RU2263481C2 - Method for treating inborn defect in tibial development - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: on distraction fibular descending and removing a distraction apparatus one should dissect patella's own ligament against abnormally low located site of fixation, in patient's femoral inter-condylar fossa one should form a cartilaginous fragment, bend it aside and remove underlying trabecular bone, then this fragment should be applied onto the bottom of this fossa to arrange a caput there, as for patella it should be located onto its typical place. Patella's own ligament should be sutured distally against proximal growth area of patient's fibula that provides, thus, both a support and a function of a limb.

EFFECT: higher efficiency of therapy.

4 dwg

Description

The invention relates to the field of medicine, namely to orthopedics and traumatology.

There is a method of treating congenital malformation of the tibia, which consists in the distraction reduction of the fibula with the subsequent formation of femur-fibula synchondrosis or synostosis (Shevtsov V.I., Makushin V.D., Kuftyrev L.M., Aranovich A.M., Chegurov OK, Ismayilov G.R. Treatment of congenital malformations of the tibia, - Kurgan: Zauralie, 1999).

The disadvantage of this method is the lack of mobility at the level of the formed joint.

The objective of the invention is to increase the efficiency of surgical treatment of congenital malformation of the tibia by creating a movable femoral-fibular joint that performs the function of the knee joint and restores the supporting and motor functions of the lower limb.

Figure 1 shows the initial state of the lower limb. Figure 2 shows the relationship between the femur and fibula after lowering the latter in a distraction apparatus. Figure 3 shows a diagram for creating a subchondral groove. Figure 4 shows the state after repositioning of the head of the fibula into the subchondral deepening of the pineal gland of the femur.

The method is as follows. The first step is applied to the Ilizarov distraction apparatus on the lower limb. Two annular supports are superimposed on the thigh (figure 1 position 1), one fibula (figure 1 position 2), one on the foot. Distraction is performed at the usual rate in order to lower the fibula until its head (figure 2 position 3) is distal to the distal epiphysis of the femur (figure 2 position 4) by 4-5 cm.

The second stage, after removing the distraction apparatus from lateral access, cuts off its own ligament of the patella (Fig. 2, position 5) from the abnormally low located attachment point. The lower surface of the distal pineal gland is exposed. In the intercondylar fossa, a cartilaginous flap is formed (Fig. 3, position 6) 2 cm wide more than the diameter of the head of the fibula. The latter bends and through the resulting defect in the cartilaginous surface with a Volkmann spoon, the underlying spongy bone tissue of the pineal gland is removed, as a result of which a depression is formed (Fig. 3, position 7). The cartilaginous flap is placed on the bottom of the formed recess (figure 4, position 8). The head of the fibula is installed in this recess (figure 4, position 9) and the achieved position is fixed with 2-3 knitting needles at an angle between the femur and fibula of 150 °. The patella (Fig. 4, position 10) is installed in its typical place, and its own ligament (Fig. 4, position 11) is hemmed with Dacron thread 2 cm distal to the proximal sprout of the fibula (Fig. 4, position 12). The wound is sutured in layers. The limb fits into the rear plaster cast.

The proposed method allows you to create a movable joint at the level of the knee joint and improve the functional state of the lower limb.

Claims (1)

A method of treating a congenital malformation of the tibia, including distraction lowering of the fibula to the location of its head distal to the distal epiphysis of the femur with subsequent fixation of the limb, characterized in that after removal of the distraction apparatus, the patellar ligament is cut from the abnormally low attachment point in the intercondylar fossa the bones form a cartilaginous flap larger than the diameter of the head of the fibula, bend it and remove the underlying sponge yu bone tissue flap is placed at the bottom of the recess into which the head of the fibula, patella set at a typical place, own a bunch sutured distally to the proximal fibula sprout zone.

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