RU2098035C1 - Method for treating bone defects caused by chondral dysplasiae (alternatives) - Google Patents

Abstract

FIELD: medicine; orthopedics. SUBSTANCE: method is based upon using osteocartilagenous exostosis present on affected bone, or, as alternative, upon using osteocartilaginous exostosis located on other bones, as plastic material. According to first alternative, surgeon must practise osteotomy of osteocartilaginous exostosis protruding from affected bone at exostosis base, while, simultaneously, practising transverse osteotomy of tubular bone under exostosis middle, followed by applying Dr. Ilizarov's distractive-compressive apparatus in order to implant exostosis onto bone defect place. According to second alternative, surgeon must first remove exostosis on some other bone (this exostosis was supposed to be removed later) and form from this removed exostosis strips of spongy bone tissue and cartilage chips. Bone strips and cartilage chips are laid on defect place and overlaid peripherally by strips of demineralized bone transplant. EFFECT: higher treatment efficiency. 2 cl

Description

 The invention relates to medicine, in particular to orthopedics.

 There is a method of eliminating ulnar squint by lengthening a shortened ulna by distraction osteosynthesis using an Ilizarov apparatus followed by plastic surgery of a distraction regenerator with autoallografts (V.A. Morgun. In the book: Actual issues of traumatology and orthopedics, issue 20. M. TSITO, 1979, p. .61-64 /.

 The disadvantage of this method is the need for repeated intervention for transplantation, prolonged restructuring of free grafts until the formation of autobone.

A known method of treating ulnar squint with exostatic chondrodysplasia by replacing the missing distal ulnar bone with bone-cartilage exostosis [1]
The disadvantage of this method of treatment is a violation of the congruence of articulating articular surfaces, prolonged reconstruction of the bone-cartilage graft to form an autobone, the tendency of the transplanted graft to osteolysis and the absence of a pronounced clinical effect in severe deformity of the forearm.

 The objective of the invention is to increase the effectiveness of treatment, accelerate the formation of distraction regenerate.

 When using bone-cartilaginous exostosis present on the affected bone, the therapeutic result of the task in case of a bone defect in cartilage dysplasias is achieved by separating the bone-cartilaginous exostosis at the base from the metadiaphysis of the bone and, together with the vessels supplying it and the perichondrium, move outwards. In the middle of exostosis, a transverse osteotomy of the metadiaphysis of the tubular bone is performed. The distraction and compression apparatus of Ilizarov is superimposed. The method of distraction osteosynthesis eliminates shortening of the bone. The formed bone defect and the forming regenerate are filled with a well-supplied bone-cartilaginous exostosis.

 With the delayed formation of distraction regenerate, the therapeutic result of the task is achieved by resecting the bone-cartilaginous exostosis of a different location, forming spongy bone cavities, the length of which is equal to the length of the alleged bone defect, open the ends of the bone fragments of the elongated bone, and sponge strips are placed around them autologous bones, put chips from cartilage, on the periphery close with strips of demineralized bone graft of the same length, the latter fix the nodes with catgut sutures in the form of a “bundle of brushwood”. Subsequently, the method of distraction osteosynthesis eliminates concomitant deformations.

 Methods of treating a bone defect in cartilage dysplasias are as follows. When using bone-cartilage exostosis with an affected bone with ulnar obliquity (option 1), a longitudinal incision of the skin, subcutaneous tissue and superficial fascia is made in the exostosis zone. Bone-cartilaginous exostosis and the adjacent metadiaphysis of the bone are distinguished from the soft tissues. A wide chisel cuts off the exostosis at its base from the metadiaphysis, displaces outward with the supply vessels. Under the middle of exostosis, a transverse osteotomy of the diaphysis of the bone is performed. The wound is sutured in layers. Impose apparatus Ilizarov. The method of distraction osteosynthesis eliminates shortening of the bone. During distraction, soft tissue displaces exostosis into the defect area.

 With the delayed formation of distraction regenerate (option 2), a longitudinal incision is made in the skin, subcutaneous inlet, superficial fascia, and a zone of delayed consolidation of the ulna or radius is highlighted. From other areas (for example, the thigh or bones of the leg, scapula), a bone-cartilaginous exostosis is resected, which must be removed. Using a Volkman spoon, remove the spongy tissue and put it in the form of chips in the zone of slow consolidation. Narrow strips of compact spongy tissue of exostosis, the length of which is equal to the length of the proposed regenerate, are cut with scissors and laid in the zone of the slow forming regenerate. On the periphery, they are closed with strips of a demineralized bone graft of a similar length. The latter are fixed with interrupted catgut sutures in the form of a “bundle of brushwood”. Layered stitches on the wound. By the method of symmetric and asymmetric distraction, the existing deformations are eliminated.

 Methods of treating a bone defect in cartilage dysplasia can improve the effectiveness of treatment, reduce the treatment time for patients by replacing the bone defect with a well-supplied exostosis tissue and defect plasty with rapidly reconstructed spongy bone tissue. They accelerate the formation of regenerate, reduce the invasiveness of the operation and improve its cosmetic effect.

Claims (2)

 1. A method of treating a bone defect in cartilage dysplasias, which involves the use of bone-cartilage exostosis, characterized in that the bone-cartilaginous exostosis used on the affected bone is used, while an exostosis osteotomy is made at its base with its outward displacement together with the vessels supplying it and transverse osteotomy of the tubular bone under the middle of the exostosis, followed by the application of Ilizarov’s distraction and compression apparatus to introduce the exostosis to the site of the defect.  2. A method of treating a bone defect in cartilage dysplasias, which consists in the use of exostosis of a different localization, characterized in that cavities of the spongy bone tissue of the required length and shavings of the cartilage that are laid on the site of the defect are formed from the exostosis and closed at the periphery with strips of demineralized bone graft with their subsequent fixation.