RU2190364C2 - Method for treating congenital kneepan dislocation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying quadriceps muscle mobilization and additional mobilization of the external muscle of the knee joint. Strained muscles on the internal broad muscle and muscular belly are cut. The so formed flaps are fixed with external perosseous fixation apparatus and training is carried out. EFFECT: retained quadriceps muscle power and strengthened internal broad muscle. 4 dwg

Description

 The invention relates to medicine, in particular to orthopedics and traumatology, in particular to methods of treating a musculoskeletal system and is used in the clinical orthopedic department "Limb development disorders".

 There is a method of treating congenital dislocation of the patella, which consists in a longitudinal section along the midline of the thighs, cutting off the broad muscle from the joint capsule, separating it from the rectus muscle and in a less strained position stitching to it, cutting off its own ligament of the patella with a bone plate and transferring it inside with hemming to a new bed, stitching along the inner edge of the rectus muscle to the fascia internal muscle, immobilization with a plaster cast (Multivolume Guide to Orthopedics and Traumatology / vol. 2 Orthopedics, under the editorship of M .V. Volkova, M., Medicine, - 1968, p.652).

 However, the known method is traumatic, since it involves a large incision of soft tissues. Cutting off the external broad muscle from the capsule of the knee joint reduces muscle strength. Hemming of the rectus muscle to the inner broad muscle with catgut sutures does not sufficiently strengthen the inner edge of the patella. Fixing the patella with a plaster cast does not exclude a partial return of the patella outward due to the onset of muscle retraction after anesthesia.

 The objective of the invention is to develop a method of treating congenital dislocation of the patella of moderate and severe degree, allowing to restore its balance with strengthening the internal broad muscle and maintaining the strength of the quadriceps muscle.

 The problem is solved in that in the method of treating congenital dislocation of the patella, including mobilization of the quadriceps femoris muscle, moving your own ligament of the patella with the bone pad of the tibial tuberosity of the medulla with establishing it along the midline, strengthening the internal broad muscle and fixing the knee joint, additionally mobilize the external wide muscle from the tractus and leotibialis from the lower to the upper third of the thigh, without cutting off the tendon of the external rectus muscle wide from the tendon, then four are displaced the head muscle inside, dissected, the tendon extension of the internal broad muscle and its muscle abdomen to the middle third, forming two flaps, after which, duplicating the flaps, connect them on both sides with sutures, the knee joint is fixed with an external transosseous fixation device with subsequent development.

The proposed method for the treatment of congenital dislocation of the patella is explained in a detailed description, an example of its implementation and copies of radiographs on which:
FIG. 1 illustrates a knee joint prior to surgery;
FIG. 2 - knee joint after surgery with fixation of the thigh, lower leg and patella by external transosseous fixation device,
figure 3 and 4 - radiograph of the knee joint after treatment.

 The method is as follows.

 In the operating room under epidural anesthesia, a soft tissue incision is made outside the patella and proximal to 15 cm.

 Stupidly and acutely separate the external broad muscle to the upper third of the thigh from the fascia and muscles located outside of it, without cutting off the tendon of the external broad muscle from the tendon of the rectus muscle. The quadriceps is moved inwards and the patella is placed in its bed. A tendon stretch and muscle abdomen of the internal broad muscle are cut along the fibers to the middle third, forming two flaps. The formed flaps are laid one on top of the other and fixed on both sides with sutures with tension, at which the formed flaps hold the patella in the midline and in the frontal plane.

 Tibial tuberosity at the site of attachment of its own ligament is moved inside. The criterion for the displacement is the angle of the patellar ligament, which is seven degrees.

 The displaced section of the tibial tuberosity with its own ligament of the patella is fixed with needles with thrust pads. Then the ends of the spokes are fixed on the supports of the external transosseous fixation apparatus.

 Fixation is carried out for three to four weeks with the simultaneous development of the knee joint.

 An example of the method.

 The patient was admitted to the hospital with a diagnosis of Congenital dislocation of the patella (Fig. 1).

 Operation Technique.

 Under anesthesia, a 15 cm incision was made from the tibial tuberosity along the outer edge of the patella to the middle third of the thigh. The external broad muscle was separated from the soft tissues located outside. Separated their own ligament of the patella with the cortical plate and moved it inside with the simultaneous movement of the outside: the rectus and the outer broad muscles with the fixation of the ligament to the new bed with two knitting needles with thrust pads. A new bed was formed along the axis of the thigh with duplication of the edges with tension, in which the patella is held in the frontal plane.

 The wound was sacked.

 An external transosseous fixation apparatus was placed on the thigh and lower leg (Fig. 2), namely: two supports were placed on the thigh and two on the lower leg. We carry two knitting needles with brazed outside through the patella with fixing them on a support located around the lower leg.

 In the postoperative period, the knee joint is developed simultaneously with the fixation of the patella.

 X-ray control the implementation of the method and the elimination of dislocation of the patella in an operative way.

 The external transosseous fixation device after reaching the normative position of the patella is dismantled (figure 3).

 The proposed method for the treatment of congenital dislocation of the patella allows to eliminate the dislocation of the patella in a less traumatic way, to reduce the likelihood of relapse, to reduce the development of deforming arthrosis. It can be used in departments of orthopedic-traumatological profile.

Claims (1)

 A method of treating congenital dislocation of the patella, including mobilization of the quadriceps femoris muscle, moving your own ligament of the patella with the bone pad of the tibial tuberosity of the medulla with establishing it along the midline, strengthening the internal broad muscle and fixing the knee joint, characterized in that they additionally mobilize the external broad muscle from the tractus ileotibialis from the lower to the upper third of the thigh, without cutting off the tendon of the external rectus muscle wide from the tendon, then the quadriceps muscle is displaced three, dissect the tendon extension of the internal broad muscle and its muscle abdomen to the middle third, forming two flaps, after which, duplicating the flaps, connect them on both sides with sutures, the knee joint is fixed with an external transosseous fixation device with subsequent development.

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