MD744Z - Method for concomitant surgical correction of metatarsus varus and hallux-valgus - Google Patents
Method for concomitant surgical correction of metatarsus varus and hallux-valgus Download PDFInfo
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- MD744Z MD744Z MDS20130168A MDS20130168A MD744Z MD 744 Z MD744 Z MD 744Z MD S20130168 A MDS20130168 A MD S20130168A MD S20130168 A MDS20130168 A MD S20130168A MD 744 Z MD744 Z MD 744Z
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- hallux
- tendon
- hallucis
- muscle
- proximal phalanx
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- 206010061159 Foot deformity Diseases 0.000 title claims abstract description 9
- 208000001963 Hallux Valgus Diseases 0.000 title claims abstract description 9
- 208000005408 Metatarsus Varus Diseases 0.000 title claims abstract description 8
- 238000000034 method Methods 0.000 title claims description 12
- 210000002435 tendon Anatomy 0.000 claims abstract description 26
- 210000003205 muscle Anatomy 0.000 claims abstract description 25
- 210000001906 first metatarsal bone Anatomy 0.000 claims abstract description 12
- 210000001255 hallux Anatomy 0.000 claims abstract description 10
- 210000001872 metatarsal bone Anatomy 0.000 claims abstract description 9
- 210000000824 sesamoid bone Anatomy 0.000 claims abstract description 9
- 210000002683 foot Anatomy 0.000 claims abstract description 6
- 210000004872 soft tissue Anatomy 0.000 claims abstract description 6
- 208000005917 Exostoses Diseases 0.000 claims abstract description 5
- 208000006735 Periostitis Diseases 0.000 claims abstract description 5
- 239000002775 capsule Substances 0.000 claims abstract description 5
- 201000010934 exostosis Diseases 0.000 claims abstract description 5
- 210000003460 periosteum Anatomy 0.000 claims abstract description 5
- 210000000878 metatarsophalangeal joint Anatomy 0.000 claims description 8
- 230000001483 mobilizing effect Effects 0.000 claims description 2
- 239000003814 drug Substances 0.000 abstract description 2
- 230000000399 orthopedic effect Effects 0.000 abstract description 2
- 238000001356 surgical procedure Methods 0.000 description 4
- 210000004744 fore-foot Anatomy 0.000 description 3
- 208000004067 Flatfoot Diseases 0.000 description 1
- 230000002146 bilateral effect Effects 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 210000000281 joint capsule Anatomy 0.000 description 1
- 230000003137 locomotive effect Effects 0.000 description 1
- 230000002980 postoperative effect Effects 0.000 description 1
- 238000011205 postoperative examination Methods 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
- 238000002054 transplantation Methods 0.000 description 1
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- Orthopedics, Nursing, And Contraception (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la traumatologie şi ortopedie şi poate fi utilizată pentru corecţia chirurgicală concomitentă a metatarsus varus şi hallux-valgus. The invention relates to medicine, in particular to traumatology and orthopedics and can be used for the simultaneous surgical correction of metatarsus varus and hallux-valgus.
Este cunoscută metoda Mc Bride cu efectuarea transplantării muşchiului aductor al halucelui pe capul primului os metatarsian. Tehnica operatorie constă în aceea că se face o incizie longitudinală pe faţa dorsală a piciorului, medial de tendonul muşchiului extensor lung al halucelui, în dreptul falangei proximale a halucelui, a articulaţiei metatarso-falangiene I şi treimii distale a primului os metatarsian, apoi se incizează capsula şi periostul, după care se evidenţiază tendonul comun al muşchiului aductor şi al fasciculului medial al muşchiului flexor scurt al halucelui care se inseră pe osul sesamoid şi baza falangei proximale a halucelui. Apoi se aplică un fir de aţă gros pe tendonul muşchiului aductor al halucelui la distanţa de 5 mm de la baza falangei proximale, după care se secţionează acest tendon. Cu acel fir de aţă se suturează tendonul de capul primului os metatarsian, după care se efectuează ablaţia osului sesamoid. Prin abord lateral se efectuează excizia exostozei, se suturează capsula articulară şi ţesuturile moi pe straturi [1]. The Mc Bride method is known for transplanting the adductor hallucis muscle onto the head of the first metatarsal bone. The surgical technique consists of making a longitudinal incision on the dorsal side of the foot, medial to the tendon of the extensor hallucis longus muscle, in line with the proximal phalanx of the hallucis, the first metatarsophalangeal joint and the distal third of the first metatarsal bone, then incising the capsule and periosteum, after which the common tendon of the adductor muscle and the medial bundle of the flexor hallucis brevis muscle, which inserts on the sesamoid bone and the base of the proximal phalanx of the hallucis, is highlighted. Then a thick thread is applied to the tendon of the adductor hallucis muscle at a distance of 5 mm from the base of the proximal phalanx, after which this tendon is sectioned. With that thread, the tendon is sutured to the head of the first metatarsal bone, after which the sesamoid bone is ablated. Through a lateral approach, the exostosis is excised, the joint capsule and soft tissues are sutured in layers [1].
