RU2170558C1 - Method for preventing femur head prosthesis dislocation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves fixing hip joint capsule with lavsan ribbon supracapsularily brought through wire loops fixed in the area of cotyloid cavity and sawn femur neck surface to carry out complex crossed conduction of the lavsan ribbon and produce its tension. EFFECT: enhanced effectiveness of treatment. 2 dwg

Description

 The method relates to medicine, namely to operative orthopedics.

 A known method of hip replacement (Keggy KJ, Huo MN, Zatorski LE Anterior approach to Total Hip replacement. // Materials Yl Congress of traumatologists and orthopedists of the CIS. - Yaroslavl - 1993. S. 432 - 446; Ankin L. N. , Ankin NL "The Practice of Osteosynthesis and Endoprosthetics", Kiev - 1994, - C 250 - 279; Zorya V.I., Shapoval A.I., Tsvirenko L.K., Tkachev A. A. Complications of total hip arthroplasty joint on new technologies. In the book: Endoprosthetics of large joints // Symposium with international participation. - M. - 2000. - P. 15-23; Rybachuk OI, Besedinsky S. N. Postoperative yvihivanie femoral head and hip ways to prevent orthopedic traumatological West // -.... 2000. - N 1. - pp 31 -35), comprising thorough crosslinking of the capsule of the hip joint and soft tissue in the end of the operation.

 A close solution to this problem can be achieved using the method described by Zorya V.I., Shapoval A.I., Tsvirenko L.K., Tkachev A.A. Complications of total hip arthroplasty using new technologies. In the book: Endoprosthetics of large joints // Symposium with international participation. - M. - 2000. - S. 15-23.

 However, this method in cases where there is a stretched, flabby and thinned capsule (its front part), flabby and weak muscles of the hip joint does not provide additional strengthening of the capsule of the joint, as one of the important factors in the prevention of dislocation of the prosthesis head with front access to the hip joint.

 The objective of the invention is to develop an effective way to strengthen the capsule of the hip joint as prevention of dislocation of the head of the prosthesis of the femur.

 The objective of the invention is achieved in that the capsule of the hip joint is strengthened with a lavsan tape, which is carried out supercapsularly through wire loops fixed in the acetabulum and sawdust of the femoral neck, allowing complex cross-sectioning of the whole mylar tape and creating its tension.

 In FIG. Figure 1 shows a diagram of an implanted hip joint prosthesis with lines indicating the beginning, sequence, and direction of an entire lavsan tape through wire loops in the anteroposterior projection.

 In FIG. Figure 2 shows a diagram of an implanted hip joint prosthesis with lines indicating the beginning, sequence, and direction of conducting an entire mylar ribbon through wire loops in axial projection.

 The method is as follows.

 During the operation, in the process of implanting a prosthesis cup into the acetabulum on bone cement, three wire loops (1) are cemented between the cup and the edges of the acetabulum (Fig. 1, 2), one of which is fixed in the cement in the area of the upper edge of the acetabulum the second in the zone of the leading edge and the third in the zone of the lower edge.

 During implantation of the endoprosthesis leg into the femoral bed between the leg and the walls of the femoral bed, two wire loops are fixed in cement, one of which is fixed between the medial wall of the femoral bed and the second between the front wall of the femoral bed and the prosthesis leg (along the midline of the prosthesis bed surface) .

 After the endoprosthesis replacement, the capsule is carefully sutured with mylar thread. Wire loops are removed over the capsule. Through the wire loops (1) conduct the lavsan tape (2a) (Figs. 1, 2), starting with the loop located in the region of the upper edge of the acetabulum, then alternately the tape is passed through the loop in the zone of the lower edge of the acetabulum (2c), through the loop the anterior femoral bed (2c), the loop of the anterior edge of the acetabulum (2e), through the loop of the medial part of the femoral bed (2e) in the direction of the loop zone of the upper edge of the acetabulum. After that, the thigh is slightly bent and rotated inwards, the tape is pulled, and the ends of the tape are connected to each other in knot (3) and sewn with mylar thread. With the help of mylar ribbon, a powerful strengthening of the capsule of the hip joint in the form of several intersections (4) was formed (Fig. 1,2). Next, the operation ends as standard.

