RU2192188C2 - Method for two-joint foot arthrodesis under arthroscopic control - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics. SUBSTANCE: the method deals with arthrodesis of talotibial and talocaneal joints at post-traumatic arthrosis of talocrural joint without axial curvatures of the shank. One should remove the cartilage of talofibular joint and synovial membrane with the help of arthroscopic equipment through cutaneous punctures, through additional cutaneous incisions upon plantar surface of the foot one should form an osseous canals via calcaneal bone, talus, tibial bone which are introduced and fixed with metal screws that provides stability of arthrodesis operation at keeping foot springiness effect. EFFECT: higher efficiency of arthrodesis. 2 dwg, 1 ex

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and can be used for arthrodesis of the tibial-tibial and talacaneal joints in post-traumatic arthrosis of the ankle joint without axial curvature of the lower leg.

 A known method of three-joint arthrodesis of the foot according to A.P. Chernov (A.S. 1063396 from 01.09.83), in which bone blocks are formed from the articular surfaces, they are then rotated (the joint is eliminated) and jammed.

 However, this method does not include excision of the cartilage and synovial membrane. In the postoperative period, the growth of cartilage tissue, its ossification, and subsequent pain are observed. In addition, arthrodesis of the talon-navicular joint leads to an irreversible loss of "springiness" of the foot.

 There is a method of arthrodesis of the talus-tibial joint, in which the joint is blocked by a bone graft cut from the lower third of the tibia and wedged into the talus (Watson - Jones R. Bone fractures and joint damage. - M .: Medicine, 1972. - p. 561, 562).

 However, this method also does not provide for excision of the cartilage and synovial membrane, and the immobilization of only one talus-tibial joint does not lead to sufficient foot strength.

 A known method of arthrodesis, which provides for the excision of cartilage, the tibial joint is blocked by a bone wedge (Surgery: Manual / Ed. I. Littman. - Budapest, 1985. - S. 954). In addition, due to the movement of the fibula, it is possible to block both the talus-tibia and the talus-calcaneal joints.

 This method is taken as a prototype, because there are significant signs common with the specified method: the cartilage of the tibial-tibial joint is excised, the arthrodesis of the tibial-tibial and talus-calcaneal joints is performed.

 However, the known method involves surgery through a skin incision, which leads to additional soft tissue injury and which alone is not enough to examine the entire ankle joint, a wedge graft is formed that does not have sufficient strength, like a metal retainer, the cartilage of the talone-fibular joint is not processed and the synovial membrane is not removed.

 The solution to the technical problem involves reducing the invasiveness of the operation, preventing the formation of ossificates from the remnants of the cartilaginous plate of the ankle joint, and ensuring durable and reliable arthrodesis of the ankle and talacaneal joints.

 The essence of the invention lies in the fact that in the known method of double joint arthrosis of the foot under the control of arthroscopy, including excision of the cartilage of the talar-tibial joint, arthrodesis of the ankle and talacaneal joint, the cartilage of the talon-fibular joint is removed, the synoviopanal is removed the peroneal joint and the synovial membrane of the ankle joint is made through skin punctures through arthroscopic instruments, through additional In the skin incisions on the plantar surface of the foot, bone channels are formed through the calcaneus, talus and tibia, into which metal screws are inserted and subsequently fixed.

 With this technology, the operation reduces the trauma of the operation, prevents the formation of ossification from the remnants of the cartilaginous plate of the ankle joint, provides strong and reliable arthrodesis of the ankle and talacaneal joints.

 A clear illustration of the method is shown in the drawings, where: FIG. 1 shows a distractor for the ankle joint, Smith &Nephew; figure 2 shows the direction of the spokes (dashed lines).

 The method is as follows.

