RU2207078C2 - Method for rebuilding knee joint in the cases of cystic lesion of tibia condyle - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out osteotomy of healthy tibia condyle. The condyle is transferred and fixed creating in this way congruent articulation surface, spatial defect is substituted in the area of transferred healthy condyle with free bone graft. Musculoperiosteocortical autograft is taken. Bed is formed on noncartilaginous surface of the injured condyle matching in shape bony portion of microsurgical autograft. Microsurgical autotransplantation is carried out. EFFECT: achieved articulation surface congruence; uniform load distribution. 6 dwg

Description

 The invention relates to the field of reconstructive traumatology, i.e. to methods of reconstruction of the knee joint with cystic lesion of the condyle of the tibia. It can be used in specialized departments of reconstructive microsurgery.

 The most common treatment for cystic condyle of the tibia is knee replacement. However, this treatment method is organ-bearing, does not give a long-term functional effect due to anatomical and biomechanical features, and does not subsequently allow surgical interventions to maintain limb function (1).

 Therefore, we believe that the closest prototype is a known method for reconstruction of the articular surface of the femoral head with cystic lesion. A method of treating dysplastic coxarthrosis is that they produce a segmental resection of the cystic lesion together with the articular plate, and replace the defect with a graft from the resected bone-cartilaginous growth (2).

 However, the known method has significant disadvantages.

 1. The method can be used only with single cysts of relatively small size.

 2. Violation of the integrity of the articular surface will subsequently lead to an increase in the phenomena of deforming arthrosis.

 3. The fixation of the transplant in the cavity is extremely difficult, which can lead to transplant migration with obvious negative consequences.

 4. Revascularization of the free bone graft in the area close to the articular surface and not connected with the periosteum is due to vessels of Haversian canals, which are end branches in this area. Accordingly, in conditions of insufficient revascularizing reserves, revascularization occurs for a sufficiently long time, which delays the duration of treatment, functional rehabilitation and, accordingly, worsens the result of treatment.

 5. Cystic degeneration of the tibial condyle in adults is most often formed as a result of a condyle fracture against the background of malnutrition. The proposed method not only does not affect the blood supply to the affected area, but also worsens it, i.e. cannot be a prevention of the formation and further development of the cystic process.

 The objective of the proposed method for reconstruction of the knee joint with cystic lesion of the tibial condyle is to increase the effectiveness of surgical treatment by increasing the effectiveness, improving functional results, reducing surgical risk, reducing treatment time, as well as preventing further development of the process.

 The problem in the method of reconstruction of the knee joint with cystic lesion of the tibial condyle, including the use of a free bone graft, is achieved by performing an osteotomy of a healthy tibial condyle, moving and fixing it, creating a congruent articular surface, replacing the volume defect in the region of the transferred healthy condyle with a free with a bone graft, a microsurgical muscle-periosteal-cortical autograft is taken, on a non-cartilaginous surface The lesions of the affected condyle form a bed in the shape of the bone part of the microsurgical autograft and microsurgical autograft is performed.

 The proposed method and features that distinguish it from those known in the medical and patent literature are not found, which allows us to conclude that it meets the criterion of "novelty."

 The essence of the invention lies in the fact that an osteotomy of a healthy tibial condyle is performed, it is moved and fixed, creating a congruent articular surface, a volume defect is replaced in the region of a healthy condyle displaced with a free bone graft, a microsurgical muscle-periosteal-cortical autograft is taken on a non-transplant surface the condyle forms a bed in the shape of the bone part of the microsurgical autograft and the microsurgical autotransplant is performed lantation.

 It is the osteotomy of a healthy tibial condyle that allows the condyle to be moved and subsequently fixed to create a congruent articular surface. At the same time, the replacement of a volume defect in the area of the transferred healthy condyle with a free bone graft creates support under the displaced condyle. T.O. the combination of these steps provides not only congruence of the articular surface, but also provides anatomical relationships in the joint with equalizing the distribution of pressure load during walking. In turn, it is not enough just to create anatomical relationships in the joint, it is necessary to create conditions to prevent the formation and further development of the cystic process. Such conditions are created by improving the nutrition of the affected bone area due to an additional source of blood supply in the form of a microsurgical muscle-periosteal-cortical autograft. The osteogenetic and revascularizing effect of a microsurgical autograft requires the creation of a good contact surface, which is achieved by forming a bed in the shape of the bone part of the microsurgical autograft on the non-cartilaginous surface of the affected condyle.

 It is the anatomical relationships in the joint and good blood supply that not only minimize inflammatory and destructive processes in the form of deforming arthrosis, but also allow for the earliest functional rehabilitation of the limb, which is the key to maintaining range of motion in the joint and reducing muscle atrophy, as well as preventing the formation of and the development of the cystic process.

