MD756Z - 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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- MD756Z MD756Z MDS20130167A MDS20130167A MD756Z MD 756 Z MD756 Z MD 756Z MD S20130167 A MDS20130167 A MD S20130167A MD S20130167 A MDS20130167 A MD S20130167A MD 756 Z MD756 Z MD 756Z
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- 206010061159 Foot deformity Diseases 0.000 title claims abstract description 10
- 208000001963 Hallux Valgus Diseases 0.000 title claims abstract description 9
- 208000005408 Metatarsus Varus Diseases 0.000 title claims abstract description 7
- 238000000034 method Methods 0.000 title claims description 10
- 210000001872 metatarsal bone Anatomy 0.000 claims abstract description 30
- 239000002775 capsule Substances 0.000 claims abstract description 19
- 210000000460 cuneiform bone Anatomy 0.000 claims abstract description 14
- 210000001255 hallux Anatomy 0.000 claims abstract description 10
- 210000000988 bone and bone Anatomy 0.000 claims abstract description 8
- 206010052428 Wound Diseases 0.000 claims abstract description 4
- 208000027418 Wounds and injury Diseases 0.000 claims abstract description 4
- 230000000149 penetrating effect Effects 0.000 claims abstract description 4
- 210000000878 metatarsophalangeal joint Anatomy 0.000 claims description 7
- 210000003371 toe Anatomy 0.000 abstract description 8
- 206010023204 Joint dislocation Diseases 0.000 abstract description 2
- 239000003814 drug Substances 0.000 abstract description 2
- 230000000399 orthopedic effect Effects 0.000 abstract description 2
- 101100008044 Caenorhabditis elegans cut-1 gene Proteins 0.000 abstract 1
- 210000001906 first metatarsal bone Anatomy 0.000 abstract 1
- 210000000281 joint capsule Anatomy 0.000 abstract 1
- 208000037873 arthrodesis Diseases 0.000 description 7
- 230000002146 bilateral effect Effects 0.000 description 3
- 238000011477 surgical intervention Methods 0.000 description 3
- 208000004067 Flatfoot Diseases 0.000 description 2
- 238000003745 diagnosis Methods 0.000 description 2
- 238000002271 resection Methods 0.000 description 2
- 238000004904 shortening Methods 0.000 description 2
- 208000000013 Hammer Toe Syndrome Diseases 0.000 description 1
- 210000003275 diaphysis Anatomy 0.000 description 1
- 238000011205 postoperative examination Methods 0.000 description 1
- 238000011321 prophylaxis Methods 0.000 description 1
- 210000001203 second metatarsal bone Anatomy 0.000 description 1
- 210000004872 soft tissue Anatomy 0.000 description 1
- 230000006641 stabilisation Effects 0.000 description 1
- 238000011105 stabilization Methods 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
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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 Lapidus, şi anume artrodeza metatarsocuneiformă a degetului 1. Din abord lateral al primului deget se face o incizie pe straturi, unde se pune în evidenţă linia articulară metatarsocuneiformă, după care se incizează capsula, se pun în evidenţă suprafeţele articulare. Se mobilizează osul metatarsian 1, se pătrunde pe sub capsulă şi se degajează osul metatarsian 1. Cu o daltă dreaptă se rezecă suprafaţa articulară a osului cuneiform până ce dalta se opreşte în cel de al doilea os metatarsian, care se răzuieşte. Apoi se răzuieşte suprafaţa articulară a bazei osului metatarsian 1. După obţinerea corecţiei se introduce o broşă Kirshner de 3 mm prin diafiza osului metatarsian 1, zona de artrodeză şi osul cuneiform. Se lasă broşa extraarticular la distanţa de 2...3 mm pentru a fi ulterior extrasă. Se suturează capsula, apoi ţesuturile moi se suturează pe straturi, ulterior se aplică un pansament aseptic [1]. The Lapidus method is known, namely the metatarsocuneiform arthrodesis of the 1st toe. From the lateral approach of the 1st toe, an incision is made in layers, where the metatarsocuneiform articular line is highlighted, after which the capsule is incised, the articular surfaces are highlighted. The 1st metatarsal bone is mobilized, the capsule is penetrated and the 1st metatarsal bone is released. With a straight chisel, the articular surface of the cuneiform bone is resected until the chisel stops in the second metatarsal bone, which is scraped. Then the articular surface of the base of the 1st metatarsal bone is scraped. After obtaining the correction, a 3 mm Kirshner wire is introduced through the diaphysis of the 1st metatarsal bone, the arthrodesis area and the cuneiform bone. The extraarticular pin is left at a distance of 2...3 mm to be later extracted. The capsule is sutured, then the soft tissues are sutured in layers, then an aseptic dressing is applied [1].
