RU2003298C1 - Method of therapy of defect of thighbone proximal section - Google Patents

Description

tissues. Having reached the lower third, the preparation of the flap is stopped, because here the main neurovascular bundle, represented by the muscle branches of the superior annual arteries, veins and nerves, is introduced into it from the side of the inner surface. To provide greater mobility, to eliminate tension and compression of the supply leg, as well as to increase the range of movement of the flap to the plastic zone, cut it distal to the neurovascular bundle, approaching the leg at an angle of 90 °, Restore the integrity of the fascial cases of the muscle flap with separate sutures. . The proximal end of a muscular-fascial-bone graft cut using the described procedure on a fixed neurovascular leg is guided to a bone defect of the femur with subsequent fixation. The distal end of the graft is sutured to the front edge of the large annual muscle. The wound is sutured in layers tightly. A plaster coxite dressing is applied.

Compared with the prototype, the method is highly effective and completely eliminates the recurrence of the disease. The use of a muscular-fascial-bone graft based on the middle annual muscle and on a fixed neurovascular leg allows not only to completely eliminate (by stitching homogeneous tissues) a bone defect, but also to revascularize the head, neck and trochanteric region of the femur. The presence of components such as arteries, veins, and nerves in the feeding leg of the flap contributes to an increase in the reparative processes of the proximal femur plastic zone. The graft cut out according to the developed technique has a large range of movement along any predetermined axis. This is due to the fact that it is cut off from the fixation sites in both the proximal and distal sections. In this case, compression, tension and bending of the neurovascular leg are completely excluded, which excludes blood circulation disturbance and innervation of all the components of a complex transplant, and, consequently, its atrophy in the postoperative period. Thus, relapse of the disease is excluded. It eliminates the need for additional research related to patient exposure - arteriography. Restoring the integrity of the fascial cases of the muscular part of the transplant increases its resistance to infection.

The invention is illustrated by the following example.

Patient K., 39 years old, was admitted to the II trauma unit of BSMP No. 1 named after 5 N. A. Semashko with complaints of pain in the hip joint. Clinical, radiological, and histological examination established the diagnosis of fibrosis of osteodisilazide of the proximal end

right femur. The patient underwent surgery. Under general anesthesia, in the position on the left side, antero-lateral access to the right hip / joint was performed. The length of the cut was

5 22 cm. Reference points: along the lateral surface of the femur to the base of the greater trochanter, then the great bend of the trochantericum a little in front and further to the crest of the ilium wing (to a point at a distance of 5 cm from the anterior axis of the ilium). In layers, a large trochanter was exposed, the neck of the femur, the intertrochanteric region. A visual examination revealed the following: significant destruction of bone tissue 10x5 x 5 cm in size, which, starting from the subcapital region, covered almost the entire neck of the femur (with the exception of the Adams arch). large skewer, intertrochanteric

0 area; the pathologically changed bone was grayish in color, fragile, and broke with tweezers.

A section of fibrous osteodysplasia, a proximal meta physician of the right femur was resected: the anterior, posterior, and upper parts of the femoral neck, a large trochanter with anterior and posterior parts of the intertrochanteric region. Control for hemostasis and radical surgery. Given the extent of the defect, it was decided to use a musculoskeletal transplant on a fixed vascular pedicle from the crest of the ilium wing. By dissection of the fascia, the anterior part of the middle annual muscle was exposed. By conducting two longitudinal sections along the muscle fibers, a U-shaped graft 12 cm long and 5 cm wide was cut from it. Under attachment of the proximal end of the graft with a circular saw, a boron and a wide chisel, the crest of the ilium wing was split for 10 cm and 5 cm deep. The bone-periosteal part was formed.

5 transplants. The transplant consisting of bone, muscle and its fascia to the lower third was isolated in a blunt and sharp way, where the muscle branches of the superior annual arteries, eens, and nerve invaded the muscle from the inner surface. To ensure greater mobility, to prevent tension of the neurovascular leg, the musculoskeletal graft was cut off in the distal section, a flap on the fixed neurovascular leg was deployed. Separate sutures restored the integrity of the fasciales of the flap. The distal end of the muscular-fascial-bone graft was sutured to the middle section of the major annual muscle. The bone-periosteal part of the proximal end of the muscle-fascial-bone graft was placed in the defect of the femoral head formed after removal of the bone destruction site and fixed with screws. Control for hemostasis. The postoperative wound was sutured tightly. A gypsum coxite dressing was applied. After the postoperative period was smooth, the wound healed by primary intention. The patient was discharged on the 16th day on an outpatient basis.

0

5

treatment. A follow-up examination after 3 and 6 months of radiography of the right hip joint showed consolidation of the plastic zone, a decrease in osteoparesis of the femoral head to its bone reconstruction. The postoperative period of the angular shape. When examining the patient at the indicated postoperative time, the limb is functional, the skin above the muscular-fascial part of the transplant is mobile, normal in color. Atrophy of a non-free muscle-fascial-bone graft based on the plaque of the wide fascia and relapse of the disease in the short and long term of the walk-in period was not observed .-,

(56) Divakov M.G. Osteoplastic artrodesis of the hip joint. - Orthopedic 20 di, traumatologists and prosthetics. 1989. Ns3, p. 61-62.

Claims (1)

The claims METHOD FOR TREATING A PROXIMAL FEMAL DEFECT DEFECT by forming an osseous graft bone from the iliac crest on a vascular pedicle, moving it to the defect area with subsequent fixation characterized in that, in order to reduce the duration of treatment by preventing graft atrophy, a periosteal bone graft on the distal fascial-muscle leg is cut out of the anterior middle annual muscle with the neurovascular bundle located therein.