RU2164097C1 - Method of hip joint capsule fixation - Google Patents

Abstract

FIELD: medicine, particularly, traumatology; applicable in treatment of hip joint capsule. SUBSTANCE: method includes first dissection of capsule in its upper part and subperiosteal separation in direction from external surface to medial surface, and at the end of operation, formation of through holes in anterior and medial walls of prosthesis femur bed distal to edge of trimming of femur neck, pulling of integral lavsan thread by double matrass suture type, reinsertion of capsule using lavsan thread stitches on walls of femur bed for fixing capsule to them that prevents dislocation of prosthesis head. EFFECT: higher efficiency. 3 dwg, 1 ex

Description

 The method relates to medicine, namely to operative orthopedics.

 Known methods for hip replacement (Keggy KJ, Huo MN, Zatorski LE Anterior approach to Total Hip replacement. // Materials of the IV Congress of Traumatologists and Orthopedists of the CIS. - Yaroslavl - 1993. S. 432 - 446; Ankin L. N. , Ankin NL "Practice of osteosynthesis and endoprosthetics", Kiev - 1994, - C 250 - 279; Zagorodni N.V. Hip joint replacement with new generation endoprostheses. // Vest. Traumatologic orthopedist. 1999. - N 4, C . 28-34; Zorya V.I., Shapoval A.I., Tsvirenko L.K., Tkachev A.A. Complications of total hip arthroplasty using new technologies. In the book: Endop otization of large joints // Symposium with international participation. - M. - 2000. - P. 15-23; Rybachuk O.I., Besedinsky S.N. Postoperative dislocation of the head of the hip joint prosthesis and ways of its prevention. // West traumatol orthopedist. - 2000. - N 1. -P. 31 -35), which provide access to the hip joint and careful stitching of the capsule and soft tissue of the hip joint at the end of the operation.

 A close solution to this problem can be achieved by using the method described by N. V. Zagorodnim: "Hip replacement of the new generation with endoprostheses. // West. Tramatol. Orthopedist. 1999. - N 4, P. 28-34, providing for: subperiosteal separation from the front surface of the trochanteric region of the lateral broad muscle of the thigh and the middle gluteus muscle as a single block, dissection of the joint capsule, and after the installation of the prosthesis, the capsule is sutured.

 However, this method does not provide for fixing the capsule of the joint (reinsertion) to the places of its anatomical attachment to the femur, as one of the important factors in restoring the integrity of the capsule and preventing dislocation of the prosthesis head with front access to the hip joint.

 The objective of the invention is to develop an effective way to restore the integrity and fastening of the capsule of the hip joint and prevention of dislocation of the head of the prosthesis of the femur.

 The objective of the invention is achieved in that at the beginning of the operation, the capsule is dissected in its upper section and subperiostally separated in the direction from the outer surface to the medial surface of the trochanteric region, and at the end of the operation, through holes are formed in the anterior and medial walls of the prosthetic femoral bed distal to the edge of the sawdust of the femoral neck in the required quantity, through which an integral fixing dacron thread is passed as a “double” mattress seam and the capsule is reinserted using stitches of the fixing la a new thread on the walls of the femoral bed to fix the capsule of the hip joint to them.

 The invention is illustrated by the following drawings.

 In FIG. 1 shows the entrance to the femoral bed of the prosthesis and the scheme for holding the fastening dacron thread through the holes.

 Figure 2 presents a diagram of the reinsertion of a fragment of the capsule of the hip joint with its fixation to the stitches of the fastening dacron thread with dacron sutures.

 Figure 3 shows a diagram of the capsule of the hip joint after its reinsertion and stitching.

 The method is as follows.

 With lateral anterior access to the hip joint, during the operation, the joint capsule is dissected above the neck of the femur and along it, starting above the upper edge of the acetabulum, and to the base of the neck of the femur, followed by subperiosteal separation of the capsule from the point of attachment to the femur, starting from the midline of the outer surface of the femur, towards the medial surface and to the lesser trochanter. Before implantation of the endoprosthesis legs in the femoral bed (1), through holes (2) are formed using a drill (Fig. 1) so that one hole is located on the medial wall (3) of the femoral bed at the level of the upper edge (4) of the small trochanter (Fig. .3), the second (5) hole is formed along the line of the front edge of the apex of the greater trochanter 1 cm below the line of sawdust of the femoral neck in its lateral edge. The remaining holes are formed in the required amount between the first two holes.

 Through all openings (2), starting from the medial wall (3) of the femoral bed (1), an integral thick fixing dacron thread is drawn so that its stitches (6) are between all openings (2), both on the outer and the inner the surfaces of the walls of the femoral bed, i.e. as a “double” mattress seam, as shown in FIG. 1, 2, 3. The thread is pulled, and the ends are tied with a knot (7), next to the hole (5), extreme from the outer surface of the femoral bed (Fig. 1).

 Then the prosthesis leg is implanted on bone cement.

