RU2303411C2 - Method for plasty of affected ligaments and tendons - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with plasty of affected ligaments and tendons of motor system. It is necessary to form slit-like dead beds from the side of the edges of both fragments of broken ligament or tendon in their thickness to place a reticulated nickelide-titanium belt with noninterwoven ligatures at its ends. Then one should tighten the fragments of broken ligament or tendon to fix the developed coupling due to applying noninterwoven ligatures of reticulated belt outwards through paracentesis in the walls of the beds followed by traction and tightening their ends with knots at the surface. The innovation enables to avoid the loss of functioning tendinous length and provide reliable tenodesis.

EFFECT: higher efficiency of plasty.

2 cl, 6 dwg, 2 ex

Description

The invention relates to medicine, namely to orthopedics and traumatology.

Ligaments and tendons belong to the passive part of the musculoskeletal system. Their function is the transfer of muscle effort or the organization of a mechanical connection between the individual elements of support and movement. Ligaments connect two or more bones, cartilage, or other anatomical structures; the tendon connects the muscle to its attachment to the bone. In medicine, it is customary to distinguish these two structures, although in the mechanical representation their functions are similar. In the future, to shorten the text, under the term "ligaments" we agree to understand generically and "tendons". Being relatively thin and inextensible, the ligaments and tendons have significant, impressive, from a technical point of view, strength and withstand enormous loads. So, for example, the tendon of the quadriceps femoris muscle can withstand a tensile strength of 600 kg, the Achilles tendon - 400 kg. It is clear that in the event of a ligament rupture that occurs during exorbitant loads, for example, during sports, restoring its integrity and especially its former strength is an intractable task. The relevance of its solution increases in connection with the marked increase in the frequency of subcutaneous tendon ruptures due to sports activities [Mironova Z. S., Bogutskaya E.V. and other achievements of sports traumatology. - Orthopedic traumatology. 1981, No. 4, pp. 48-51] and dystrophic processes in the pathogenesis [Harms J., Biehl G. and another. Patologie der Paratenonitis achillae a bei Hochleistungs - sportlern. - Arch. Orthop. Unfall-Chir. 1977, 88, P.65-74].

Among severe damage to the ligaments, ruptures along the length of the ligament itself and tears from the “driven” element, the bones, are differentiated by location and localization. Depending on this, known methods are used and new methods of surgical (and only surgical) treatment are developed - plastics of damaged ligaments and tendons (Reinsertion). The list of actions of the methods of plastics of gaps and tears contains technical differences that favor the division of the invention into two independent objects (a group of inventions united by a common approach to solving the problem).

Depending on the age of the patient and the age of the gap, various plastic methods are used.

Known, for example, is a method for plastic surgery of tendon ruptures of the quadriceps femoris, technically uncomplicated and suitable for the treatment of fresh, most treatable ruptures [V.D. Chaklin. Fundamentals of operative orthopedics and traumatology. M .: Medicine. 1964. S.738]. The method, in addition to the routine actions of accessing, detecting a gap and completing the closure of the wound, comprises repositioning, tightening the butt stumps and fixing the formed joint. Two thick silk sutures are sutured through the thickness of the tendon at a distance of 2-3 cm from the ends, the ends of the sutures are cross-linked or U-shaped to the ends of the stumps and tied after being pulled together to close.

The method, despite its widespread prevalence, is not sufficient. The tendon, due to its longitudinal fibrillation, weakly retains the ligature, gets loose, and with significant mechanical stress, the gap recurs. To strengthen the connection of a torn tendon, especially an old one (several days after injury), reinforcing connecting elements of autoplastic or substitute biocompatible material are used.

A known method of plastics torn Achilles tendon [Krasnov AF, Miroshnichenko VF, Kotelnikov GP Traumatology, M., 1995, p.445], using as a connecting element a tendon transplant or a wide fascia from the other limb. In chronic ruptures, when the triceps muscle of the tibia contracts during immobilization and extends the distal end of the rupture, the connecting element facilitates the reposition of stumps and strengthens the joint. The method varies with the path of application of the graft. Its disadvantage is low solvency due to degradation and resorption of the graft, devoid of nutrition.

More durable and durable are the connecting elements of artificial biocompatible materials. A known method of plastics of torn tendons and ligaments using dacron ribbons or vascular dacron prostheses [Krasnov AF, Miroshnichenko VF, Kotelnikov GP Traumatology. M., 1985, p. 94-95]. The tape is placed in slit-like deaf beds made in the thickness of the tendon from the ends of the gap, and is fixed through piercing.