Este cunoscută metoda după H.J. Spooner din anul 1937, care constă în aceea că se efectuează o incizie semicirculară în primul spaţiu interdigital, se rezecă 2/3 distale ale falangei proximale a halucelui, păstrând doar baza ei, şi se inseră tendonului muşchiului aductor, după care se rezecă articulaţia metatarso-falangiană a halucelui şi se fixează baza falangei pe bontul osului metatarsian I. Apoi se efectuează artrosinteza cu broşe, capsulorafia şi ţesuturile moi se suturează pe straturi [2]. The method according to H.J. Spooner from 1937 is known, which consists in making a semicircular incision in the first interdigital space, resect the distal 2/3 of the proximal phalanx of the hallux, preserving only its base, and inserting the tendon of the adductor muscle, after which the metatarsophalangeal joint of the hallux is resected and the base of the phalanx is fixed on the stump of the metatarsal bone I. Then, arthrosynthesis is performed with pins, capsulorrhaphy and the soft tissues are sutured in layers [2].
Dezavantajele metodelor cunoscute constau în aceea că după efectuarea corecţiei există un număr mare de pacienţi, la care în perioada postoperatorie apare o hipercorecţie a metatarsului varus, totodată este mare rata de apariţie a hallux-valgus. Un dezavantaj important este înlăturarea osului sesamoid, care joacă un rol important în biomecanica antepiciorului. De asemenea este mare rata de recidive metatarsus varus şi hallux-valgus după efectuarea metodelor cunoscute. The disadvantages of the known methods are that after the correction there is a large number of patients, in whom in the postoperative period there is a hypercorrection of the metatarsus varus, at the same time the rate of hallux valgus is high. An important disadvantage is the removal of the sesamoid bone, which plays an important role in the biomechanics of the forefoot. There is also a high rate of recurrence of metatarsus varus and hallux valgus after the known methods.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode de tratament chirurgical, care să înlăture dezavantajele menţionate, şi anume să fie tehnic uşor de efectuat cu o fixare mai bună a tendonului, datorită cărui fapt are loc menţinerea sigură a osului metatarsian şi a falangei în poziţie corectă şi totodată fără înlăturarea osului sesamoid important în biomecanica antepiciorului. The problem solved by the invention consists in developing a surgical treatment method that would eliminate the aforementioned disadvantages, namely, be technically easy to perform with better fixation of the tendon, due to which the metatarsal bone and the phalanx are safely maintained in the correct position and at the same time without removing the sesamoid bone, which is important in the biomechanics of the forefoot.