 Next, reinsert the capsule (8). For this, the suture dacron thread (9) (figure 2) is carried out in the area of the hole (5) under both stitches located on the outer surface of the front wall (10) of the femoral bed, and converging in the hole. Start from the outermost (5) from the outer surface of the femoral bed, as shown in FIG. 2. Sew the capsule (8) in the place corresponding to the place of the stitches under which the suture dacron thread was threaded (9) (Fig. 3) (we are talking about the reinsertion of the capsule), pull the capsule (8), pull and tie the suture dacron thread (9 ) You can impose additional seams (II) on the capsule (figure 2), which fix the capsule to the individual stitches along them.

 Likewise, re-insertion of the capsule is continued towards the medial wall of the femoral bed (FIG. 3).

 After this, the capsule is stitched together with lavsan thread at the site of its dissection (12).

 Clinical example.

 Patient Dubrovskaya Aleksandra Fedorovna, born in 1926, was admitted to the medical institution TMO-2 on 01.04.99 for planned surgical treatment for right-sided rheumatoid coxarthrosis of the 3rd stage. with severe racemose reconstruction, flexion-adducing contracture, NF joint of the 4th degree. Pain syndrome.

 Concomitant diagnosis: IHD. Extrasystolic arrhythmia, H 2A. Hypertonic b-n, 2 tbsp., Moderate stable hypertension. Atherosclerosis of the aorta. Rheumatoid polyarthritis, a seronegative form, with a minimal degree of activity, with systemic manifestations. ICD, stone of the left kidney. SLE, a stone of the right salivary gland. Hypotheriosis of mild degree. Diffuse-knotted goiter.

 In the hospital, the patient is examined by a therapist, anesthetist, ENT, dentist, gynecologist, rheumatologist OKB, prof. Filippenko N.G. Relative contraindications to surgical treatment were revealed. Given the insistent request of the patient and relatives (daughter, doctor of MMU LLP Hospital No. 2) to perform endoprosthetics, as well as the revealed pathology, the patient was offered endoprosthetics of the left hip joint with Müller cup N 50 on Palakos R bone cement, Müller leg N 10 on Palakos bone cement R".

 The patient and relatives were warned of possible intra- and postoperative complications associated with the operation and anesthesia. Consent to the operation is received.

 Intubation narcosis (epidural anesthesia + mechanical ventilation). Intraoperative transfusion is provided. 800 ml of washed and individually selected erythrocytes A (11), rhesus (-) and 1000 ml of single-group plasma were ordered for the operation.

 04/20/99, Operation N 117 - Endoprosthetics of the right hip joint with a Muller cup N 50 on Palakos R bone cement, M. Müller leg N 10 on Palakos R bone cement.

 P / O diagnosis: the same.

 Khir: Kolesnik A.I.

 Ass. Neelam Hamid, horde Debesh Kumar.

 Anesthesiologist: Smorodinova O.I.

Anesthesia: endotracheal anesthesia
Op. sister: Yakovleva T.M.

 Duration: 3 hours 35 minutes.

Blood loss: 800 ml
Protocol
1. A section up to 17 cm long on the outer surface of the joint, the trochanteric region and the capsule of the left t / b joint are layered in layers. Hemostasis and toilet wounds with antiseptics during the operation.

 2. The capsule is dissected and separated from the neck. The head is dislocated from the cavity, it is deformed, sharply flattened.

 3. After preliminary processing of the acetabulum with cutters N 48 - 50, a Muller cup N 50 was implanted on bone cement "Palakos R".

 4. The proximal femur is treated with a rasp N 7.5, - 10.

 5. In the medial and anterior walls of the femoral bed, 4 through holes were made with a hole d = 2 mm, through which a polyester tape N 8 was drawn as an 8-type weave in the holes, stretched and tied.

 6. An Müller leg N 10 was implanted on the Palakos R bone cement.

 7. Toilet wounds with an antiseptic.

 8. The capsule is sewn with lavsan to the stitches in the area of the holes with the simultaneous capture of two adjacent stitches. Additional seams with lavsan were applied, fixing the capsule to individual stitches along them.

 9. Layer wound closure with 2 drains left for active aspiration. Rubber graduates in subcutaneous fat.

 8. Elastic bandaging of legs.

 Thus, the result was achieved due to the fact that at the beginning of the operation, the capsule is dissected in its upper section and subperiostally separated in the direction from the outer surface to the medial surface of the trochanteric region, and at the end of the operation, in the anterior and medial walls of the femoral bed of the prosthesis, distal to the edge of the sawdust of the femoral neck form through holes in the required quantity, through which an integral fixing dacron thread is held as a “double” mattress seam and the capsule is reinserted using stitch Mylar and mounting thread on the walls of the femoral box to lock them hip capsule.

Claims (1)

 The method of attaching the capsule of the hip joint, which consists in dissecting the capsule of the hip joint, arthroplasty of the hip joint, followed by suturing of the capsule and soft tissues of the hip joint at the end of the operation, characterized in that at the beginning of the operation, the capsule is cut in its upper section and subperiostally separated from the surface from to the medial surface, and at the end of the operation, in the anterior and medial walls of the femoral bed of the prosthesis distal to the edge of the sawdust of the femoral neck mimic through holes in the required quantity through which a whole dacron thread is drawn as a “double” mattress seam and reinsert the capsule using stitches of the dacron thread on the walls of the femoral bed to fix the capsules to them, and then the capsule is sewn in its upper section.

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