RU2186543C2 - Method for surgical treatment of rheumatoid arthrosoarthritis - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology, surgery. SUBSTANCE: method deals with osseous tunnelling with a tubule hollow drill of 0.6-0.8 cm diameter. Tunnelling of soft tissues is additionally conducted. The method enables to obtain constant and prolonged revascularization, stimulate reparative process in articulation, decrease articulatory intumescence and pain. EFFECT: higher efficiency of therapy. 2 ex, 8 dwg

Description

 The invention relates to medicine and can be used in the surgical treatment of diseases of large joints: knee, hip, shoulder and others in surgery and traumatology.

 A known method for the surgical treatment of deforming arthrosoarthritis, which consists in arthroplasty of a diseased joint, including removal of internal structures, cartilage and ligaments or removal of the joint as a whole in the form of an endoprosthetics operation (A.P. Meshkov. Joint disease. Diagnosis and treatment. Because of NMMI, N Novgorod, 1994, p. 140). However, when applying this method, a local effect on the joint occurs, sometimes with undesirable consequences, exacerbating the deforming processes in the joint, leading to gross violations of the statodynamic function of the limb.

 Closest to the proposed invention is a method of surgical treatment of deforming arthrosis according to B.C. Gankin. A method of surgical treatment of deforming arthrosis and arthropathy, which consists in the fact that after drilling a tunnel (without a biopsy), a bone fragment on a muscle leg is implanted in it with the aim of revascularizing the joint (B.C. Gankin, abstract of doctor's dissertation M, 1988).

 The disadvantage of this method is massive surgical trauma, the need for osteotomy of the iliac crest and muscle leg of the gluteus maximus muscle (m. Gluteus m. A. X.).

 The objective of the invention is to develop a method for the surgical treatment of deforming arthrosoarthritis, which allows for decompression of intraosseous pressure, improve revascularization of soft tissues around the joint and bones, restore the system of lympho-venous drainage (outflow) in the joint area and improve nutrition of the cartilage tissue of the joint. This problem is solved by the method of surgical treatment of deforming arthrosis-arthritis by tunneling of bone and soft tissues, and bone tunneling is carried out by a hollow tube drill, the diameter of which is 0.6-0.8 cm.

 The claimed method allows to improve the statodynamic functions of the limb, preserve the anatomy of the joint and increase the duration of its functioning. This method is applicable in the treatment of deforming arthozoarthritis of large joints: hip, knee, shoulder. The deformation of these joints is based on destructive-inflammatory processes, circulatory system disorders and lymphatic venous drainage in the joint area. Tunneling of muscles and bone with a tubular hollow drill, the diameter of which is 0.6-0.8 cm, makes it possible to level these processes, reduce intraosseous pressure and improve revascularization and lymphatic venous drainage in the joint area. When using a hollow drill with a diameter of 0.4 cm, the diameter of the tunnel is insufficient for revascularization, and the use of a drill with a diameter of more than 0.8 cm leads to traumatic fracture of the bone. However, tunneling of the bone with hollow drills with a diameter of 0.6-0.8 cm without joint tunneling of soft tissues does not lead to a persistent and long-lasting effect of revascularization and, accordingly, a decrease in intraosseous pressure and improvement of revascularization of soft tissues around the joint and bones are not achieved.

 The method is carried out in this way: in the region of the corresponding joint, tunneling of soft tissues, bones and constituent elements in the region of the joint is performed, as a result of which intraosseous pressure is decompressed, and from the soft tissues through the tunnels development of roundabout blood supply occurs due to neoangiogenesis, and lymph is also drained into the venous collector , which provides stimulation of the reparative process in the joint, which is clinically manifested in the form of relieving pain (weather pain), reducing swelling and normal analysis of statodynamic function of a limb.

In the surgical treatment of deforming arthrosoarthritis of the hip joint (Fig. 1) from one entrance point tunnel:
1. the neck of the femur with a tube drill with a diameter of 0.6-0.8 • 15 cm;
2. the upper edge of the gluteal region;
3. own gluteus maximus muscle,
4. the lower edge of the gluteal region;
5. the outer surface of the thigh.

 Tunneling of soft tissues (2-5) in the joint area is performed with a tube scalpel of 0.8 • 20 cm.

