RU2230511C1 - Method for treating false articulation in tubular bone - Google Patents

Abstract

FIELD: medicine, traumatology.

SUBSTANCE: along longitudinal osseous axis through area of false articulation one should make a groove of (1.7-2.5) d length, where d - external osseous diameter at the level of false articulation, two arc-wise curved plates should be prestraightened to be successively introduced into the groove by applying them in opposite cortical osseous layers to orient them so that after restoring initially preset shape the protuberances of arc-wise curved plates should be opposite, and free spaces of the groove should be filled with the crumb of porous titanium nickelide, moreover, thickness of arc-wise curved plates corresponds to 0.7-1.2 mm, and their arc height and width correspond to (0.2-0.3) d that develops compression without any usage of apparatuses for external fixation.

EFFECT: higher efficiency of osteogenesis stimulation.

2 dwg

Description

The invention relates to surgical methods for the treatment of the musculoskeletal system, mainly false joints and non-healing fractures of the tubular bones.

One of the well-known directions in the treatment of delayed consolidation of fractures and false joints of long tubular bones is bone grafting using cortical and spongy allogeneic grafts, crushed bone, and demineralized bone matrix.

A known method [1] of treating a false joint of the femoral neck, including horizontal osteotomy on 1/3 of the bone and longitudinal osteotomy in the sagittal plane, the formation in the proximal fragment of the groove, moving the graft into it on the feeding leg, formed on the distal fragment from the small trochanter with the attachment point muscle, and filling the defect with bone taken from the proximal section.

Method [2] of free bone autoplasty in the treatment of a false joint of the leg bone involves osteotomy of the fibula, formation of a fragment with a beveled upper cone from the proximal tibia and implantation of the graft after a 180 ° turn to the fracture site with overlapping defect due to lengthening of the beveled end.

According to the method [3] for treating a false joint of the femoral neck, a medializing osteotomy is performed, allografts are introduced in a converging direction through the neck into the head, and compression is created by means of a screw.

With the high effectiveness of the above methods and other known methods of treating false joints using bone grafting, their common drawback is the high invasiveness and complexity of reconstructive surgery.

The most widespread in the treatment of pseudoarthrosis are methods using compression-distraction external fixation devices.

Thus, according to the method [4] for treating a false joint with an edge defect, an autograft is formed from adjacent tissues at the level of the fragment defect, rotate it 90 ° with the osteotomy plane being set to the side of the defect, it is metered to the bone tissue with bone regenerate formation, and segment deformation is eliminated and create compression fragments.

There is also known a method [5] for treating a false joint of a long tubular bone, including an osteotomy of a distal bone fragment along a line passing obliquely through its sclerotic and healthy areas, reposition with centering of the opposing ends of the main fragments, and subsequent stable fixation using a compression-distraction apparatus.

According to [6], the use of compression-distraction devices is especially indicated in the treatment of pseudoarthrosis, combined with osteomyelitis and severe scarring of the skin, tight (fibrotic) pseudoarthrosis, defects of long tubular bones, accompanied by curvature of the limb axis.

A disadvantage of the known methods using compression-distraction devices is a rather high morbidity associated with repeated reconstruction of the bone, the possibility of introducing infection through the spokes.

The closest analogue adopted as a prototype of the proposed method for treating a false joint of the tubular bone is the method of “small osteosynthesis” [7] with compression brackets (fixatives) from a material with thermomechanical shape memory that does not require opening the false joint and refreshing the ends of bone fragments.

The prototype method consists in exposing the bone at the level of the false joint through a small skin incision and installing one or two compression brackets of titanium nickelide, the legs of which are inserted above and below the region of the false joint to a thickness or deeper than the cortical layer, and the compression jumpers are placed along the longitudinal axis of the bone.

The advantage of the prototype method is the strong fixation of compressed fragments, minimal invasiveness of the operation and the possibility of early functional load of the limb.

The objective of the invention is to increase the effectiveness of treatment while maintaining a low invasiveness of the operation by creating, along with compression distraction effects on the pseudoarthrosis.

The prerequisites of the proposed method for the treatment of pseudarthrosis are the results of studies on the causes of impaired bone adhesion [8, 9], as well as studies on the mechanism of reparative osteogenesis, which have recently received much attention.

According to [10], in the treatment of patients with pseudoarthrosis, including those complicated by osteomyelitis, it was found that the compression factor has a beneficial effect on the fusion of fragments, causes positive biochemical changes, and creates conditions for suppressing the life of microbial associations. As a result of compression osteosynthesis with an open reposition with unsatisfactory standing of the fragments, the inflammatory process in the outbreak lasted a short time and ended in recovery. However, when all aseptic measures were observed and fragments were in perfect condition, unsatisfactory results were observed in 16% of cases of treatment of fusion disorders.

Numerous studies [11, 12, 13] of the principle of distraction of the pseudoarthrosis zone revealed the occurrence of elements of secondary bone formation at the ends of fragments under tension. At the same time, enchondral ossification and desmal osteogenesis gradually replace each other, and increased vascularization leads to the growth of bone glands along the bundles of collagen fibers, i.e. the formation of new bone tissue based on existing structures. In addition, in the dynamics of bone regeneration during distraction osteosynthesis, an increase in rosette-forming cells (E-ROCK) in the peripheral blood occurs, which is associated with the functional state of lymphopoiesis.

The essence of the invention lies in the fact that according to the method of treating a false joint of a tubular bone, comprising installing clamps made of a material with thermomechanical shape memory in the region of the false joint, a slit is made along the longitudinal axis of the bone through the region of the false joint (1.7-2.5 ) d, where d is the outer diameter of the bone at the level of the pseudoarthrosis, and two arcuate curved plates are used as fixators, which are pre-straightened and subsequently placed in the slot, installed in the counter cortical layers of the bone and orienting so that after the restoration of the initially given shape, the convexity of the arched curved plates was turned in opposite directions, and the free spaces of the slot are filled with small fragments of porous titanium nickelide, while the thickness of the plates is 0.7-1.2 mm, and their arc height and width are (0.2-0.3) d.