Esenţa invenţiei constă în aceea că se efectuează o incizie longitudinală pe faţa dorsală a plantei piciorului, şi anume medial de tendonul muşchiului extensor lung al halucelui, de-a lungul falangei proximale a halucelui, articulaţiei metatarsofalangiene a halucelui şi treimii distale a primului os metatarsian, apoi se incizează capsula şi periostul, se mobilizează tendonul comun al muşchiului aductor şi al fasciculului medial al muşchiului flexor scurt al halucelui, care se aplică pe osul sesamoid şi pe baza falangei proximale a halucelui, se ligaturează tendonul muşchiului aductor al halucelui la distanţa de 5 mm de la baza falangei proximale, după care se secţionează tendonul, se execută un canal prin capul primului os metatarsian, prin care se trece firul de aţă din partea mediană spre partea laterală, apoi spre baza falangei proximale şi se suturează de partea laterală a osului metatarsian, după care printr-un abord efectuat pe partea laterală a articulaţiei metatarsofalangiene a halucelui se excizează exostoza, apoi se efectuează capsulorafia şi se suturează ţesuturile moi pe straturi. The essence of the invention consists in making a longitudinal incision on the dorsal surface of the sole of the foot, namely medial to the tendon of the extensor hallucis longus muscle, along the proximal phalanx of the hallucis, the metatarsophalangeal joint of the hallucis and the distal third of the first metatarsal bone, then incising the capsule and periosteum, mobilizing the common tendon of the adductor muscle and the medial bundle of the flexor hallucis brevis muscle, which is applied to the sesamoid bone and the base of the proximal phalanx of the hallucis, ligating the tendon of the adductor hallucis muscle at a distance of 5 mm from the base of the proximal phalanx, after which the tendon is sectioned, a channel is made through the head of the first metatarsal bone, through which the thread is passed from the medial side to the lateral side, then to the base of the proximal phalanx and sutured to the lateral side of the metatarsal bone, after which Through an approach performed on the lateral side of the metatarsophalangeal joint of the hallux, the exostosis is excised, then capsulorrhaphy is performed and the soft tissues are sutured in layers.
Rezultatul invenţiei constă în aceea că după efectuarea metodei de corecţie osul sesamoid rămâne intact, are loc o fixare sigură a tendonului muşchiului aductor al halucelui, care menţine în poziţie corectă osul metatarsian şi halucele; spre deosebire de metodele cunoscute are loc o corecţie concomitentă a metatarsus varus şi hallux-valgus, totodată se reduce până la minimum numărul de recidive. The result of the invention is that after performing the correction method, the sesamoid bone remains intact, there is a secure fixation of the tendon of the adductor hallucis muscle, which maintains the metatarsal bone and hallucis in the correct position; unlike known methods, there is a simultaneous correction of metatarsus varus and hallux-valgus, at the same time the number of relapses is reduced to a minimum.
Exemplu de realizare a invenţiei Example of embodiment of the invention
Metoda revendicată constă în transplantarea tendonului muşchiului aductor al halucelui pe baza falangei proximale a halucelui trecut printr-un canal efectuat în capul primului os metatarsian cu corecţia şi fixarea într-o poziţie corectă a osului metatarsian şi a I falange, iar tehnic se realizează în modul următor: se efectuează o incizie longitudinală pe faţa dorsală a piciorului, şi anume medial de tendonul muşchiului extensor lung al halucelui, de-a lungul falangei proximale a halucelui, articulaţiei metatarso-falangiene a halucelui şi treimii distale a primului metatarsian. Apoi se incizează capsula şi periostul. După care se mobilizează tendonul comun al muşchiului aductor şi al fasciculului medial al muşchiului flexor scurt al halucelui, care se aplică pe osul sesamoid şi baza falangei proximale a halucelui. Apoi se ligaturează cu un fir de aţă gros tendonul muşchiului aductor al halucelui la distanţă de 5mm de la baza falangei proximale. După care se secţionează acest tendon. Apoi se efectuează un canal prin capul primului os metatarsian, prin care se trece firul de aţă din partea mediană spre partea laterală, se întoarce înapoi spre baza falangei proximale şi se suturează de partea laterală a osului metatarsian. Printr-un abord efectuat pe partea laterală a articulaţiei metatarsofalangiene a halucelui se excizează exostoza, apoi se efectuează capsulorafia şi suturarea ţesuturilor moi pe straturi. The claimed method consists in transplanting the tendon of the adductor hallucis muscle on the basis of the proximal phalanx of the hallucis passed through a channel made in the head of the first metatarsal bone with the correction and fixation in a correct position of the metatarsal bone and the first phalanx, and the technique is performed in the following way: a longitudinal incision is made on the dorsal side of the foot, namely medial to the tendon of the extensor hallucis longus muscle, along the proximal phalanx of the hallucis, the metatarsophalangeal joint of the hallucis and the distal third of the first metatarsal. Then the capsule and the periosteum are incised. After that, the common tendon of the adductor muscle and the medial bundle of the flexor hallucis brevis muscle are mobilized, which is applied to the sesamoid bone and the base of the proximal phalanx of the hallucis. Then, the tendon of the adductor hallucis muscle is ligated with a thick thread at a distance of 5mm from the base of the proximal phalanx. After that, this tendon is sectioned. Then, a channel is made through the head of the first metatarsal bone, through which the thread is passed from the medial side to the lateral side, it is returned back to the base of the proximal phalanx and it is sutured to the lateral side of the metatarsal bone. Through an approach made on the lateral side of the metatarsophalangeal joint of the hallucis, the exostosis is excised, then capsulorrhaphy and suturing of the soft tissues in layers are performed.
