RU2210999C1 - Method for performing closed compression arthrodesis of talocalcanean articulation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing two wires through the talus and fixing them in Ilizarov apparatus ring forming base support. A wire is introduced into proximal portion of the talus and stretched on the threaded rods ends fixed in base ring. Half-ring is connected to the base ring by means of distraction articulation unit. Compression conditions are created between the talus and the anterior part of the calcaneus. Calcaneus shape is repaired using distal part of the apparatus. The apparatus is stabilized. EFFECT: enhanced effectiveness of treatment in acute period; reduced risk of traumatic complications; accelerated treatment course.

Description

 The invention relates to medicine, in particular to traumatology and orthopedics.

 There is a method of talacaneal arthrodesis for fractures of the calcaneus after its fusion by open resection of the articular surfaces with the introduction of a bone graft into the joint and subsequent application of a plaster cast (L. A. Yakimov. Damage in the area of the calcaneal-calcaneal joint. M., 1990, diss. .. Ph.D., 216 p.).

 The method is traumatic, since it requires an open resection of the articular surfaces, can be performed only in the distant period of the injury after the fusion of the calcaneus fragments. The load on the limb is allowed after 4-6 weeks after the operation, the plaster cast is removed 8 weeks after the operation, then a course of rehabilitation therapy is carried out.

 Closest to the proposed method is a two-stage method of arthrodesis of the subtalar joint, where at the first stage of the operation, side incisions in the projection of the subtalar joint perform a modeling resection of the deformed walls of the calcaneus, the ligaments connecting the talus and calcaneus are dissected, the articular cartilage is excised and the transplant bed is prepared for . The wound is sutured and the Ilizarov apparatus is applied, two spokes of which are held in the frontal plane through the talus and calcaneus, and 3 spokes are held through the distal part of the tibia. After the healing of the skin wound, walking with a metered load on the foot with crutches is allowed and micro-distraction of the heel bone is performed, which allows the Achilles tendon and the skin of the lateral surfaces of the foot to be painlessly stretched when creating a gap (diastasis) between the talus and calcaneus. The second stage of the operation will be performed, as a rule, in three weeks, without removing the device. Access to the subtalar joint is through the old scar on the outer lateral surface of the foot. The surfaces of the talus and calcaneus are “freshened”, and an auto- or allograft is driven into the gap formed. The wound is sutured, and after its healing, walking with a metered load is allowed (RF Patent 2164389, A 61 V 17/56, 2001).

 The disadvantages of this known method are its high morbidity and duration of treatment.

 The objective of the invention is to develop a less traumatic and less long-term method of primary arthrodesis of the talacaneal joint, allowing to restore the shape of the calcaneus in the acute period of injury.

 The problem is solved by the method consisting in the fact that 2 knitting needles are passed through the talus bone crosswise, they are fixed in the ring of the Ilizarov apparatus, forming the base support, the knitting needle is held in the proximal part of the calcaneus, and it is pulled at the ends of the threaded rods attached to the base ring, through the distal part of the calcaneus, 2-3 knitting needles and fasten them in the semicircle of the apparatus, connect the semicircle to the base ring using a distraction-articulated node, perform compression between the talus and the anterior by the calcaneal bone, the distal part of the apparatus, the calcaneus is restored to shape, the apparatus is stabilized.

 In practice, the method is carried out as follows: two knitting needles cross-pass through the talus and are fixed in the ring of the Ilizarov apparatus. In the proximal part of the calcaneus, a spoke is perpendicular to its axis and stretched at the ends of the threaded rods attached to the base ring. Through the distal part of the calcaneus, 2-3 knitting needles are held and fastened in the semicircle of the apparatus, moreover, the semicircle with the base ring is connected by a distraction-hinge assembly. By creating compression between the base part of the apparatus and the anterior calcaneus, distraction of the distal part of the apparatus, the necessary compression is performed in the ankle-calcaneal joint and restoration of the shape of the calcaneus. After completion of the dynamic component, the apparatus is stabilized. The load on the limb is allowed immediately after applying the apparatus. The device is dismantled after 6-8 weeks. No further rehabilitation is required.

 Specific example: I. B. - 14356 - tr. Name: K.N.R. - born in 1963 He entered the clinic on 02.20.2001 after falling from a height. Clinical and radiological examination established the diagnosis: closed multi-fragmented intraarticular fracture of the left calcaneus with displacement of fragments. On the 2nd day, under the conduction anesthesia, 2 spokes were held crosswise through the talus and fixed in the ring of the Ilizarov apparatus. In the proximal part of the calcaneus, a spoke is drawn perpendicular to the axis and stretched at the ends of the threaded rods attached to the base ring. Through the distal part of the calcaneus, 3 spokes were drawn and fixed in the semicircle of the apparatus. The half ring with the base ring is connected by a distraction-hinge assembly. Then, compression was made between the talus and the proximal part of the calcaneus, and the distal part of the calcaneus is distracted and repaired. After the completion of the dynamic component, the device is stabilized. The load on the limb is allowed after applying the apparatus. After the onset of bone ankylosis in the talocaneal joint and consolidation of the calcaneal fracture, the apparatus was removed after 7 weeks. Rehabilitation measures were not required. The patient returned to normal life.

 The method according to the invention is less traumatic, less long and allows you to restore the shape of the calcaneus in the acute period of injury.

Claims (1)

 Method of primary closed compression arthrodesis of the ankle-calcaneal joint with the help of a spoke apparatus, characterized in that two knitting needles are passed through the ankle bone crosswise, securing them in the ring of the Ilizarov apparatus, forming a basic support, carrying the knitting needle in the proximal part of the calcaneus and pulling it at the ends of the threaded rods attached to the base ring, pass through the distal part of the calcaneus 2-3 knitting needles and fasten them in the semicircle of the apparatus, connect the semicircle to the base ring using a distraction ball nirnogo node, compress between the talus and the anterior calcaneus, the distal part of the apparatus restore the shape of the calcaneus, stabilize the apparatus.