The invention is illustrated by drawings, on which:

figure 1 - design of the latch;

figure 2 - installation diagram of the clamps.

According to figure 1, the latch is an arcuate curved plate 1 with a thickness of 0.7-1.2 mm, length L = (1.4-2.2) d (d is the outer diameter of the bone at the level of the false joint). The width b and the height of the arc k of the plate are (0.2-0.3) d.

The plate is made of titanium nickelide of the ТН-IХЭ, ТН-10 or ТН-20 grades and is preformed at a temperature of 450-600 ° С.

The method is as follows.

The radiograph of the patient determines the location and size of the pseudoarthrosis, on the basis of which they select the parameters of the clamps 1 required to eliminate the defect.

Through a small incision in the skin, the bone is exposed at the level of the pseudoarthrosis and a circular saw is made to cut (cut) 2 bones through the region of the pseudoarthrosis so that the line of defect is located in the middle of the formed incision. Propyl is performed, if possible, with a deepening in the opposite cortical layer, but without going to the outer cortical surface of the bone, or through. The width of the cut is usually 1.0-1.5 mm, and the length is (1.7-2.5) d.

The plates 1 are cooled and straightened in a cooled state, and then they are sequentially introduced into the slot 2 and the first is placed in the opposite cortical bone layer, all the way to the inside on the cortical surface of the bone, and the second in the nearby cortical layer. In this case, the plates are oriented in such a way that when restoring the originally given shape, their convexity is turned in opposite directions. The free spaces of the slots are filled with small fragments 3 of porous titanium nickelide.

Due to contact heating, each of the plates tends to take a convex shape in the space bounded by the walls of the slot, compressing one of the walls with its converging ends and irritating-stretching the other from the side of the arc of the plate. And since multidirectional plates are used, the compression-distraction effect that stimulates the process of bone regeneration is experienced by both diametrically opposite cortical layers of the bone in the pseudoarthrosis. Crumbs of porous titanium nickelide, which has a through porosity, are the "scaffold" for the emerging bone tissue.

The surgical wound is sutured tightly. A shortened functional dressing in the form of a splint or capturing only one joint closest to the surgical wound is applied to the operated limb.

Thus, the proposed method allows simple means, without resorting to osteotomy and refreshing the ends of the fragments, without the use of extrafocal fixation devices, to stimulate reparative osteogenesis by creating a compression-distraction effect in the region of the false joint and thereby increase the effectiveness of treatment of the false joint of the tubular bone with a low invasiveness of the operation.

According to the description, the method can be carried out in clinical conditions with conventional instrumental equipment and using materials known in practice orthopedics, which confirms its industrial applicability.

List of references

1. A.S. USSR No. 1614801, IPC A 61 B 17/56, published December 23, 90

2. Makazhanov H.Zh., Makazhanov O.Kh. Autoplasty for false joints. - Alma-Ata: Kazakhstan, 1977.

3. A.S. USSR No. 1736457, IPC A 61 B 17/56, published 05/30/92

4. A.s of the USSR No. 1568991, IPC A 61 B 17/56, published 07.06.90

5. The application of the Russian Federation for invention No.2000130024, A 61 B 17/56, published on September 20, 2002.

6. Tkachenko S.S. Osteosynthesis // Guide for doctors. - L .: Medicine. - 1987.

7. Guide to osteosynthesis with fixators with thermomechanical memory. Part 1. Compressing staples and ring-shaped retainers, / ed. doctor of medical sciences V.V.Kotenko /. -Novokuznetsk .: VNPTS of implants with shape memory. - 1996 - S.60-62, Fig. 36, 37, prototype.

8. Rutsky V.V. Electrical stimulation of osteoreparation: Author. Diss. ... Dr. honey. sciences. - L., 1982.

9. Gaidukov V.M. False joints. - SPb .: Science. - 1995.

10. Gudushauri O.N. Extrafocal compression osteosynthesis in case of non-fused fractures and false joints: Abstract. diss. ... Dr. honey. sciences. - M., 1965.

11. Kovtun V.V., Makarevich S.P., Karchebny N.N. The experience of using external fixation devices in the treatment of fractures of limb bones, their complications and consequences // Orthopedics, traumatology. - 1990. - No. 10. - S. 36-38.

12. Shevtsov V.I., Makushin V.D., Kuftyrev L.M. Rehabilitation of patients with multiple false joints of long tubular bones.

13. Kummer F.J. et al. Closed treatment of canine nonunion by controlled compression and distraction using an Ilizarov fixator: a preliminary stady / F.J. Kummer, R.J. Meislin, A. Pankovich et. al. // J / Orthoped. - 1990. - V.13, No. 12. - R.1379-1381.

Claims (1)

A method of treating a false joint of a tubular bone, including installing clamps made of a material with thermomechanical shape memory in the false joint region, characterized in that a slot (1.7-2.5) d is made along the longitudinal axis of the bone through the false joint region, where d is the outer diameter of the bone at the level of the pseudoarthrosis, two arcuate curved plates are used as retainers, which are pre-straightened and sequentially inserted into the slot, setting bone and orient in opposite cortical layers so that after restoration of the initially given shape, the convexities of the arcuate curved plates are turned in opposite directions, and the free spaces of the slots are filled with a crumb of porous titanium nickelide, while the thickness of the arcuate curved plates is 0.7-1.2 mm, and their arc height and the width is (0.2-0.3) d.

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