RU2217103C2 - Allotransplant for making plastic repair of proximal part of talocrural articulation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: device has measuring distance on donor distal tibia epiphysis between internal malleolus apex and later point of the metaepiphysis; the obtained size is entered into transplant passport. The tibia is cut off with osteotomy plane being perpendicular to its axis 2-3 mm far from subchondral plate with quadrate protrusion retained on the osteotomy surface. Quadrate side length is equal to 6 mm. The quadrate protrusion projects from the middle of the medial transplant surface to the middle of the fibular notch. EFFECT: avoided cicatricial degeneration with articulation function being retained. 2 dwg

Description

 The invention relates to medicine, namely to arthrology, and is applicable for the treatment of post-traumatic deforming arthrosis of the ankle joint with a primary lesion of the distal metaepiphysis of the tibia.

 Treatment of intraarticular fractures of the ankle joint often leads to unsatisfactory results. Even with good adaptation of the fragments, several years after the injury, deforming arthrosis is formed with severe pain and impaired joint function. Arthrodesis, performed with the ineffectiveness of conservative treatment [1, 2], is a stabilizing operation and relieves the patient of pain, however, a violation of the biomechanics of walking and an increase in the load on the front foot leads to damage to the ram-calcaneal and Chopar joints, which may require further surgical correction [2]. In addition, as a result of the redistribution of load, the spine suffers.

 Existing methods of arthroplasty using fascia or dura mater [1], which are the prototype of the proposed method, do not lead to restoration of the function and supportability of the limb, as the tissue proposed for interposition does not provide congruence of the mating surfaces, is quickly replaced by a scar, which again leads to impaired function foot and pain syndrome [1].

 As a result, we proposed an original anatomical allograft of the distal tibia, made according to the scheme developed by us.

The source of the manufacture of bone grafts of the distal metaepiphysis of the tibia is the corpses of people who died from diseases or injuries at the age of not more than 60 years. Bone harvesting is carried out in the first 5-6 hours after the death of the donor, if it was stored at a temperature of 18 ± 5 ^o C.

 After receiving negative responses to AIDS, HbsAg, anti-HCV, Wasserman reaction, normal biochemical parameters (bilirubin, cholesterol), the bone is mechanically cleaned of soft tissues using surgical instruments.

 For the anatomical correspondence of the allograft to the recipient's ankle joint with compasses, the distance between the tip of the inner ankle and the most lateral point of its metaepiphysis is measured in millimeters on the donor distal metaepiphysis of the tibia (Fig. 1). The obtained size is indicated in the transplant certificate.

 Then, the tibia is cut off with an osteotomy plane with an osteotomy plane perpendicular to the axis of the tibia, 2-3 mm from the subchondral plate, leaving a square protrusion ("spike") on the osteotomy surface for attachment to the tibia of the recipient with a side width of 6 mm osteotome), going from the middle of the medial surface of the graft to the middle of the fibular notch on the same graft (Fig. 2). In turn, during an operation on the osteotomized surface of the tibia of the recipient, a groove of 6 mm wide is formed in the frontal plane with walls equal to the width of the osteotome, the axis of which is the line connecting the middle of the inner lateral surface of the tibia at the resection level and the middle of the outer ankle, on the same level for articulation with an allograft (as a styloid connection).

 After manufacturing the transplant, it is sterilized according to the method developed and adopted at the institute [3].

LIST OF REFERENCES
1. Movshovich I.A. Operative orthopedics. // Moscow, "Medicine" - 1983. P. 285-288.

 2. Pfahler M. Krodel A. Tritschler A. Zenta S. Role of internal and external fixation in ankle fusion. Archives of Orthopedic & Trauma Surgery. 115 (3-4): 146-8, 1996.

 3. Savelyev V.I., Zhirnov V.A., Ivankin D.E., Etitein Yu.T., Podorozhnaya V.T. Methods of chemical sterilization of demineralized bone grafts. Methodical recommendations / Leningrad 1990. - 12 p.

Claims (1)

An allograft for plasty of the proximal ankle joint, characterized in that when forming it, the distance between the tip of the inner ankle and the lateral point of its metaepiphysis is measured on the donor distal metaepiphysis of the tibia, the size obtained is entered into the graft passport, the tibia is cut off with its perpendicular axis and the plane , at a distance of 2-3 mm from the subchondral plate with leaving on the osteotomy surface of the graft a square protrusion with a size rum of the sides of 6 mm, going from the middle of the medial surface of the graft to the middle of the fibular notch.

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