RU2257173C1 - Method for healing the bones of knee joint at osteomyelitic lesion - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should remove nonviable tissues, apply femoral end into the edges of both opposite shin bones, perform fixation till fusion with the help of compression-distraction apparatus. In peculiar case, at treating affected articular ends one should dissect and keep proximal fibular end. In peculiar case, at bringing together opposite ends of the bones the area of their contact should be overlapped with dissected fibular fragment and patella. The method enables to increase mechanical strength of fusion.

EFFECT: shortened terms of therapy.

2 cl, 4 dwg, 1 ex

Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with lesions of the knee joint of various etiologies.

A known method of replacing an extensive defect of the tibia (Application No. 93045682 of the Russian Federation, MKI ⁶ A 61 17/56. The method of replacing an extensive defect of the tibia / Larionov A.A., Lapynin A.I., RTC “WTO” named after academician G. .A. Ilizarova (RF) .- Declaration 09.09.93. Publish. 20.03.96; Bull.8).

However, this technique is advisable to apply with equal thickness of bone fragments.

A known method of fusion of bones in the absence of disputes of the knee joint is when a hole is made in one of the fragments having a larger diameter, and the other is immersed in it. Moreover, the periosteum covers the place of contact, and the patella fits into this area (Shevtsov V.I. et al. Method of transosseous osteosynthesis in the treatment of patients with chronic osteomyelitis / V.I. Shevtsov, A.I. Lapynin, N.M. Klyushin. - GIPP “Trans-Urals”, 2001, 221 p., P.23).

However, with an extensive lesion, it is not always possible to form a hole, and the periosteum is usually absent. At the same time, fitting of the patella with such fixation of fragments requires filigree technique during its processing.

The present invention is to develop a method of fusion of the bones that form the knee joint, with their osteomyelitis lesion, which provides increased mechanical strength of the fusion and reduction of treatment time.

The problem is solved in that in a method including the fusion of bones of the knee joint in osteomyelitis lesion, removal of non-viable tissues, intercompression of fragments and fixation to fusion using a compression-distraction apparatus, during the compression, the end of the femur is dosed into the ends of both opposite shin bones, and when processing the affected articular ends, the proximal end of the fibula is cut off and the proximal end of the fibula is preserved, while the area of opposing ends of the bones when compared AI overlaps truncated fragment of the fibula and patella.

The present invention is illustrated by a description, a specific example of its implementation and the attached copies of x-rays, on which:

Figure 1 is a copy of the x-ray of the patient before treatment;

Figure 2 is a copy of the x-ray of patient B. after sequestrnecrectomy;

Figure 3 is a copy of a radiograph of patient B. after creating a block of four bones;

Figure 4 is a copy of the radiograph of patient B. after treatment.

The method is as follows.

After anesthesia and limb treatment, osteosynthesis of the thigh and lower leg is performed by the Ilizarov apparatus. In this case, the locking knitting needles are carried out at the level of the middle and lower third of the thigh, proximal and middle third of the lower leg. In a tense state, the spokes are mounted in external supports installed at the appropriate level, which are connected by threaded rods to two systems on the thigh and lower leg. Through a soft tissue incision in the projection of the affected knee joint, access is made to the bones that form it: the femoral and tibial, fibular and patella. Then, depending on the nature of the lesion, they are processed to remove all non-viable tissues, and the proximal part of the fibula is cut off and stored.

The affected articular ends are treated in such a way that, after approaching, an end emphasis of the femur in the end part of the tibia and fibula is formed, and the contact area is overlapped by a cut off fragment of the fibula and patella.

The operation is completed by wound closure, aseptic dressings and stabilization of the apparatus system.

Dosed compression begins five days after surgery and continues until the femur contacts the butt of the tibia and fibula in a regime of 0.25 mm four times a day. To achieve a dense overlap of this area with a cut off fragment of the fibula and patella, they can be fixed with needles to the femoral-tibial block.

Next, the apparatus is transferred to the fixing mode, which is maintained until a stable static-dynamic load is obtained.

The restoration of the required limb length is performed at the second stage of treatment or directly during the fusion. In the latter case, in addition to the processing of the articular ends, an extension osteotomy of the lower leg or thigh bones is performed and a regenerate of the required size is formed. The adhesion strength is controlled by clinical testing and radiological.

The practical use of the method is illustrated by a clinical example.

A 37-year-old patient V. was admitted to the clinic of the RTC “WTO” named after academician G.A. Ilizarov with a diagnosis of chronic post-traumatic osteomyelitis of the left thigh and fistulous tibia. Pathological supracondylar fracture of the hip. To eliminate the inflammatory process zone and restore limb support ability, the patient underwent surgery: sequesternectomy of the left femur, tibia, fibula osteotomy in the upper third, osteosynthesis of the Ilizarov hip and lower leg. In the postoperative period, metered approximation of fragments to contact was carried out with the formation of a block of four bones from the femur, tibia, fibula and patella.

As a result, the purulent process was stopped and fusion of fragments in the correct position was achieved.

The proposed method of fusion of the bones of the knee joint in osteomyelitis lesions is used in the clinical departments of the RTC “WTO” named after Acad. G.A. Ilizarova.

Claims (3)

1. A method of fusion of knee bones in osteomyelitis lesions, including removal of non-viable tissues, intercompression of fragments and fixation to fusion using a compression-distraction apparatus, characterized in that during compression, the end of the femur is dosed into the ends of both opposite bones of the lower leg. 2. The method according to claim 1, characterized in that when processing the affected articular ends, the proximal end of the fibula is cut off and maintained. 3. The method according to claim 1, characterized in that when comparing the opposing ends of the bones, the area of their contact is blocked by a cut off fragment of the fibula and the patella.

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