 The patient lies on his back. On the tibia and calcaneus, a distraction rod apparatus is attached (Fig. 1). Traction is performed, the joint gap of the ankle joint increases. Through skin punctures an arthroscope is inserted into the cavity of the ankle joint. A shaver is inserted and the synovial membrane is removed by synovial cutters. Olive and round arthroscopic burs are introduced alternately connected to a shaver. Boron removes cartilage on all cartilaginous surfaces of the tibia, fibula, talus, which make up the ankle joint. Boron treatment is performed alternately until the appearance of "blood dew". The distractor is removed. Two skin incisions are made on the plantar surface of the foot along the edges of the tendon of the plantar aponeurosis in the projection of the talus, each 0.8 cm long, through which X-shaped Kirschner spokes are passed through the talus-calcaneal and talus-tibial joints. Knitting needles extend to the surface of the skin in the lower third of the leg. X-ray control is performed. Bone canals are drilled along guide spokes with a drill with a diameter of 10 mm. During its passage, the drill destroys the cartilage of the ram-calcaneal joint. Two spongy screws are inserted into these canals, the screws are tightened and fixed so that their heads lie on the calcaneus, and the ends somewhat extend beyond the cortical plate of the tibia. Plantar incisions are sutured with cutaneous sutures. Arthroscopic punctures are pulled together with a band-aid with an antiseptic. An aseptic dressing is applied. Plaster cast for 3 weeks.

 The proposed method operated on 3 patients with post-traumatic arthrosis of the ankle and talacaneal joints.

 Example. Patient L. was admitted to the VAZ Center for Occupational Medicine on 01/14/99 with a diagnosis of a consolidated fracture of the ankles of the right lower leg, neck of the talus of the right foot, post-traumatic arthrosis, and pain. 01/15/99 he underwent surgery according to the proposed method.

 The patient is laid on his back. A distraction rod apparatus was fixed on the tibia and calcaneus. They made a traction, which increased the joint gap of the ankle joint. Through skin punctures an arthroscope, a shaver, were introduced into the cavity of the ankle joint. The synovial membrane is removed with synovial cutters. Alternately olive-shaped and round arthroscopic burs were introduced, previously connected to the shaver installation. The burs performed cartilage removal on all the cartilaginous surfaces of the tibia, fibula, talus, which make up the ankle joint. Boron treatment was performed alternately until the appearance of "blood dew". The distractor was removed. Two skin incisions were made on the plantar surface of the foot along the edges of the tendon of the plantar aponeurosis in the projection of the talus, each 0.8 cm long. Kirshner's needles were passed through the X-shaped calcaneal and calcaneal and tibial-joint joints through them. Knitting needles were introduced to the surface of the skin in the lower third of the leg. They made an x-ray control. Bone canals were drilled on guide spokes with a drill with a diameter of 10 mm. Two spongy screws were inserted into these canals, the screws were tightened and fixed so that their heads lay on the calcaneus, and the ends somewhat exceeded the cortical plate of the tibia. Plantar incisions were sutured with cutaneous sutures. Arthroscopic punctures were tightened with a band-aid with an antiseptic. An aseptic dressing. Plaster cast for 3 weeks.

 After removal of the gypsum immobilization, a course of rehabilitation treatment was carried out. 6 weeks after the operation, the patient painlessly stepped on the operated limb, started to work. The latches have not yet been removed.

 Clinical testing of the method showed that in all cases of surgical treatment good results were achieved. A significant decrease in pain was noted. The foot was stable and at the same time retained a “springy” effect. On radiographs, the active formation of a single bone block was noted.

 The proposed method of double-joint arthrodesis of the foot under the control of arthroscopy is less traumatic, provides a strong and functional arthrodesis and quick rehabilitation, and by the end of the sixth week from the moment of surgery to restore the patient's ability to work.

Claims (1)

 A method of double-joint arthrodesis of the foot under the control of arthroscopy, including excision of the cartilage of the tibi-tibial joint, arthrodesis of the ankle and talacaneal joints, characterized in that the cartilage of the talon-fibular joint is removed, the synovial membrane of the ankle-joint and the tartar joint are removed, the ankle joint is produced through skin punctures through arthroscopic instrumentation, through additional skin incisions on the plantar surface The feet form bone channels through the calcaneus, talus and tibia, into which metal screws are inserted and subsequently fixed.

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