RU2260392C2 - Method for elongating extremity bones - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out double osteotomy of bone to be elongated when bone as minimum. Dosed selected fragment distraction is cyclically done in continuously variable tempo at each elongation level with mean distraction tempo being kept constant over the whole segment as 1.25 mm per day. Stable fixation is carried out until the formed bone regenerate turns into mature bone tissue.

EFFECT: enhanced effectiveness of soft tissue and neurovascular formations adaptation to variable sizes of extremity segment.

8 dwg

Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with shortened limbs.

A known method of lengthening the bones of the extremities [1] by double osteotomy and dosed distraction of the selected bone fragments to restore its length with subsequent stable fixation using a compression-distraction apparatus. At the same time, the rate of distraction at each level of osteotomy throughout the entire elongation period is maintained uniform, within one millimeter per day.

However, with large shortenings, a uniform rate of distraction causes inhibition of the osteogenesis process, which leads to the formation of an inferior bone regenerate, the need to stop the distraction, and perform additional surgical procedures, including rheostomy. In general, this increases the duration of treatment, requires additional courses of functional rehabilitation.

A known method of lengthening limb bones [2] by multilocal osteotomy and dosed fragment distraction, in which at the final stage, as a rule, at the level of distal osteotomy, a directed decrease in its daily rate is carried out, which prevents the formation of an inferior regenerate.

However, a partial one-time decrease in the rate of distraction at one of the levels of bone lengthening does not provide stimulation of the process of distraction osteogenesis and does not cause, especially with large values of elongation, timely adaptation of soft tissues and neurovascular formations to the changed sizes of the reconstructed segment.

Thus, when using this method, the development of complications is also not excluded: contractures, pains, paresis, etc., requiring additional courses of rehabilitation treatment and an increase in its total duration.

The objective of the invention is to develop a method of lengthening the limb bone, preventing the development of postoperative complications and providing a reduction in its total duration by creating optimal conditions for tissue regeneration.

This problem is solved by the fact that in the method of lengthening the bone of the limb, which includes performing a minimum of double osteotomy of the elongated bone followed by dosed distraction of the selected fragments and their stable fixation until the sections of the formed bone regenerate are rebuilt into mature bone tissue, the bone fragments are distracted at a constantly changing rate at each of the elongation levels, while maintaining the average rate of distraction for the entire segment within 1.25 mm per day.

The inventive method is illustrated by a description and an example of clinical use.

The method is as follows.

After anesthesia and treatment of the operative field, the osteosynthesis of a shortened segment is performed using known techniques, holding the knitting needles, attaching them to the supports of the compression-distraction apparatus and performing the required amount of bone osteotomy.

In the postoperative period, dosed distraction of the selected fragments is performed until the required segment length is restored, during which its rate for each of the elongation levels is constantly changed, keeping the average rate of distraction for the entire elongated segment not more than 1.25 mm per day. Moreover, under the average rate of distraction for the entire segment, the ratio of the sum of the rates of distraction at each of the elongation levels to the sum of the latter is taken.

So, for example, if on the first day of distraction with double osteotomy of the bone at the level of the proximal elongation, distraction is performed at a rate of 1.25 mm per day, and at the level of the distal elongation at a rate of 0.25 mm per day for 3-4 doses, then on the second day, the distraction rate for the proximal level is set, for example, 1 mm per day, and the distal - 0.5 mm per day. On the third day, the rate of distraction at both levels can be equal to 0.75 mm per day, and on the fourth, respectively 0.5 mm per day and 1 mm per day.

In the future, the change in the rate of distraction at each of the levels can be made in the reverse order, and after the return of the rate of distraction to the initial values at the proximal and distraction levels, it changes again and is thus cyclically maintained until the necessary segment length is restored.

In this case, the initial rate of distraction for each of the elongation levels is determined based on the patient's age, condition and stock of soft tissues. But in any case, the average daily rate of distraction for the entire elongated segment should not exceed 1.25 mm per day.

Upon completion of distraction, the apparatus is transferred to the stable fixation mode, which is maintained until the sections of the formed distraction regenerate are reconstructed into mature bone tissue.

The practical use of the method is illustrated by the following clinical observation.

Patient I., 16 years old, diagnosis: achondroplasia, short stature (Figs. 1, 5). To increase the longitudinal dimensions of the shoulders, an operation was performed: double osteotomy of both humerus bones; osteosynthesis by Ilizarov apparatus.

In the postoperative period, starting from the fifth day, dosed distraction of the selected fragments was carried out using a compression-distraction apparatus, and the rate of distraction on the right shoulder throughout the extension period at each level cyclically changed, and on the left remained the same - at the level of 1 mm in day.

On the right shoulder on the first day of distraction, its rate was set for the proximal level of 1.25 mm / day, for the distal level of 0.25 mm / day.

On the second day, distraction was performed at a rate of 1.0 mm / day at the proximal and 0.5 mm / day at a distal level.

On the third - 0.75 mm / day at each of the elongation levels.

On the fourth - 0.5 and 1.0 mm / day.

Starting from the fifth day, the change in the rate of distraction at the elongation sites was performed in the reverse order: they increased by 0.25 at the proximal and decreased by 0.25 at the distal.

The distraction was carried out for 59 days, cyclically changing its pace at each level to increase the size of the right shoulder by 9 cm (Fig.6). After that, the apparatus was transferred to a stable fixation mode, which was maintained for 21 days (Fig. 7). By the end of the indicated period of fixation, a radiological picture was noted characterizing the degree of maturity of the formed areas of bone regenerate sufficient for the dismantling of the apparatus. In this case, an increase in its density was observed uniformly over the entire area with the absence of a radiologically visible connective tissue layer. The movements in the shoulder and elbow joints during the entire treatment period were kept within the normal range; the patient did not show complaints of special pain. The treatment period was 84 days (Fig. 8).

With lengthening of the left shoulder, which was performed with the same uniform rate of distraction of 1 mm per day at each level of osteotomy, by the end of the distraction period, an underdevelopment of the regenerate was observed, formed at the distal level of elongation with its partial thinning, which necessitated a decrease in the rate of distraction to 0.5 mm per day, increased the duration of the fixation period to 58 days (Fig.1-4).

At the same time, movements in the shoulder and elbow joints were limited due to pain and the development of flexion-extensor contracture of these joints, which required an additional rehabilitation course after the dismantling of the apparatus. The total treatment period for the left shoulder was 118 days (without rehabilitation).

Thus, the use of the method prevents the development of postoperative complications and reduces the overall duration of treatment by creating optimal conditions for tissue regeneration.

Sources of information

1. Popkov A.V., Shevtsov V.I. Achondroplasia. / A guide for doctors. - M.: Medicine, 2001, p. 89-91.

2. In the same place, with. 192-193.

Claims (1)

A method of limb bone lengthening, comprising performing a minimum of double osteotomy of an elongated bone followed by dosed distraction of the selected fragments and their stable fixation until the sections of the formed bone regenerate are rebuilt into mature bone tissue, characterized in that the distraction of the bone fragments is performed cyclically, with a constantly changing rate on each of levels of elongation, while maintaining the average rate of distraction for the entire segment within 1.25 mm per day.

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