Metoda revendicată a fost aplicată pe un lot de 16 pacienţi, la care nu s-a determinat prezenţa recidivelor la examinările postoperatorii repetate. The claimed method was applied to a group of 16 patients, in whom the presence of relapses was not determined during repeated postoperative examinations.
Exemplu Example
Pacienta B., 33 ani, a fost internată în secţia traumatologie cu diagnosticul: picior plat transvers bilateral gr. III. hallux-valgus gr. III, formă elastică. A fost investigată clinic şi paraclinic. A fost efectuată intervenţia chirurgicală la ambele picioare prin metoda revendicată, şi anume transplantarea tendonului muşchiului aductor al halucelui pe baza falangei proximale a halucelui trecut printr-un canal efectuat în capul primului os metatarsian cu corecţia şi fixarea într-o poziţie corectă concomitentă a metatarsus varus şi hallux-valgus. La controlul repetat, peste 6, 12, 18 luni, nu s-au depistat complicaţii şi recidive. Patient B., 33 years old, was admitted to the traumatology department with the diagnosis: bilateral transverse flatfoot gr. III. hallux valgus gr. III, elastic form. She was investigated clinically and paraclinically. The surgical intervention was performed on both feet by the claimed method, namely the transplantation of the tendon of the adductor hallucis muscle on the basis of the proximal phalanx of the hallucis passed through a channel made in the head of the first metatarsal bone with the correction and fixation in a correct position of the metatarsus varus and hallux valgus simultaneously. At the repeated control, after 6, 12, 18 months, no complications and relapses were detected.
1. Baciu C. Chirurgia şi protezarea aparatului locomotor. Editura medicală Bucureşti, 1986, 502 p. 1. Baciu C. Surgery and prosthetics of the locomotor apparatus. Bucharest Medical Publishing House, 1986, 502 p.
2. Карданов А.А. Хирургия переднего отдела стопы в схемах и рисунках, Москва, 2012, 120 p. 2. Карданов А.А. Surgery of the front part of the foot in diagrams and drawings, Moscow, 2012, 120 p.
