RU2233638C2 - Method for operative treatment of false articulation in proximal department of brachial bone - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should conduct economical resection of false articulation's ends, telescopically introduce autotransplant out of patient's fibula to fix it in diaphysis with a screw. Then comes osteosynthesis performed with nickelide-titanium clamps with effect of thermo-mechanical memory of shape so, that one of the construction stems should fix diaphysial part of brachial bone and a transplant and another one - the head only, moreover, constructions made of titanium nickelide should be introduced into brachial bone fragments from diametrically opposite directions. The method suggested enables to provide stability of fractures and earlier restoration of articular movements.

EFFECT: higher efficiency of therapy.

1 dwg, 1 ex

Description

The invention relates to medicine, namely to orthopedics and traumatology, and may be applicable for surgical treatment of the false joint of the proximal humerus.

In surgical treatment of false joints of the humerus, the main goal is to ensure complete stability of the fragments. The latter is achieved through the use of various kinds of metal structures. But due to the fact that the processes of bone reparative regeneration are suppressed with false joints, along with strong fixation of fragments, methods of stimulating bone formation processes should be used. For this purpose, most authors perform osteoplastic surgery with transplantation of autografts in the region of the pseudoarthrosis taken from fragments of the humerus or from more distant places. Others use allografts to stimulate osteogenetic processes. As with autoplasty and with alloplasty, grafts are usually implanted extramedullary (Abramov Yu.G. - On the assessment of bone homoplasty in the treatment of non-healing fractures and pseudoarthrosis of the extremities. - Orthopedics, traumatology and prosthetics. - 1969. - No. 9. - - P.43-46; Tkachenko S.S., Gaidukov V.M. On the treatment of pseudoarthrosis of the humerus. - Orthopedics, traumatology and prosthetics. - 1983. - No. 1. - P.4-8).

A known method of surgical treatment of the above pathology is a prototype in which a bone allograft is used as a replacement and binding material. Fragments are isolated from the anterior-medial access, and scar-altered tissue is excised. After removal of the altered tissues in the proximal fragment (head of the humerus), a nest up to 3 cm deep and 2-2.5 cm in diameter is formed from the side of the plane of the false joint. The distal end of the allograft is tightly inserted into the bone marrow canal of the peripheral fragment of the shoulder to a depth of 7-8 cm, and the upper end of the allograft into the formed nest in the proximal fragment (head of the humerus) by 3 cm. Thus, according to the author, there is a strong connection of fragments of the humerus. The wound is sutured in layers and a thoracobrachial gypsum dressing is applied (Makarov A.P. Intramedullary osteosynthesis with a homograft for complex and chronic fractures of the surgical neck of the humerus. - Abstract of dissertation for the degree of Doctor of Medical Sciences. - L., 1972, S.15-17) . However, the proposed method has several disadvantages. Firstly, long-term external immobilization is necessary until the bone fragments are fused, which, in turn, even when the fusion has taken place, leads to stiffness of the shoulder joint. Secondly, fragmentation and resorption of the allograft is possible, which leads to the loss of stable fixation and, as a result, non-fusion of bone fragments of the humerus, which leads to disability of the patient.

The technical result (medical and social effect) of the invention consists in the early restoration of the full range of movements in the shoulder joint while fully maintaining the anatomical relationship.

This is achieved due to the fact that they produce an economical resection of the ends of the pseudoarthrosis, bone autoplasty with a fibular graft and osteosynthesis with nickel titanium staples having the effect of thermomechanical shape memory.

Among the well-known technical solutions, objects of a similar purpose containing distinctive features from the prototype were not found. The authors are not aware of technical solutions with the characteristics indicated in the claims aimed at achieving the same goal as the claimed method of surgical treatment of the false joint of the proximal humerus as claimed in the invention.

The method is as follows. One of the known approaches exposes fragments of the humerus, excise scar tissue in the area of the pseudoarthrosis, and make an economical resection of the ends of the pseudarthrosis. In a known manner, an autograft from the fibula is taken up to a length of 80.0 mm. An autograft is introduced telescopically into the shoulder diaphysis over a length of 50.0-55.0 mm. The graft in the diaphysis is fixed with one screw, which is inserted perpendicular to the axis of the diaphysis through both cortical layers of both bones, and the end protruding in the proximal direction is processed conically. Two channels of different diameters and depths are formed in the head of the shoulder into which the proximal end of the humerus diaphysis and the protruding part of the autograft are respectively telescopically inserted. The direction of the canals should be chosen so that during the adaptation of the fragments, the magnitude of the cervical-diaphyseal angle of the humerus is restored - 130-140 °. The final fixation of the fragments is carried out by introducing two staples made of titanium nickelide, which have the effect of thermomechanical shape memory, so that one of the legs of the structure fixes the diaphyseal part of the humerus and the graft, and the other only the head. Titanium nickelide structures are introduced in the same plane towards each other. The wound is sutured in layers tightly. Immobilization is done with a Deso dressing for 4 weeks.

The essence of the application for the invention is illustrated by the drawing, which shows the position of fragments, graft and metal after surgery, where the proximal humerus (1, 2) is fixed to the diaphysis (4) with titanium nickelide structures (6) and a bone allograft (3), the last fixed in the bone marrow canal with a screw (5). The diaphysis of the humerus and the graft are telescopically inserted into the proximal region.

The consequence of the above operation provides an increase in the contact area of both fragments and creates additional stability, the use of structures with thermomechanical shape memory provides sufficient compression for the entire period of consolidation of the fragments and the graft, which achieves the main objective of the invention.

Clinical example. B-I R., 61 years old, and / b No. 3010/94, was admitted to the department of pathology of the shoulder joint with a diagnosis of False joint of the surgical neck of the left humerus. The injury is 1.5 years old. 06/08/94, performed surgical intervention according to the method described above. 6 months after the operation, the patient is fully self-serving, limb movements are fully restored with additional inclusion in the function of the scapula.

Claims (1)

A method for surgical treatment of the pseudoarthrosis of the proximal humerus, consisting in economical resection of the ends of the pseudoarthrosis, bone autoplasty with a fibular graft introduced telescopically, characterized in that the autograft is fixed in the diaphysis with a screw and osteosynthesis is performed with nickel titanium brackets having the form of a thermomechanical memory so that one of the legs of the structure fixes the diaphyseal part of the humerus and the graft, and the other only the head, and Design of NiTi introduced into fragments humerus from diametrically opposite directions.