RU2136241C1 - Method of osteotomy of femur in treatment of coxarthroses - Google Patents

Abstract

FIELD: medicine, particularly, traumatology and orthopedics; applicable in treatment of diseases with degenerative-dystrophic processes in region of hip joint. SUBSTANCE: method includes formation of longitudinal fragment of medial surface of femur with thickness equalling one half or one third part of transverse size and up to 8 cm long, with process carried under lesser trochanter; gradual moving of fragment proximal end to under lower edge of acetabulum with use of pushing wires. EFFECT: elimination of defective adduction, reduced lameness and increased volume of motion in hip joint. 5 dwg

Description

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

 It is generally recognized that circulatory disorders of the hip joint region have pathogenetic significance when it is affected by a degenerative-dystrophic process and are fundamental in the onset and development of the disease.

 Improving zonal blood circulation by activating the existing and developing new collateral blood flow through the formation of bone regenerates in a given direction was proposed by G.A. Ilizarov (G. Ilizarov. Some theoretical and clinical aspects of transosseous osteosynthesis from the perspective of general biological patterns that we discovered // Experimental, Theoretical and Clinical Aspects of transosseous osteosynthesis developed at KNIIEKOT: Abstracts of the report of the international conference (Kurgan, 1986, pp. 7-12).

 High oblique subtrochanteric osteotomy according to Mac Murray or Powels is currently a recognized method in the surgical treatment of coxarthrosis (Guryev VN Bilateral coxarthrosis and its surgical treatment. Tallinn, 1975, pp. 144-160).

 This method of osteotomy is accepted by us as a prototype. However, it has the following disadvantages: complete bone intersection, the need for skeletal surgery during surgery, the use of bone fixators for fixation, the need for additional immobilization with bulky gypsum dressings, which not only worsens the local blood circulation of the hip area, prolongs the treatment time, and conditions appear for severe somatic complications, but there are nonunion at the level of the osteotomy itself.

 To improve the blood supply to the hip joint with the aim of treating coxarthrosis and overcoming the disadvantages of the prototype, we proposed and applied medial osteotomy of the proximal femur.

 The exclusion of the complete transverse intersection of the bone positively distinguishes it from the prototype.

 The method is as follows: from 2-3 small cuts along the front surface of the thigh bone, with a set of bits, we form a fragment of the medial surface of the femur half or a third of the diameter starting from the small trochanter, extending distally by 7-8 cm. Through the outer surface of the hip and femur at the level of the small trochanter, we carry out 1-2 pusher needles, all the way to the proximal part of the intraosseous surface of the fragment. On the upper thigh we impose an external fixation apparatus (Fig. 1). From the 6th – 7th postoperative day, with the help of knitting pushers, we mediate the medial fragment inside and form the distraction regenerate along Ilizarov in the transverse direction. We move only the proximal part of the fragment by 1.5-2.5 cm under the lower edge of the acetabular cavity (figure 2).

 After fusion of the osteotomy area and removal of the apparatus, we carry out a set of rehabilitation measures until disability is restored. In all cases, clinically it was possible to achieve the elimination of pain or their significant reduction, elimination of vicious adduction, reduction of lameness, increase in range of motion in the hip joint.

 Dissection of the femur near the joint is accompanied by the intersection of dilated venous vessels, pathologically altered arterial vessels, the endings of the sympathetic nerves. Medialization of the femoral fixation point of the adductor muscles eliminates the vicious adduction and reduces the stress of the lower parts of the joint capsule. Wide opening of the medullary canal near the joint eliminates intraosseous and intraarticular hypertension. Thickening of the bone under the joint, the creation of an additional fulcrum under the lower edge of the acetabular cavity reduces the load on the femoral head. Moving the fragment, the formation of distraction regenerate in the transverse direction in the immediate vicinity of the joint leads to an improvement in the existing and development of a new collateral blood flow in the hip joint. The formation of bone marrow in the process of fusion is accompanied by the germination of newly formed blood vessels in the affected head of the femur, which also improves blood supply to the hip region (Nettov G.G. Effect of intertrochanteric osteotomy on the nervous apparatus of the hip joint // Orthopedics traumatology and prosthetics. 1982, N5, pp. 31-34 .; Ilizarov G.A., Samchukov M.L. Reconstruction of the femur according to Ilizarov in the treatment of deforming arthrosis of the hip charter // Orthopedics traumatology and prosthetics. 1988, N6, p. 10-1 3).

 An example of the application of the method in the clinic. Patient S., 46 years old. Diagnosis: deforming arthrosis of the left hip joint 2-3 degrees against the background of aseptic necrosis of the femoral head (Fig. 3). Sick for 5 years, treated conservatively - without effect, over the past year has noted a sharp increase in pain, and therefore forced to use crutches.

 1.02.92 the patient underwent surgery: medial osteotomy of the proximal left femur, fixation of the left thigh with an external fixation device (Fig. 4). The distance started from the 7th postoperative day, 1 mm per day, lasted 18 days. The device was removed 70 days after surgery, the period of subsequent rehabilitation was another 75 days (Fig. 5). The patient’s pains passed, the gait rhythm normalized, the range of movements increased by 30% compared with the preoperative one. Radiologically there is an increase in the joint space, sclerosis of areas of aseptic necrosis, in the osteotomy zone, fusion in the achieved position. Examined 2 years after the end of treatment - the achieved result is saved, works as a watchman, walks without limp, over long distances with a cane.

 The clinic with positive outcomes performed 4 operations. Long-term follow-up from 1 to 3 years.

 Thus, we have shown the advantages of the proposed method of osteotomy, its practical feasibility and clinical usefulness.

Claims (1)

 A method for osteotomy of the femur in the treatment of coxarthrosis, comprising moving a fragment of the femur medially under the lower edge of the acetabular depression and subsequent osteosynthesis, characterized in that, while maintaining the continuity of the diaphysis, they form a longitudinal fragment of the medial surface of the femur half or a third of the diameter up to 8 cm long the proximal end of the fragment beginning above the small trochanter is gradually moved by the use of pusher spokes installed in the external fixation apparatus, m cause gradual displacement fragment regenerate bone formation and fusion fragment diaphysis.

Images