 The combination of these factors not only reduces the surgical risk and the risk of postoperative complications, but also increases the effectiveness of surgical and rehabilitation treatment, improves functional results, and also reduces treatment time.

 Thus, the totality of all the distinguishing features allows you to achieve your goal and get a positive result.

 The implementation of the method is illustrated by drawings.

 Figure 1. X-ray before surgery.

 FIG. 2. An osteotomy of a healthy condyle was performed. A free bone graft was taken.

 FIG. 3. The condyle is fixed, creating a congruent articular surface. A defect in volume in the area of the transferred healthy condyle is replaced by a free bone graft.

 FIG. 4. Performed microsurgical autotransplantation on the non-cartilaginous surface of the affected condyle.

 Figure 5. The operation is completed.

 6. X-ray after surgery.

 The method is as follows. In a patient with cystic lesion of the tibial condyle, access is made, an osteotomy of the healthy tibial condyle is performed, it is moved and fixed, creating a congruent articular surface, the volume defect in the region of the transferred healthy condyle is replaced by a free bone graft, the microsurgical muscular-periosteal-skeletal graft is taken, the non-cartilaginous surface of the affected condyle form a bed in the shape of the bone part of the microsurgical autograft and perform microsurgical autotransplantation.

 Clinical example. Patient F., and / b 473901. Clinical diagnosis: Cystic lesion of the internal condyle of the right tibia with impaired congruence of articular surfaces.

 Received complaints about the impossibility of full support on the right lower limb, hallux valgus deviation of the right lower leg.

 From the anamnesis: in 1994, as a result of an accident, she received an open segmental diaphyseal fracture of both bones, trans-alkaline with a displacement fracture of the right tibia. She was treated in the Ilizarov apparatus. Fusion of the transcondylar fracture of the tibia was obtained in the wrong position: the inner condyle is lowered, deployed in the frontal plane. Lavsanoplasty of the inner lateral ligament of the right knee joint was performed twice. March 6, 1996 - a lifting osteotomy of the internal condyle of the right b / b was performed with fixation with screed bolts, Campbell corrugation of the inner lateral ligament, fibula osteotomy in the upper third, high oval osteotomy of the right tibia. 04/01/97 - the Ilizarov apparatus was placed on the right shin.

 On admission: right lower leg valgus rejected. Restriction of active and passive movements in the right knee joint. On radiographs: the area of the right condyle of the tibia is cystically altered. The joint gap is deformed.

 03/27/01, the patient underwent surgery: reconstruction of the right knee joint, including raising the osteotomy of the external condyle, replacement of the defect with a free bone graft, transplantation of a microsurgical muscle-periosteal-cortical autograft to the internal condyle, i.e., the osteotomy of the healthy condyle was performed according to the proposed method. bones, its movement and fixation with the creation of a congruent articular surface, the replacement of a volume defect in the area of the displaced healthy condyle with free stnym graft fence microsurgical musculo-periosteal-autograft cortical forming bed on nehryaschevoy affected condyle surface in the form of bone parts microsurgical autograft and executed microsurgical autotransplantation. Received fusion. The patient undergoes functional rehabilitation treatment.

 The proposed method is implemented in the department of reconstructive microsurgery RSCH RAMS and will be widely used in clinical practice.

 Using the proposed method for reconstruction of the distal shoulder with improperly fused and non-fused intraarticular fractures allows the following.

 1. Improve the effectiveness of surgical treatment.

 2. Improve functional results.

 3. Reduce surgical risk.

 4. Reduce treatment time.

 5. To prevent the formation and development of the cystic process.

Sources of information
1. N.N. Trapeznikov, L.A. Eremina, A.T. Amiraslanov, P.A. Sinyukov. Bone tumors. -M .: Medicine, 1986, 303 p.

 2. A. S. Imamaliev, M.V. Parshikov, V.I. Dawn. A method for the treatment of dysplastic cosarthrosis. SU aut. testimonial. USSR 1264930, A 61 B 17/56, 1986, BI 39, 1986.

Claims (1)

 A method for reconstruction of the knee joint in case of cystic lesion of the tibial condyle, including the use of a free bone graft, characterized in that an osteotomy of a healthy tibial condyle is performed, it is moved and fixed, creating a congruent articular surface, and a volume defect in the area of the transferred healthy condyle is replaced with a free bone graft a microsurgical muscle-periosteal-cortical autograft is taken on the non-cartilaginous surface of the affected muscle Single bed is formed in the form of bone parts microsurgical autograft and performing microsurgical autotransplantation.

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