RU2012261C1 - Method of reconstructing proximal section of femur and device for effecting same - Google Patents

Abstract

FIELD: medicine, particularly, traumatology. SUBSTANCE: osteotomy was carried out transversely at level of on-bone retainer. Device incorporated on-bone plate 1 having openings 7 and 8, eyelugs 9, dial flexed to 60-deg arc, rack 3, slot 4 and stem 5 pivotally disposed in eyelets 9. In-bone screw 6 was fitted in slots 4 of rack 3 by toothed washer, with toothed clamps 13 having contact with stem 5 being press-fitted in eyelugs 9. EFFECT: simplicity of design. 2 cl, 4 dwg

Description

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

 A known method of treating varus deformity of the thigh using a compression-distraction apparatus (see Orthopedics. M.: 1957, v. 2, p. 610-620).

 However, the known method does not provide a full degree of correction of the deformation of the femoral neck, is traumatic and does not provide multi-plane correction.

 A known method of treating varus deformity of the femoral neck (see ed. St. N 685279, class A 61 B 17/00). The method involves correcting the deformation in a closed way using the Ilizarov distraction apparatus.

 However, the method is not accurate and allows correction in only one plane.

 The angular metal plates AR and POLDI are widely used, designed to fix bone fragments after corrective osteotomy of the trochanteric region of the thigh. Their main drawback is the presetness of a certain angle, while during the operation often there is a need to use plates with a different angle. In addition, the accuracy of the correction depends on the correct insertion of the intramedullary part of the plate and its coincidence with the axis of the femoral neck, which is not always possible. In this case, it is necessary to use additional devices (protractors, detorsion rings, various landmarks), as well as produce additional radiographs during the operation, which takes time. In addition, difficulties are created during the comparison of fragments, keeping them in the correct position until the final fixation.

 A device for osteotomy is known (see ed. St. USSR N 1219057, class A 61 B 17/16, 1984), containing a osseous plate with holes and ears with a scale, a curved plate with a slot, a serrated surface and a shank pivotally mounted in ears, and the intraosseous screw installed in the slot of the strap using a toothed washer, and the shanks of the ears are connected by gearing.

 However, this device does not provide reliable fixation of bone fragments while eliminating deformation in the frontal and horizontal planes.

 The purpose of the invention is to eliminate deformation additionally in the frontal and horizontal planes and increase the reliability of fixation of fragments with the exception of subsequent gypsum immobilization for early functional treatment.

 In FIG. 1 shows a device for implementing the method of reconstruction of the proximal femur; in FIG. 2-4 - the steps of the method using the device.

A device for implementing the method for reconstructing the proximal femur contains a osseous plate 1 with a hinge assembly 2, ^a bar 3 curved along an arc 60 ^{about a} slot 4 and a shank 5 with a serrated notch on the sides, an intraosseous screw 6. Plate 1 is made with holes 7 for screws for osteosynthesis and two longitudinally arranged oval holes 8 for provisional screws, with the help of which the distal fragment is moved during correction, necessary for adaptation and compression of the fragments. The plate 1 has ears 9, in one of which a rectangular hole 10 is made, and in the other a round hole 11 for the fixing screw 12. A clip 13 with a toothed end surface is pressed in the hole 11 of the plate 1. The lugs 9 of the plate 1, the shank 5 is pivotally mounted strap 3. On the outer surface of the lugs 9 of the plate 1 and the shank 5 is applied scale marks 14 with a scale division 10 ^on. With the help of a swivel, the deformations of the proximal end of the thigh in the frontal plane are accurately corrected by the intended value.

On the lateral surface of the strap 3, a scale is made with a division price of 5 ^° , which determines the amount of correction in the horizontal plane.

 The intraosseous screw 6 has a compression thread 15 at one end and a stop 16 at the other end, a neck of rectangular section corresponding to the slot 4 of the strap 3, the washer 17, the threaded section with the nut 18. When the nut 18 is loosened, the screw 6 moves along the slot of the strap 3, and the washer 17, respectively, on its outer surface, and the rotation of the fragments of the thigh occurs around the vertical axis of the thigh. When tightening the nut 18, the threaded rod is firmly fixed in a predetermined position.

 The device is used for varus, hallux, torsion deformities of the proximal end of the thigh and their combinations. A feature of the application of the device is osteotomy with the latch already applied and with it.