Este cunoscută, de asemenea, metoda Brandes sau Keller, care constă în rezecţia bazei falangei proximale a degetului 1. Din abord lateral al degetului 1, se face o incizie pe straturi până se găseşte interlinia articulară a articulaţiei metatarsofalangiene a halucelui. Se incizează capsula în formă de “ Y “, se eliberează baza falangei proximale a degetului 1, se luxează, apoi cu o daltă dreaptă se rezecă 1/3 din baza acestei falange. Rezecţia se face perpendicular. Ulterior se face capsulorafia, se tracţionează lamboul capsular, pentru aranjarea halucelui în poziţie corectă. Artrosinteza se efectuează cu o broşă [2]. The Brandes or Keller method is also known, which consists of resection of the base of the proximal phalanx of the 1st finger. From the lateral approach of the 1st finger, an incision is made in layers until the articular interline of the metatarsophalangeal joint of the hallux is found. The capsule is incised in the shape of a “Y”, the base of the proximal phalanx of the 1st finger is released, it is dislocated, then with a straight chisel 1/3 of the base of this phalanx is resected. The resection is made perpendicularly. Subsequently, capsulorrhaphy is performed, the capsular flap is pulled, to arrange the hallux in the correct position. Arthrosynthesis is performed with a broach [2].
Dezavantajele metodelor cunoscute constau în aceea că se scurtează degetul din contul înlăturării porţiunilor din osul metatarsian şi a falangei proximale, ce duce la incomodităţi estetice şi totodată nu este stabilă fixarea cu broşe în timpul artrodezei, ceea ce face posibilă apariţia recidivelor. The disadvantages of known methods are that the finger is shortened by removing portions of the metatarsal bone and the proximal phalanx, which leads to aesthetic discomfort, and at the same time, the fixation with pins during arthrodesis is not stable, which makes relapses possible.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode de tratament chirurgical, care ar înlătura dezavantajele menţionate, şi anume să fie tehnic uşor de efectuat, să nu permită scurtarea halucelui, să asigure o fixare mai stabilă în timpul artrodezei, datorită cărui fapt să fie menţinut sigur osul metatarsian şi falanga în poziţie corectă cu profilaxia apariţiei recidivelor. 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, not allow shortening of the hallux, ensure a more stable fixation during arthrodesis, due to which the metatarsal bone and phalanx are safely maintained in the correct position with the prophylaxis of relapses.