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| MDS20130168A MD744Z (en) | 2013-10-11 | 2013-10-11 | Method for concomitant surgical correction of metatarsus varus and hallux-valgus |
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| MDS20130168A MD744Z (en) | 2013-10-11 | 2013-10-11 | Method for concomitant surgical correction of metatarsus varus and hallux-valgus |
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Citations (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU126057A1 (en) * | 1959-05-04 | 1959-11-30 | Н.С. Зельдис | Hallux Valgus treatment method |
| RU2259174C1 (en) * | 2004-05-05 | 2005-08-27 | Бейдик Олег Викторович | Surgical rehabilitation method for treating hallux valgus patients |
| RU2004131802A (en) * | 2004-11-01 | 2006-04-10 | Федеральное государственное учреждение науки "Российский научный центр "Восстановительна травматологи и ортопеди " им. акад. Г.А.И Федерального агенства по здравоохранению и социальному развитию"(ФГУН "РНЦ "ВТО" им. акад. Г.А.Илизарова Росздрава") | HALLUS VALGUS TREATMENT METHOD AND EXTERNAL FIXATION DEVICE FOR ITS IMPLEMENTATION |
| RU2295311C2 (en) * | 2003-02-20 | 2007-03-20 | Научно-исследовательский детский ортопедический институт им. Г.И. Турнера | Method for treating foot deformations in children |
| RU2005140647A (en) * | 2005-12-27 | 2007-07-10 | Общество с ограниченной ответственностью "Подиатр" (RU) | METHOD FOR STUDYING STATUS OF FOOT DEPARTMENTS AND A DEVICE FOR ITS IMPLEMENTATION |
| RU2320287C1 (en) * | 2006-11-02 | 2008-03-27 | Федеральное государственное учреждение "Нижегородский научно-исследовательский институт травматологии и ортопедии Федерального агентства по здравоохранению и социальному развитию" | Method for surgical therapy of transverse platypodia |
| RU2010113377A (en) * | 2010-04-05 | 2011-10-20 | Геннадий Анатольевич Пальшин (RU) | METHOD FOR TREATING TRANSVERSE PLATFORM IN HALLUX VALGUS |
-
2013
- 2013-10-11 MD MDS20130168A patent/MD744Z/en not_active IP Right Cessation
Patent Citations (8)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU126057A1 (en) * | 1959-05-04 | 1959-11-30 | Н.С. Зельдис | Hallux Valgus treatment method |
| RU2295311C2 (en) * | 2003-02-20 | 2007-03-20 | Научно-исследовательский детский ортопедический институт им. Г.И. Турнера | Method for treating foot deformations in children |
| RU2259174C1 (en) * | 2004-05-05 | 2005-08-27 | Бейдик Олег Викторович | Surgical rehabilitation method for treating hallux valgus patients |
| RU2004131802A (en) * | 2004-11-01 | 2006-04-10 | Федеральное государственное учреждение науки "Российский научный центр "Восстановительна травматологи и ортопеди " им. акад. Г.А.И Федерального агенства по здравоохранению и социальному развитию"(ФГУН "РНЦ "ВТО" им. акад. Г.А.Илизарова Росздрава") | HALLUS VALGUS TREATMENT METHOD AND EXTERNAL FIXATION DEVICE FOR ITS IMPLEMENTATION |
| RU2281713C2 (en) * | 2004-11-01 | 2006-08-20 | Федеральное государственное учреждение науки "Российский научный центр "Восстановительная травматология и ортопедия" им. акад. Г.А.Илизарова Федерального агентства по здравоохранению и социальному развитию" (ФГУН "РНЦ "ВТО" им. акад. Г.А.Илизарова Росздрава") | Method for treating hallux valgus and apparatus for external fixation for its implementation |
| RU2005140647A (en) * | 2005-12-27 | 2007-07-10 | Общество с ограниченной ответственностью "Подиатр" (RU) | METHOD FOR STUDYING STATUS OF FOOT DEPARTMENTS AND A DEVICE FOR ITS IMPLEMENTATION |
| RU2320287C1 (en) * | 2006-11-02 | 2008-03-27 | Федеральное государственное учреждение "Нижегородский научно-исследовательский институт травматологии и ортопедии Федерального агентства по здравоохранению и социальному развитию" | Method for surgical therapy of transverse platypodia |
| RU2010113377A (en) * | 2010-04-05 | 2011-10-20 | Геннадий Анатольевич Пальшин (RU) | METHOD FOR TREATING TRANSVERSE PLATFORM IN HALLUX VALGUS |
Non-Patent Citations (2)
| Title |
|---|
| Baciu C. Chirurgia şi protezarea aparatului locomotor. Editura medicală Bucureşti, 1986, 502 p. * |
| Карданов А.А. Хирургия переднего отдела стопы в схемах и рисунках, Москва, 2012, 120 p. * |
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| Publication number | Publication date |
|---|---|
| MD744Y (en) | 2014-03-31 |
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