Due to the low biocompatibility of the material of the mylar implant, the method is not sufficient. According to the greatest similarity of the technical essence, he was selected as a prototype of the proposed method for plastics of torn tendons and ligaments.

When the ligaments are torn off from the “driven” bone, the bed for the connecting element is performed in the thickness of the bone near the separation site. A known method of plastics of torn ligaments (tenodesis) [RF Patent No. 2202972, B. I. No. 12, April 27, 2003]. A torn end of the ligament is placed in the slit-like bone bed, which is preformed into a flat bag reinforced with a plate implant made of porous titanium nickelide. The package is fixed in the bed through cross-cutting firmware.

The method provides sufficient tenodesis strength. Its disadvantage is the need for immersion of the tendon in the bone groove, which leads to the loss of the functioning length of the tendon.

By the greatest similarity, this analogue is selected as a prototype of the proposed method of plasty of torn tendons and ligaments.

The technical result of the proposed inventions is to increase the solvency of plastics of damaged ligaments and tendons.

The specified technical result is achieved by the fact that in the method of plasty of torn ligaments and / or tendons of the musculoskeletal system, including the formation of slit-like deaf beds in the thickness and from the ends of both fragments of a torn ligament or tendon, placement of a connecting implant in them, reposition and retraction of these fragments fixation of the formed compound, a mesh nickelide-titanium tape with unwoven filaments at its ends is used as a connecting implant; Anna ligament or tendon fixation and formed compound is accomplished by carrying nevpletenyh filaments mesh belt outside through the punctures in the walls of the boxes, traction and tying the ends thereof on the surface of nodes, as well as further through-stitching formed of suture material compound TiNi.

In an embodiment, the indicated technical result is achieved by the fact that in the method of plasty of torn ligaments and / or tendons of the musculoskeletal system, including the formation of slit-like deaf beds in the thickness and from the side of the end of the torn ligament or tendon and bone in the place of separation, placement of the connecting implant in the beds , reposition and constriction of these fragments, fixation of the formed compound, a mesh nickelide-titanium tape with unwoven threads at its ends is used as a connecting implant, tyagivanie said fragments and fixing compound formed is carried nevpletenyh conducting filaments mesh belt outside through the punctures in the walls of the boxes, traction and tying the ends thereof on the surface of nodes, as well as further through-stitching formed of suture material compound TiNi.

The attainability of the technical result is due to the combined consequence of the properties of the essential features of the invention. The mesh tape of titanium nickelide implanted into the thickness of the tendon forms a strength framework for the end sections and is a connecting link in the formed anastomosis. The strength properties of titanium nickelide correspond to the best of the class of modern biocompatible materials and are sufficient for normal tendon tensile stresses. The elastic properties of titanium nickelide and ligament tissue are similar. Therefore, under tensile loads, the deformation of the formed complex ligament - connection - ligament is consistent, not leading to overvoltage at the boundaries of these components. This reduces the risk of postoperative complications, significantly increases the strength of the joints, reduces the time of rehabilitation and anatomical and physiological recovery of this zone.

The mesh structure of the connective implant is permeable-porous, contributing to the acceleration and improvement of the processes of integration of the implant with ligament tissue, i.e. impregnation with a liquid medium, the generation of connective tissue, its transformation into functional. Vascularization of the regenerated tissue complements the blood supply to the restored ligament.

The tape shape of the implant corresponds to the anatomy of the connected fragments.

Unwoven threads at the ends of the tape, the trajectory of the threads, the sequence of actions of the connection and fixation ensure the efficiency of the method.

The fixation of the formed compound through piercing with titanium nickelide suture material, which has similar properties to the material of the connecting implant, meets the requirements of the above consistency of the tensile strain of the complex.

In the method of plasty of torn ligaments, the feature relating to the bed for the connecting implant is differentiated. One bed is made in bone tissue. This creates a number of features in the operation technique. The result is the restoration of the bone-ligament complex. The presence of a connecting implant allows you to maintain a normal functioning length of the ligament, i.e. maximum anatomical and physiological correspondence of this zone.

The above complex of positive consequences of using the distinguishing features of both methods is summarized in the technical result - increasing the viability of the plastics of damaged ligaments and tendons.

The absence in the prior art of a similar complex of features of the methods indicates that the proposed technical solution meets the criterion of "inventive step".

The illustrations show:

Figure 1 - appearance of a torn Achilles tendon.

Figure 2 - Achilles tendon, restored by the proposed method: 1 - mesh connecting implant, 2 - knots of untwisted non-woven threads, 3 - nodal joints of the junction of the stumps.