Esenţa invenţiei constă în aceea că se efectuează o incizie pe straturi din partea laterală a primului deget până la linia articulară metatarsocuneiformă, după care se incizează capsula, se mobilizează suprafeţele articulare şi osul metatarsian 1, apoi pătrunzând sub capsulă se eliberează osul metatarsian 1; cu o daltă dreaptă se rezecă suprafaţa articulară a osului cuneiform sub un unghi deschis în partea laterală, se răzuieşte suprafaţa articulară a bazei osului metatarsian 1; se efectuează o altă incizie pe straturi pe partea laterală a degetului 1 la nivelul articulaţiei metatarsofalangiene până la interlinia articulară, se incizează capsula în formă de Y, se eliberează baza falangei proximale a degetului 1, se efectuează o luxare, apoi cu o daltă dreaptă se rezecă perpendicular 1/3 din baza acestei falange, din porţiunea de os rezecată se modelează un transplant de formă triunghiulară, conform spaţiului format între osul metatarsian şi osul cuneiform, şi se introduce în spaţiul menţionat, după care se fixează transplantul sub un unghi cu două broşe Kirshner de 2...3 mm prin osul metatarsian 1, transplant şi osul cuneiform cu exteriorizarea capetelor broşelor, totodată se fixează halucele prin introducerea coaxială cu axa degetului a unei broşe prin oasele falangiene şi osul metatarsian 1, se suturează capsulele articulare metatarsocuneiformă şi metatarsofalangiană, iar plăgile se suturează pe straturi. The essence of the invention is that an incision is made in layers from the lateral side of the first finger to the metatarsocuneiform joint line, after which the capsule is incised, the articular surfaces and the 1st metatarsal bone are mobilized, then penetrating under the capsule, the 1st metatarsal bone is released; with a straight chisel, the articular surface of the cuneiform bone is resected at an open angle on the lateral side, the articular surface of the base of the 1st metatarsal bone is scraped; another incision is made in layers on the lateral side of the 1st finger at the level of the metatarsophalangeal joint up to the joint interline, the Y-shaped capsule is incised, the base of the proximal phalanx of the 1st finger is released, a dislocation is performed, then with a straight chisel 1/3 of the base of this phalanx is resected perpendicularly, a triangular-shaped transplant is modeled from the resected bone portion, according to the space formed between the metatarsal bone and the cuneiform bone, and it is introduced into the mentioned space, after which the transplant is fixed at an angle with two 2...3 mm Kirshner pins through the 1st metatarsal bone, the transplant and the cuneiform bone with the externalization of the pins' ends, at the same time the hallux is fixed by introducing a pin coaxial with the finger axis through the phalangeal bones and the 1st metatarsal bone, the metatarsocuneiform and metatarsophalangeal joint capsules are sutured, and the wounds are suture in layers.
Rezultatul invenţiei constă în aceea că după efectuarea metodei revendicate are loc o fixare sigură, datorită prezenţei unei baze de stabilizare, în poziţie corectă a osului metatarsian şi a halucelui fără scurtarea lui, cu corecţia 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 claimed method, a secure fixation occurs, due to the presence of a stabilization base, in the correct position of the metatarsal bone and the hallux without its shortening, with the concomitant 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 aceea că se efectuează o intervenţie chirurgicală de artrodeză osteoplastică metatarsocuneiformă cu autogrefă din baza falangei proximale a degetului 1. Se efectuează o incizie pe straturi din partea laterală a primului deget până la linia articulară metatarsocuneiformă, după care se incizează capsula, se mobilizează suprafeţele articulare şi osul metatarsian 1, apoi pătrunzând sub capsulă se eliberează osul metatarsian 1; cu o daltă dreaptă se rezecă suprafaţa articulară a osului cuneiform sub un unghi deschis în partea laterală, se răzuieşte suprafaţa articulară a bazei osului metatarsian 1; se efectuează o altă incizie pe straturi pe partea laterală a degetului 1 la nivelul articulaţiei metatarsofalangiene până la interlinia articulară, se incizează capsula în formă de Y, se eliberează baza falangei proximale a degetului 1, se efectuează o luxare, apoi cu o daltă dreaptă se rezecă perpendicular 1/3 din baza acestei falange, din porţiunea de os rezecată se modelează un transplant de formă triunghiulară, conform spaţiului format între osul metatarsian şi osul cuneiform, şi se introduce în spaţiul menţionat, după care se fixează transplantul sub un unghi cu două broşe Kirshner de 2...3 mm prin osul metatarsian 1, transplant şi osul cuneiform cu exteriorizarea capetelor broşelor, totodată se fixează halucele prin introducerea coaxială cu axa degetului a unei broşe prin oasele falangiene şi osul metatarsian 1, se suturează capsulele articulare metatarsocuneiformă şi metatarsofalangiană, iar plăgile se suturează pe straturi. The claimed method consists in performing a surgical intervention of osteoplastic arthrodesis of the metatarsocuneiform with autograft from the base of the proximal phalanx of the 1st finger. An incision is made in layers from the lateral side of the first finger to the metatarsocuneiform joint line, after which the capsule is incised, the articular surfaces and the 1st metatarsal bone are mobilized, then penetrating under the capsule the 1st metatarsal bone is released; with a straight chisel the articular surface of the cuneiform bone is resected at an open angle on the lateral side, the articular surface of the base of the 1st metatarsal bone is scraped; another incision is made in layers on the lateral side of the 1st finger at the level of the metatarsophalangeal joint up to the joint interline, the Y-shaped capsule is incised, the base of the proximal phalanx of the 1st finger is released, a dislocation is performed, then with a straight chisel 1/3 of the base of this phalanx is resected perpendicularly, a triangular-shaped transplant is modeled from the resected bone portion, according to the space formed between the metatarsal bone and the cuneiform bone, and it is introduced into the mentioned space, after which the transplant is fixed at an angle with two 2...3 mm Kirshner pins through the 1st metatarsal bone, the transplant and the cuneiform bone with the externalization of the pins' ends, at the same time the hallux is fixed by introducing a pin coaxial with the finger axis through the phalangeal bones and the 1st metatarsal bone, the metatarsocuneiform and metatarsophalangeal joint capsules are sutured, and the wounds are suture in layers.