Clinical example
Patient Polyutskaya LI, born in 1931, was admitted to the medical institution TMO-2 on September 21, 1999 for planned surgical treatment for the false joint of the left femoral neck. The failure of the metal osteosynthesis of the neck of the left thigh. Severe cystic restructuring of the head of the left thigh, flexion-adducing contracture, and NF joint of the 4th degree. Pain syndrome.

 Concomitant diagnosis: IHD. Angina is unstable, stabilization in the second FC. H1. Hypertensive b-n, 2 tbsp., Mild labile hypertension. Chronic bronchitis with asthmatic component. PTB left lower leg. Osteochondrosis.

 In the hospital, the patient is examined by a therapist, anesthetist, ENT, and dentist. There were no absolute contraindications to surgical treatment. Taking into account the request and age of the patient and relatives for performing endoprosthetics, as well as the revealed pathology, the patient was offered endoprosthetics of the left hip joint with Müller plate N 50 on bone cement “Palakos P”, Müller leg N 11 on bone cement “Palakos P”.

 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. Intraoperative transfusion is provided. 800 ml of washed and individually selected erythrocytes 0 (1) Rh (+) positive and 1000 ml of single-group plasma were ordered for the operation.

 09/28/99, Operation N 213-214 - Endoprosthetics of the left hip joint with a Müller cup N 50 on bone cement “Palakos P”, a leg of M. Müller N 11 on bone cement “Palakos P”. Strengthening the soft tissues of the hip joint with mylar ribbon. P / O diagnosis: the same.

 Khir: Kolesnik A.I.

 Ass .: Brezhneva N.L., Ivanova G.P.

 Duration: 3 hours 35 minutes.

Blood loss: 1200 ml
Anesthesiologist: Chursin Yu.M.

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

Protocol
1. A section with a length of up to 21 cm on the outer surface of the joint, the trochanteric region is exposed in layers. Hemostasis and toilet wounds with antiseptics during the operation.

 2. Removed a three-blade nail and a screw.

 3. The capsule of the joint is exposed. Hemostasis and toilet wounds with antiseptics during the operation. The capsule is dissected. The head is freely located from the neck, dislocated from the cavity, it is deformed. Hemostasis and toilet wounds with antiseptics during the operation.

 4. After preliminary processing of the acetabulum with cutters N N 48 - 52, a Muller cup N 50 was implanted on bone cement “Palakos P”. Wire loops (1) are fixed by cement (Fig. 1, 2) along the edges of the acetabulum (top, front, bottom).

 5. The proximal femur is processed with a rasp N 7.5, - 11.25. An Müller leg N 11 was implanted on the Palakos P bone cement and two wire loops (1) in the anterior and medial zone of the femoral bed.

 6. The head is set into the cavity. The range of motion in the joint is sufficient.

 7. Toilet wounds with an antiseptic. Layer-by-layer stitching of the capsule with the removal of wire loops over the capsule (1). Through the loops a lavsan ribbon (2a, 2c, 2c, 2d, 2e) was drawn (Figs. 1, 2), with several crosses (4) in the anterior section, stretched with slight bending and internal rotation of the thigh, and the ends are connected into a knot (3 ) and stitched with lavsan in the upper loop area.

 8. The wound is sutured, leaving two drains for active aspiration. Rubber graduates in subcutaneous fat.

 9. Elastic bandaging of legs.

 Thus, the result is achieved due to the fact that the capsule of the hip joint is strengthened with a lavsan tape, which is passed through the wire loop supra-capsularly fixed in the acetabulum and sawdust of the femoral neck, allowing complex cross-section of the whole lavsan tape and its tension. The complex cross of the tape, its tension during flexion and internal rotation of the thigh greatly strengthens the capsule of the joint, which is an effective prevention of dislocation of the head of the prosthesis of the hip joint.

Claims (1)

 A method for the prevention of dislocation of the head of a prosthetic prosthesis, comprising dissecting a capsule of the hip joint, endoprosthetics, followed by suturing of the capsule and soft tissues of the joint at the end of the operation, characterized in that the stitched capsule is strengthened with lavsan tape, carried out crosswise, percapsularly through wire loops fixed in the acetabular region hollows and sawdust of the femoral neck, with subsequent tension and fixation of its ends.

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