RU2201166C2 - Method for fenestrated iliac wing - Google Patents

Abstract

FIELD: medicine, traumatology, surgery. SUBSTANCE: at the angles of supposed transplant out of the wing by keeping continuity of iliac crest perimeter one should perforate openings through which Jigly's saw should be directed to gradually treat the transplant from all sides. EFFECT: decreased traumatization of tissues. 3 dwg

Description

 The invention relates to medicine, namely to orthopedics and traumatology, i.e., to methods for producing a free cortical-spongy autograft.

 Several analogues of obtaining cortical-spongy free autografts with replacement, support and stimulating osteoparaction are known in the treatment of patients with false joints and bone defects / K. Pirogov, 1853; Ollier, 1867; Rudnev M.M., 1880; Radzimovsky I.V., 1881; Lexer E., 1933; Petrov N.N., 1913; Kornev P.G., 1927; Nemilov A.A., 1940; Novachenko N.P., 1946; Boychev B., 1958; Movshovich I.A., 1994 /. The most widely used osteoplastic material is free autografts, taken from the crest of the tibia, the greater trochanter of the femur and the wing of the ilium. A common disadvantage of the known methods for producing bone autografts is the formation of stepped depressions, distorting the contours and violating the frame of the donor site; the likelihood of the osteotomy line going beyond the limits indicated for the weakening of the mechanical strength of the donor site until the onset of a secondary fracture; the need to clean autografts from cartilage, which prevents its engraftment to the perceiving bone bed.

 As a prototype, a method of obtaining a free autograft from the iliac wing was taken, the advantages of which are good blood supply / and, therefore, engraftment to the bone bed / spongy tissue and the possibility of taking more of it with less risk of impaired mechanical integrity and the occurrence of a pathological fracture of the pelvic bone / Movshovich I . A., 1994 /. A prototype method is implemented as follows. A cut of the skin and deep soft tissues 12-14 cm long is made along the iliac crest from its anteroposterior spine. Having reached the bone, they skeletonize it to the desired extent from the outside and inside, releasing the donor site of the given shape and size for soft tissue. Then outline the contours of the latter / Fig. 1, b /. After taking the autograft, soft tissues are laid in their place and sutured in layers, leaving, if necessary, rubber drainage.

The disadvantages of the prototype are the following:
1 / the likelihood of the osteotomy line exceeding the limits of the ilium planned with weakening of the mechanical strength of the ilium up to the onset of a secondary fracture of the ilium;
2 / the need for laborious cleaning of the obtained transplant from cartilage tissue located along the iliac crest;
3 / functional inconvenience when wearing clothes from the donor site, expressed in the pressure of the formed bone edges from step depressions on the soft tissues up to the development of internal pressure sores;
4 / a contradiction to the requirements of cosmetics, expressed in the formation of stepwise depressions on the donor site, clearly defined visually, especially in women and thin subjects.

 The purpose of the invention is to reduce the morbidity and duration of the operation, to improve the quality of osteotomy with the prevention of the likelihood of the formation of cosmetically flawed and functionally vicious step depressions on the donor site, while maintaining the frame of the ilium.

 This goal is achieved in that the autograft is taken by means of a graduated osteotomy of the ilium wing.

 The invention is as follows. A typical skin incision and skeletonization of the ilium wing are performed for a given length. Then, the contours of the proposed transplant are outlined, at the corners of which a drill with a drill, 0.2-0.5 cm in diameter, holes are drilled (Fig. 2, a). The Jigley wire saw is held in one hole from the outside in and is output in the opposite direction through another / neighboring / hole / Fig.2, b /. Thus, the graft is sequentially sawn from all / usually four / sides and removed / Fig.3/, soft tissue is laid in its place and sutured in layers.

The advantages of the proposed method for producing a free cortical-spongy autograft are as follows:
1 / improving the quality of osteotomy with the exception of the likelihood of its line going beyond the intended range;
2 / elimination of the need to clean the graft from the cartilaginous tissue present on the iliac crest and preventing the autograft from engraftment to the bone bed;
3 / maintaining the frame of the ilium wing;
4 / prevention of both functional inconvenience and cosmetic impairment on the part of the donor site associated with the formation of stepwise deposition.

 An example of obtaining a cortical-spongy free autograft by performing a terminal osteotomy of the ilium wing is the following observation.

 Patient R., 22 years old, was admitted to the orthopedic department of the RTC / case history 3-609 / 11.08.97 with complaints of periodic moderate aching pain in the left heel area, which first appeared after the injury 3 weeks ago and intensified with axial load. X-ray revealed a solitary cyst of the calcaneus body with dimensions of 5.0 x 3.5 cm, about which the operation was performed as planned on 08/19/97: removal of a solitary cyst of the left calcaneus with autoplasty of the defect.

 The graft was carried out as follows. From the anteroposterior spine of the left iliac bone along the crest of the latter, a linear incision was made of the skin and underlying soft tissues 12 cm long. In a sharp and blunt way, the donor site of the ilium is skeletonized from the outside and inside. The contours of the proposed transplant were outlined, at the corners of which a drill with a drill, 0.3 cm in diameter, 4 holes were drilled in the body of the ilium, the upper 2 of which are located 0.7-1.0 cm below the crest of the latter. Through the drilled holes, a Jigley saw was performed in pairs from the outside inward and back and an osteotomy was performed on all four sides around the graft. Thus, an autograft with dimensions of 6.0 x 4.0 cm was obtained. The window defect remaining on the donor site was covered inside and outside by the periosteum and muscles, leaving tubular drainage removed on the second day after the operation.

 The obtained autograft is split into 2 parts and tightly embedded in the defect formed after resection of a solitary calcaneal cyst. The postoperative period was uneventful. Both wounds healed by primary intention. Sutures were removed on the ninth day. Visually, the contours of the iliac crests are symmetrical and unchanged.

 The patient was discharged 08/29/97

 Thus, the proposed method for taking a free cortical-spongy autograft from the iliac wing is reliable, beneficial and more optimal compared to the traditional method of autoplasty, it improves both immediate and long-term results of treatment of orthopedic patients requiring free osteoplasty, which allows us to recommend its for wide practical application.

Claims (1)

 A method of obtaining a cortical-spongy autograft with maintaining the continuity of the perimeter of the iliac crest, characterized in that they produce a graduated osteotomy: holes are drilled at the corners of the proposed graft through which the Jigley saw is carried out and the graft is successively cut from all sides.

Images