In the surgical treatment of deforming arthrosoarthritis of the knee joint (Fig. 2), tunneling is performed in the following sequence:
1. tunneling of the anterior thigh muscle: points 1,2,3,4
5. The lateral surface of the knee joint.

6. lateral calf muscle
7. the medial surface of the knee joint.

8. the medial pedicle of the calf muscle
9. soleus muscle of the leg (median tunnel)
10. condyles of the thigh
11, 12 - metadiaphysis of the tibia.

 Thigh tunneling is performed with a scalpel 0.8-1.2 • 30 cm, and shins 0.6-0.8 • 30 cm. The tunnel in the bone is produced with a tube drill with a diameter of 0.8 cm • 15 cm in the hip and 0.6 • 15 cm in the lower leg.

In the surgical treatment of deforming arthrosoarthritis of the shoulder joint, the operation is performed according to the following scheme (Fig. 3):
1. tunneling of the head of the humerus with a tubular hollow drill with a diameter of 0.6 • 15 cm
2. tunneling of the deltoid muscle
3. trapezius muscle tunneling
4. tunneling of the pectoralis major muscle
5. tunneling of the lateral surface of the triceps
6.7 - tunneling of the extensor surface of the forearm.

 Tunneling of the soft tissues of the shoulder is performed with a tube scalpel 0.6 • 30 cm, and the forearm 0.5 • 30 cm.

 Example 1

 B-naya M, 46 years old, East. bol. 1722 was admitted to the department on 1.06.97 with a diagnosis of deforming arthrosoarthritis of both knee joints of the II stage, elephantiasis of the right lower leg of the I-II stage. From the anamnesis of the disease it was found that the patient was fully examined at the All-Russian Exhibition Center (Moscow) for the disease and had an attempt at microsurgical correction of elephantiasis of the right lower leg without effect. Objectively: knee joints are swollen, sharp pain when walking and squats. Radiographically there is a narrowing of the joint gap, deformation of the contours of the joint. Rheovasographically observed minimal circulatory disorders. 06/12/97 performed operation: tunneling of soft tissues and bones of both knee joints and the rear of the foot on the right. (Fig. 4, 5). Intraoperatively performed canalography (Fig.6), which clearly showed the message of the intraosseous canal with tunnels in the soft tissues of the limb. The postoperative period was uneventful. It is allowed to walk from the second day, a complex of conservative therapy is prescribed. Sutures were removed on day 11. The pain syndrome is minimal, the movements in the joints have increased, the swelling of the limbs is moderate. In satisfactory condition was discharged on the 20th day after surgery. Examined after 3, 6, 11 months after surgery. He does not note pain in the joints, edema is not observed. There is a slight swelling in the rear of the foot. X-ray progression of deforming arthrosis is not observed (Fig. 7). The effect of the operation is rated as good. There are 8 such operations.

 Example 2

 Boy X, 56 years old, East. bol. 1245 was admitted to the department on 01.25.98 with a diagnosis of deforming arthrosis of the right hip joint, stage II-III, severe pain. After examination (x-ray, rheovasography, physical examination) - the diagnosis is confirmed. On 2.02.98, an operation was performed: tunneling of soft tissues and bones of the right hip joint according to the accepted procedure. On the control intraoperative canalogram clearly visible channel communicating with the tunnels in the soft tissues (Fig. 9). The postoperative period was uneventful. Allowed to walk on the second day. Sutures were removed on day 11 after surgery. Discharged in good condition without pain with satisfactory joint function 18 days after surgery. Examined after 3 months, the patient did not show complaints, did not note pain, used the limb in full (traveled by car, worked in a personal plot). The effect of the operation is rated as good. Observation of the patient continues. There are 2 such operations.

 In this perspective, another operation was performed for deforming arthrosis of the shoulder joint with lower plexitis in 1996. To date, movements in the joint have been fully restored, and restoration of hand function in full has also been observed (Bnoy Shendo, 56 years old, source ball 3256, 1996, Kustanai, Republic of Kazakhstan).

Claims (1)

 A method for the surgical treatment of deforming arthrosoarthritis, including bone tunneling, characterized in that it additionally carries out tunneling of the soft tissues, and tunneling of the bone is carried out with a tube hollow drill, the diameter of which is 0.6-0.8 cm.

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