RU2230513C1 - Method for repeatedly making prosthetic appliance of hip joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves removing proximal femur fragment and fractured femoral splinter of the endoprosthesis as a whole block, removing the distal fractured endoprosthesis splinter and bone cement. The so arisen bone defect is substituted with individually reproduced proximal fragment of the demur on the femoral endoprosthesis fragment under inspection.

EFFECT: avoided intertrochanteric area destruction.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in operations of endoprosthetics of the hip joint.

Hip replacement has taken a leading place in the surgical treatment of severe forms of hip joint pathology. This operation eliminates or significantly reduces pain, restores movement in the joint, provides supportability of the limb, improves gait and, as a result, significantly improves the patient's quality of life.

In the coming years after surgery, good and satisfactory results are observed in 80-90% of patients. However, with dynamic observation at a longer time, there is a tendency to a gradual decrease in the proportion of positive results. There is a need for revision operations (replacement of components or the endoprosthesis as a whole). One of the reasons for revision surgery is a fracture of the femoral component of the endoprosthesis. This is a well-known, although quite rare (0.28-1.1%) complication (V. Karptsov et al., 1994; Sherepo K.M., 1994; Wroblewsky, 1982).

According to the scientific literature, the following reasons can lead to a fracture of the femoral component of the endoprosthesis:

1. Incorrect centering of the femoral component of the endoprosthesis in the medullary canal of the femur (varus installation). This technical error leads to excessive load in the area of the / 3 of the femoral component, which causes a fatigue fracture of the structure.

2. Instability of the femoral component of the endoprosthesis, which may be caused by the resorption of the inner cortical layer of the bone marrow canal of the femur.

3. External traumatic effect on the femur.

4. Concealed technical marriage of a design or its low-quality manufacturing.

Replacing a broken femoral component of the endoprosthesis requires emergency surgery - re-endoprosthetics. However, the operation of endoprosthetics of the hip joint in case of a fracture of the femoral component of the endoprosthesis (especially with cement fixation) is a technically quite complicated and traumatic surgical intervention. Moreover, the main problems arise when removing the proximal fragment of the femoral component of the endoprosthesis and bone cement, by which it is fixed. Here are the main difficulties that arise:

a) Removal of bone cement and fracture of the femoral component of the endoprosthesis requires considerable physical effort and can lead to complete destruction of the intertrochanteric region of the femur.

b) If this does not happen, then the trochanteric region remaining after the removal of the fragment and bone cement is subjected to further resorption.

A known method of removing an intramedullary foreign body located in a retrograde manner (Neverov V.A., Zakari S.M. Revision hip joint replacement. - St. Petersburg, 1997, p. 57). Its essence consists in opening the knee joint, trepanation of the medullary canal through the intercondylar space and knocking the femoral component of the endoprosthesis from the bottom up with a thin rod.

However, it has a significant drawback: in this way it is almost impossible to remove the proximal fragment of the femoral component of the endoprosthesis.

Closest to the claimed solution is a method of extracting a foreign body from the bone marrow canal of long tubular bones and a device for its implementation (positive decision for the grant of patent No. 96103689/14/006903 /). Removal of a fragment of the femoral component of the endoprosthesis is carried out by a series of small-amplitude vibrations along the axis of the femur in the opposite direction to the open area of the medullary canal. It is carried out using a fairly complex device (vibrator, special nozzle, sweep). However, it also has significant disadvantages:

1. Not all medical institutions have this device in their arsenal.

2. A short fragment of the femoral component of the endoprosthesis fixed with bone cement is very difficult to remove in this way without destroying the bone tissue of the trochanteric region.

The purpose of the proposed method: to improve the results of endoprosthetics of the hip joint.

The objectives of the proposed method:

1. To carry out the least traumatic removal of the proximal fragment of the femoral component of the endoprosthesis implanted on bone cement.

2. Replace the resulting bone defect with individually reconstituted bone cement with the proximal femur on the revised femoral component of the endoprosthesis.

The essence of the proposed method is to remove the proximal fragment of the femur and the broken fragment of the femoral component of the endoprosthesis (fixed with bone cement) as a single unit, remove the distal fragment of the endoprosthesis and bone cement and replace the resulting bone defect with individually reconstituted proximal femur on the revision femoral component of the endoprosthesis.

The proposed method is as follows.

In the preoperative period, using an X-ray examination, the anatomical dimensions of the proximal fragment of the femur are determined, which are supposed to be removed during the operation of the endoprosthesis of the hip joint. Then, based on these data, individual reconstruction of bone cement is carried out on the revision component of the endoprosthesis of the proximal femur fragment (RF patent for invention No. 2195219).

Under general anesthesia with an external lateral incision (from the projection of the acetabular component of the endoprosthesis and 5-7 cm below the site of the fracture of the femur and the femoral component of the endoprosthesis), access to the proximal femur. The neck and head of the endoprosthesis are isolated. The proximal fragment of the femur (together with the fragment of the femoral component of the endoprosthesis fixed with bone cement located in it) is isolated and removed in a single block. A distal fragment of the femoral component of the endoprosthesis and bone cement are removed from the medullary canal of the distal femur fragment. Carry out cement implantation of the revision femoral component of the endoprosthesis with individually recreated proximal femur. Stitching and drainage of the surgical wound is carried out.

Clinical example.

Patient Krylova O.A., 62 years old, East. b. No. 38/03, After a household injury, on 02.01.02, a subcapital fracture of the neck of the right thigh occurred (drawing, a). In the department of pathology of large joints of RosNIIITO them. P.P. Vredena (St. Petersburg) performed an operation - bipolar endoprosthesis replacement of the right hip joint with cement fixation of the femoral component (drawing, b). 11 months later, during a traffic accident, a fracture occurred in / 3 of the right thigh and the femoral component of the endoprosthesis (drawing, c). The patient was hospitalized in the Department of Pathology of Large Joints of RosNIIITO named after P.P. Harmful. During the examination and preparation for the endoprosthetics operation, the damaged lower limb was fixed by the skeletal traction system. In the preoperative period, an individual reconstruction of the proximal femur was performed using bone cement on the revision component of the Phoenix endoprosthesis. 01.16.03 an operation was performed - removal of the proximal femur in a single unit with a proximal fragment of the femoral component of the endoprosthesis and the distal fragment of the femoral component of the endoprosthesis (drawing, d), total re-endoprosthesis of the right hip joint (drawing, e). The postoperative period was uneventful. Primary wound healing, sutures were removed on the 12th day. The patient is trained to walk on crutches. The length of the limbs is the same. She received rehabilitation treatment: FTL, exercise therapy to increase the range of motion in the operated hip joint. The function of the hip joint: flexion - 90 °, extension - 180 °, abduction - 25 °, adduction - 20 °.

Claims (1)

A method of endoprosthesis replacement of the hip joint, characterized in that in case of fractures of the proximal femur and the femoral component of the endoprosthesis with cement fixation, the proximal fragment of the femur and the fragment of the femoral component of the endoprosthesis are removed in a single block, then the distal fragment of the fractured femoral component is removed and the endoprosthesis and bone are removed femoral component with individually reconstituted bone cement with the proximal femur .