Figure 3 - appearance of the torn ligament of the patella.

Figure 4 - fragment of the operation - plastics of the torn ligament of the patella: 1 - mesh connective implant, 4 - unwoven filaments of the mesh connective implant, 5 - bed of the patella and tendon for the mesh connective implant.

Figure 5 - ligament of the patella restored by the proposed method. Through piercing stitches are not shown.

6 is an x-ray of the restored patellar ligament.

The attainability of the technical result is confirmed by examples of specific implementation of the proposed method in the trauma unit of the clinical hospital No. 1 of Novokuznetsk.

Example 1

Patient Yu., 49 years old, was admitted to the department with a diagnosis of subcutaneous rupture of the Achilles tendon (figure 1). The method during the operation is as follows:

Under conduction anesthesia, access to the gap zone was made. The flabby and swinging ends of a torn tendon are excised. At the ends of both stumps, slit-like deaf beds are made to a depth of 3 cm. A mesh tape implant 1 (Fig. 2) with non-woven threads at both ends is placed, about half the length in each bed. Implant dimensions 60 × 15 mm; made of nickel-titanium wire with a diameter of 0.06 mm, the mesh size of the textile weave 0.25 mm The length of four non-woven (at each end of the tape) threads is 40 mm. The ends of the non-woven threads are drawn through the punctures in the walls of the boxes to the outside and, after the stumps are repositioned to the closed state and pulled together by traction of the threads, are tied with knots 2 on the tendon surface. The joint of the tendon and the thickness of the reinforced ends of the tendon are stitched with suture material from titanium nickelide 3 (through piercing stitches are not shown). The surgical wound is closed by suturing. The limb is fixed for two weeks with a plaster tire. After a two-month rehabilitation period, the patient was examined. The absence of patient complaints, recurrent signs indicates the successful functioning of the implant and the viability of the operation.

Example 2

Patient X., 22 years old, was admitted to the department with an injury - separation of his own ligament of the patella of the right knee joint (Fig. 3). Operation - tenodesis with plastic - torn ligaments carried out by the proposed method. The method is as follows:

Under masked anesthesia, the frontal area reveals a lesion zone, torn parts of the ligament with numerous cysts are excised. In the stump of the ligament and thicker of the patella, slit-like deaf beds 5 are made (Fig. 4), where a mesh tape implant 1 with braided threads 4 at the ends is placed. The characteristics of the connecting implant are similar to those mentioned in the first example. At the proximal end of the bone bed and the distal end of the bed of the ligament punctures are made for passing through them unwoven threads. The ends of the non-woven threads through the punctures are brought out and after approaching to touch the stump of the ligament and the inlet of the patella bed are tied with knots on the surface of the patella and ligament.

In the postoperative period for three weeks, the limb was fixed with a splint followed by rehabilitation.

An anamnesis and X-ray examination of the patient after 8 weeks revealed fusion and normal functioning of the ligament, restoration of the full range of movements in the knee joint (Fig.6).

These examples, the opinion of the closest colleagues in the field of medicine, the state of the proposal itself indicate its readiness for widespread clinical use, i.e. meeting the criteria of the invention of "industrial applicability".

Claims (2)

1. The method of plastics of damaged ligaments and / or tendons of the musculoskeletal system, including the formation of slit-like deaf beds from the ends of both fragments of a torn ligament or tendon in their thickness, placement of a connecting implant in the formed beds, reposition and retraction of these fragments, fixing the formed connection, characterized in that a mesh nickelide-titanium tape with unwoven threads at its ends is used as a connecting implant, constricting fragments of a torn ligament and or tendons and fixation of the formed compound is carried out by unstretched filaments of the mesh tape outward through punctures in the walls of the boxes, traction and knotting of their ends with knots on the surface, as well as additional through piercing of the formed compound with suture material from titanium nickelide. 2. A method for plastics of damaged ligaments and / or tendons of the musculoskeletal system, including the formation of a slit-like deaf bed on the side of the end of the torn ligament or tendon in their thickness and the formation of a slit-like deaf bed in the thickness of the bone at the site of separation, placement of the connecting implant in the beds, reposition and the tightening of these fragments, the fixation of the formed compound, characterized in that a mesh nickelide-titanium tape with unwoven threads at its ends is used as a connecting implant, with yagivanie said fragments and fixing compound formed is carried nevpletennyh conducting filaments mesh belt outside through the punctures in the walls of the boxes, traction and tying the ends thereof on the surface of nodes, as well as further through-stitching formed of suture material compound TiNi.

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