RU2051635C1 - Method for plasty of lateral parts of knee joint - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method for plasty of lateral parts of knee joint consists of recovery of joint surface of lateral parts of femur or tibia with not free osteochondrous autoplastic graft taken from head of fibula. EFFECT: method of arthroplasty of knee joint ensures lessening of operation traumatization, reduced treatment terms and joint stability in postoperative period.

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and can be used to restore the function of the knee joint with deforming arthrosis of various etiologies.

 Known methods for restoring the function of the knee joint with ankylosis, which include transplanting a whole monolithic joint of allogeneic origin. However, the known methods do not provide sufficient function of the knee joint of the operated limb. They are traumatic, because associated with extensive resection of the entire metaphysis and part of the diaphysis of the bone. A large defect in the articular ends of the articulating bones resulting from resection requires the replacement of a significant transplant. Subsequently, this leads to a prolonged restructuring of the graft, its partial necrosis, resorption, and ultimately to deforming arthrosis of the joint, or to relapse of ankylosis, or to instability of the joint.

 Long-term transplant reconstruction necessitates prolonged immobilization of the limb, which is complicated by atrophy of the limb muscles and joint contraction. The method cannot be applied with isolated destruction of the articular surface of one condyle and with incomplete ankylosis of the knee joint.

 In addition, in a number of patients with incomplete ankylosis of the knee joint (for example, ankylosis only between the external condyles and the tibia), the use of massive transplants for arthroplasty is impractical not only because of their long-term reconstruction, but also because such an intervention requires dissection and removal cruciate ligaments of the joint.

There is a method of restoring the function of the knee joint when it is affected by a tuberculosis or tumor process, as well as with deforming arthrosis, by isolating the articular surfaces and replacing an existing defect or lesion with a bone-cartilage autograft taken from the least loaded part of the joint surface of the femur or patella [1 ]
The disadvantage of this method is that when restoring the congruency of the articular surface of the most loaded section of the knee joint, at the same time, a defect in the articular cover is created in the less loaded section, which subsequently leads to the development of deforming arthrosis; A bone-cartilage autograft, devoid of nutrition, in most cases degenerates into connective tissue, which cannot perform the function of articular cartilage for a long time, undergoes a degenerative-dystrophic change and creates conditions for the recurrence of deforming arthrosis.

 The purpose of the invention is the restoration of the articular surface of the lateral parts of the knee joint with a non-free bone-cartilage autograft, reducing the duration of treatment.

 This is achieved by the fact that to restore the articular surface of the lateral parts of the femur or tibia, a non-free bone-cartilaginous autograft is used, taken from the head of the fibula with the tendon m.biceps femori; which is fixed to the metaphysical parts of the femur or tibia with kapron, catgut sutures or structures with the effect of "shape memory".

 The method is as follows. The position of the patient on the back with a sliding tire under the operated limb, allowing you to bend the leg in the knee joint at an acute angle. An external arcuate access from the lower third of the thigh to the upper third of the lower leg exposes the knee joint. The cavity of the knee joint is mobilized from scars; if necessary, the tuberosity of the tibia is cut off and the ligament of the patella and patella are taken up in a single block. The altered cartilage, scar tissue and a layer of subchondral bone 7-10 mm thick are removed from the external condyle of the femur or tibia, preserving the attachment sites of the lateral and cruciate ligaments.

 From the additional linear incision along the outer surface of the lower leg in the upper third of the subperiosteal, the head of the fibula is distinguished. The fibular collateral ligament is intersected, the head of the fibula and the non-free bone-cartilaginous autograft are cut off while maintaining the attachment point of the tendon m.biceps femori. After that, the condyle is placed in the prepared bed and fixed transossally with kapron or catgut sutures, or with structures with the effect of “shape memory”.

 The integrity of the crossed fibular collateral ligament is restored (the latter is fixed to the external condyle of the tibia by transossal nylon sutures).

The operation ends with layer-by-layer suturing of the wound with the installation of active drains (removed after 24-48 hours). Immobilization of the limb is carried out by the posterior plaster cast in the position of flexion of the knee joint at an angle of 160-150 ^about , which stops after removing the stitches for 10-14 days.

 After healing, the wounds begin to develop movements in the knee joint.

 Dosed load begins for 3-4 months, after x-ray confirmation of the bone fusion of the autograft with the maternal bone.

 PRI me R. Patient G., 24 years old, was admitted to the department in connection with an incorrectly fused fracture of the external condyle of the right tibia; post-traumatic arthrosis of the right knee joint. Injury for 8 months. before receipt.

 Clinically, the patient was determined: swinging movements in the right knee joint, his hallux valgus deformity, pain.

 X-ray effects of compression fracture of the external condyle of the right tibia, subluxation of the head of the fibula.

 In this regard, the patient underwent arthroplasty surgery according to the proposed method. Drainages removed on the second day after surgery. For 14 days, the limb was immobilized by the rear plaster cast. The wound healed by primary intention. After removal of the sutures, the development of movements in the knee joint was started without axial load on the limb. A range of motion in the joint of 90 "was achieved with full extension.

 After 3.5 months. X-ray confirmed bone fusion of the graft and maternal bone. The patient is allowed axial load. The result of the treatment is regarded as good.

 Thus, our proposed method of arthroplasty of the knee joint is slightly traumatic, clinically effective, contributes to the full restoration of the function and anatomy of the knee joint; the non-free autograft used by us while maintaining proper nutrition (due to the tendon leg of m.biceps femori) grows together with the mother’s bone and undergoes a complete reconstruction without deformation of the articular surface by the third or fourth month, which is confirmed by x-ray; the method creates optimal conditions for transplant fusion and in the most loaded parts of the knee joint it reconstructs full-fledged cartilage structures; fixation of the transplant with constructions with the effect of "shape memory" allows you to start the early development of movements in the knee joint, which reduces the treatment time by 1.5-2 times.

Claims (1)

 METHOD OF PLASTIC LATERAL DEPARTMENT OF THE KNEE JOINT by restoring the articular surface of the external condyle of the femur or tibia with a non-free bone-cartilaginous autograft, characterized in that the most loaded sections of the articular surface of the knee joint are replaced by an autograft from the anterior bone graft from the small bone.