RU2242945C2 - Surgical method for treating the cases of patella fracture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves placing interlaced Cuneo sutures with lavsan threads over femoral quadriceps muscle and proper patellar ligament. Thread ends are pulled through two parallel patellar bone tunnels and tied near the superior and inferior poles to maintain dynamic autocompression of fragments.

EFFECT: enhanced effectiveness of treatment.

3 dwg

Description

The invention relates to medicine and relates to methods for surgical treatment of diseases and consequences of injuries of the musculoskeletal system, in particular patients with a fracture of the patella.

The following methods of treating patella fractures are known:

1. The Wrecking Method [1].

A feature of the method is the cutting of a U-shaped flap from its own ligament of the patella, rapprochement of fragments of the patella and fixing them with a cut flap.

The disadvantages of the method: the weakening of its own ligament of the patella, insufficient strength of fixation of the fragments by sutures superimposed on the periosteum and fragments of the patella.

2. The method of Schulze [2].

The essence of the method is the rapprochement of fragments with special forceps, suturing on the lateral extensor apparatus and a circular periepellar silk suture.

The disadvantage of this method is the injury of the extensor apparatus significantly reduces the tensile strength of the quadriceps femoris and other parapatellar structures due to the injury itself and degenerative processes. In this regard, the strength of fixation with sutures through these tissues may be insufficient.

3. Method C. N. Izmalkova [3].

The essence of the method is the formation along the axis of the patella in both fragments of two parallel bone tunnels through which the lavsan thread is held in the form of a double loop. The ends of the thread suture the tendon of the rectus femoris muscle and bind together. The method provides dynamic compression of fragments.

This method is taken as a prototype.

The disadvantage of the prototype is the low efficiency of treatment in cases where the distal fragment is small.

The aim of the invention is to increase the effectiveness of treatment in cases where the distal fragment is small.

This goal is achieved by imposing interlocking sutures of Kuneo, the ends of which are drawn through the bone tunnels and tied at the upper and lower poles of the patella.

In the graphic image fig. Figure 1 shows the suturing of Kuneo 1 on its own ligament of the patella 2 and the tendon of the quadriceps femoris 3, Fig. 2 - formation of bone tunnels 4 in patella fragments 5, Fig. 3 - holding the threads of the patellar sutures 6 in the distal and proximal directions and tying the threads at the upper and lower poles of the patella.

The method is as follows. Soft tissues are dissected layer by layer with an internal parapatellar incision up to 10 cm long, the patella, the patellar ligament and the tendon of the quadriceps femoris are exposed. On the ligament of the patella and tendon of the quadriceps femoris, Kuneo sutures are made with lavsan threads. Fragments of the patella after removal of blood clots from the joint cavity are compared and held with forceps. They form two parallel tunnels in the longitudinal direction. The ends of the threads of the upper seam Kuneo spend in the distal direction, the lower seam Kuneo in the proximal direction. After comparing the bone fragments and restoring congruency in the patellofemoral articulation, the sutures are tied at the upper and lower poles of the patella. The continuity of the damaged parapatellar extension is restored by the interrupted sutures of the chrome-plated catgut. Tying the threads at the upper and lower poles of the patella creates simultaneous compression of the associated bone fragments. In biomechanical terms, a dynamic physiological bilateral compression is created. Contraction of the quadriceps femoris muscle pulls the lower fragment to the upper fragment, and the threads of the lower suture of Kuneo, tied at the upper pole of the patella, will hold the upper fragment in place. Thus, a physiological compression of the fragments is created, due to the contraction of the quadriceps femoris. Stable, non-decreasing over time fixation of the fracture will reduce the time of immobilization and restoration of limb function. The proposed method can be used to separate the patella from its own ligament. After suturing the wound, a gypsum boot is applied for 6 weeks.

The fundamental difference between the proposed method and the known one is the application of intermittent sutures by Kuneo lavsan to the tendon of the quadriceps femoris muscle and the patellar ligament, the suture through the vertical channels and tying of the ends of the sutures at the upper and lower poles of the patella, creating a dynamic compression of the patella fragments.

The advantage of the proposed method over the known is as follows: improves the strength of the fastening of the fragments with dynamic autocompression. This is achieved by suturing Kuneo on his own ligament of the patella and the tendon of the quadriceps femoris, drawing the ends of the threads through the bone tunnels of the patella and tying them at the upper and lower poles of the patella. The method can be applied at any level of fracture of the patella and separation from its own ligament.

The proposed method with a positive effect was performed in a patient with a fracture of the patella.

Patient Sh., 63 years old, was admitted to the clinic of traumatology and orthopedics of Samara State Medical University March 20, 2002 with a diagnosis of a stale fracture of the right patella. 2 months have passed since the moment. March 25, 2002, the operation was performed according to the proposed method. The postoperative period was uneventful.

The plaster cast is removed after 6 weeks. Postoperative rehabilitation was carried out. The result of the operation is good.

The method can be recommended in practical medicine.

Sources of information:

1. Guide to orthopedics and traumatology. M., 1968, v. 3, p. 678.

2. Guide to orthopedics and traumatology. M., 1968, v. 3, p. 679.

3. RF patent No. 2018278, M. Cl. A 61 B 17/56, 1994

Claims (1)

A method of surgical treatment of patella fractures by forming bone fragments in the fragments of the tunnels and suturing, characterized in that, in order to increase the effectiveness of the treatment, Kuneo sutures are placed on the patellar ligament and tendon of the quadriceps femoris, the ends of the threads are drawn through the bone tunnels of the patella and they are tied on the upper and lower poles of the patella.

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