 The technique of corrective osteotomy for varus deformity of the femoral neck and retrotorsion using this device is as follows. After exposure of the greater trochanter and the subtrochanteric region, an osteotomy line is plotted at the level of the trochanter or immediately above it. At this level, a Jigley saw is started under the femur. It is 1-1.5 cm above the mark so that the articulated node is at the level of the proposed osteotomy, the intraosseous screw 6 is screwed intracostally to the neck. In the described technique, in contrast to the known methods, its direction can not coincide with the axis of the neck and this fact does not affect the accuracy of the correction, therefore, x-rays that control the position of the intramodular part of the latch are not needed. The entire device is assembled, the plate 1 is fixed on the outer surface of the femur through the oval holes 8 in their lower poles with two provisional screws, without turning them 1/2 - 1 turn. Notice the initial position on the scale of the strap 3 and the hinge assembly. A handle is screwed onto the shank of the nut. A transverse osteotomy is performed with a Jigley saw. Guided by the marks of the scales of the strap 3 and the hinge assembly, the necessary correction is made by a pre-calculated value. Initially, the pathological retrotorsia of the neck is eliminated with the nut 18 released by turning the distal fragment together with the plate 1 and the strap 3 inwards while simultaneously moving the central fragment outwards. The achieved position is fixed with a nut 18. When the radius of the arc of the strap 3 of the surface of the intertrochanteric region corresponds, there is almost no displacement of fragments relative to each other, their rotation occurs along the axis of the thigh.

 Then eliminate the varus deformity of the neck. With the fastening screw 12 released, the central fragment is valgated with the handle 20 and at the same time the distal fragment is withdrawn. The distal fragment with the provisional screws is shifted up along the slot and the bar 3 by 0.5-1.5 cm. The provisor screws are turned up and finally fixed to the diaphysis with screws through round holes 7.

 With hallux valgus and pathological antetorsia, a similar operation is performed with the reverse direction of correction, and the provisional screws are inserted into the upper poles of the oval holes 8.

 Reliable fastening of the hinge node of the fixator, the strength of its other elements, good compression of bone fragments allow you to abandon additional gypsum immobilization, and immediately after the healing of the postoperative wound carry out functional treatment.

 The device was used in clinical practice of the Moscow Children's Regional Orthopedic and Surgical Hospital, in 40 patients, positive results were obtained.

PRI me R. Patient F., born in 1975, was admitted to MODOKHB on November 22, 88, with a diagnosis of juvenile epiphysiolysis of the head of the right thigh of the third degree. The function of the right hip joint is severely limited. Radiographically observed downward displacement of the epiphysis ^{of the} 30 and 60 ^{of the} posterior.

11.30.88 g produced intertrochanteric corrective osteotomy of the right femur. In order to improve centering of the epiphysis in the acetabulum via corrector latch valgizatsiya performed at ^about 30, ^about 50 derotation flexion and anteriorly to the central piece 45 ^a and a subsequent fixation fragments.

 The postoperative period is smooth. Plaster immobilization was not used. Conducted early functional treatment.

 After 6 months, complete consolidation at the site of the osteotomy and restoration of the function of the hip joint was noted, the gait improved. As a result of the correction of all components of the deformation with a given correction, the centering of the head in the cavity, the support ability of the limb are improved and the range of movements in the hip joint is increased, the progression of the disease and the development of coxarthrosis are prevented. (56) Copyright certificate of the USSR N 1219057, cl. A 61 B 17/58, 1984.

Claims (2)

 1. A method of reconstructing the proximal femur by exposing the bone, installing the osseous fixative, fixing it to the bone, osteotomy, correction of fragments, characterized in that, in order to eliminate deformation in addition in the frontal and horizontal planes, osteotomy is performed in the transverse direction at the level of the hinge of the osseous retainer. 2. A device for reconstructing the proximal thigh, comprising a osseous plate with holes and ears with a scale, a curved plate with a serrated surface, a slot and a shank pivotally mounted in the ears, and an intraosseous screw installed in the slot of the plate by means of a toothed washer, the shank and ears being connected by a serrated engagement, characterized in that, in order to increase the reliability of fixation of fragments while eliminating deformation in the frontal and horizontal planes, the bar is curved along an arc of 60 ^o , and the ears are equipped with They are pressed with clamps with a toothed surface.

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