches with a stick. By 2 months. after the operation - walking without a stick 1.5-2 km.

The same amount of movement in the joint is maintained. The patient after 3 months started to work as a driver. Walks up to 5 km. Gait is normal.

Inspection after 2 years.

Considers himself completely healthy, movement in the joint. Bending up to 90 °, extending to 175 °.

Restoration of joint function with a wide dissection of compacted, sharply modified paraarticular tissues and excision of adhesions, obliterating the articular cavity, became possible only with the use of multiple pads from

the umbilical cords, both in the joint cavity, between the edges of the dissected paraarticular tissues, and in the intermuscular spaces.

The umbilical cord laid on the wound surfaces was depoglycosaminoglycans, which ensure the normalization of the metabolic processes necessary for reparative tissue regeneration. Sufficiency of glycosaminoglycans in the period of reparative regeneration in the operated joint also provided the opportunity to create a slip in the capsule-ligament apparatus as a necessary biomechanical condition for the formation of organotypic regenerates, creating the conditions for restoring the physiological function of the operated joint.

The proposed method has been applied in the treatment of severe contractures and fibrous

ankylosis in trauma and orthopedic clinics. Its use allows for a more complete restoration of the functions of the knee joint.

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Claims (1)

Invention Formula The method of treatment of fibrous ankylosis of the knee joint by arthrotomy, artolysis, dissection of fibrous tissues, external and internal wide muscles in the transverse direction to achieve the required range of motion, characterized in that to ensure movement in the joint while maintaining the length limbs, in place of tissue dissection stack allopupoviny.