Metoda revendicată a fost utilizată pe un lot de 22 pacienţi, după care nu s-a determinat prezenţa recidivelor la examinările postoperatorii repetate. The claimed method was used on a group of 22 patients, after which the presence of relapses was not determined during repeated postoperative examinations.
Exemplul 1 Example 1
Pacientul D., 57 ani, a fost internat în secţia de traumatologie cu diagnosticul: picior plat transvers bilateral, hallux-valgus gr. 3, degetul 2 în ciocan. A fost investigat clinic şi paraclinic. S-a efectuat intervenţia chirurgicală, unde s-a aplicat metoda revendicată, şi anume artrodeza osteoplastică metatarsocuneiformă cu autogrefă din baza falangei proximale a degetului 1 cu corecţia şi fixarea concomitentă în poziţie corectă a metatarsus varus şi hallux-valgus. La controlul repetat, peste 6, 12 şi 18 luni, nu s-au depistat complicaţii şi recidive. Patient D., 57 years old, was admitted to the traumatology department with the diagnosis: bilateral transverse flatfoot, hallux valgus gr. 3, hammer toe 2. He was clinically and paraclinically investigated. The surgical intervention was performed, where the claimed method was applied, namely osteoplastic metatarsocuneiform arthrodesis with autograft from the base of the proximal phalanx of the 1st toe with the correction and simultaneous fixation in the correct position of the metatarsus varus and hallux valgus. At the repeated control, after 6, 12 and 18 months, no complications and relapses were detected.
Exemplul 2 Example 2
Pacienta V., 55 ani, a fost internată în secţia de traumatologie cu diagnosticul: picior plat transvers bilateral, hallux-valgus gr. 3 bilateral, subluxaţia falangelor proximale a degetelor 2, 3, 4 şi 5. A fost investigată clinic şi paraclinic. S-a efectuat intervenţia chirurgicală, unde s-a aplicat metoda revendicată, şi anume artrodeza osteoplastică metatarsocuneiformă cu autogrefă din baza falangei proximale a degetului 1 cu corecţia şi fixarea concomitentă în poziţie corectă a metatarsus varus şi hallux-valgus. La controlul repetat, peste 6, 12, şi 18 luni, nu s-au depistat complicaţii şi recidive. Patient V., 55 years old, was admitted to the traumatology department with the diagnosis: bilateral transverse flatfoot, hallux valgus gr. 3 bilateral, subluxation of the proximal phalanges of the 2nd, 3rd, 4th and 5th toes. She was investigated clinically and paraclinically. The surgical intervention was performed, where the claimed method was applied, namely the osteoplastic arthrodesis of the metatarsocuneiform with autograft from the base of the proximal phalanx of the 1st toe with the correction and simultaneous fixation in the correct position of the metatarsus varus and hallux valgus. At the repeated control, after 6, 12, and 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. Medical Publishing House, Bucharest, 1986, 502 p.
2. Карданов А.А. Хирургия переднего отдела стопы в схемах и рисунках, Москва, 2012, 120 p. 2. Kardanov A.А. Surgery of the front part of the foot in diagrams and drawings, Moscow, 2012, 120 p.
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