RU2271766C2 - Method for lengthening a tubular bone - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should affect segment's integrity followed by dosed movement of fragments with apparatus of external fixation along helical trajectory at their deviation against longitudinal axis. The innovation suggested enables to develop a valuable bony regenerate.

EFFECT: higher efficiency.

5 dwg, 1 ex

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 tubular bone, providing for the violation of the integrity of the bone and the dosed longitudinal movement of the selected fragments by the necessary amount using an external fixation apparatus (Achondroplasia. Manual for doctors / Edited by A.V. Popkov, V.I. Shevtsov. - M .: Medicine, 2001 .-- p. 93-95).

However, the use of this method is associated with long periods of treatment, in addition, during the elongation of segments by a large amount, patients develop complications in the form of neurological disorders and inferiority of the formed bone regenerate.

A known method of lengthening the tubular bone by multilocal violation of the integrity of the bone segments and the dosed longitudinal traction of several bone fragments simultaneously (Achondroplasia. A guide for doctors / Edited by A.V. Popkov, V.I. Shevtsov. - M .: Medicine, 2001. - p. 95-100).

However, the use of this method is also associated with the possibility of obtaining inferior bone regenerate, which is due to the individual regenerative abilities of patients.

The objective of the invention is to develop a method for lengthening the tubular bone, which prevents the development of postoperative complications due to the formation of volumetric bone regenerate in areas of distraction lengthening of the segment.

This problem is solved by the fact that in the method of lengthening the tubular bone, including violation of the integrity of the segment and the dosed longitudinal movement of the selected fragments by the necessary amount using an external fixation device, the dosed movement of the fragments is carried out along a spiral path.

The inventive method is illustrated by a description, an example of practical use and illustrative material which depicts:

figure 1 - x-ray of the legs of the patient before treatment;

figure 2 - x-ray of the legs of the patient after violation of the integrity of the tibia;

figure 3 - x-ray diffraction of the legs of the patient in the process of distraction;

figure 4 - photographic x-ray of the legs of the patient in the process of fixation;

5 is a photographic x-ray of the legs of the patient after treatment (at the time of dismantling the apparatus).

The method is as follows.

After anesthesia and treatment of the surgical field, osteosynthesis of a shortened segment is performed by known methods. In the course of its implementation, depending on the chosen option for lengthening - monolocal or multilocal, the required number of spokes is carried out transversely, which are attached to the external supports of the device in a taut state. The latter are interconnected by threaded rods and hinged nodes, providing a dosed multi-plane displacement of the supports relative to each other. Through minimal incisions of the soft tissues, they access the surface of the bone segment and perform its osteotomy (corticotomy) at one or more levels. After performing control radiography, the wounds are sutured, the apparatus systems are stabilized.

In the postoperative period, metered longitudinal dilution of the fragments is carried out, moving them along a spiral trajectory with partial axial deviation. Such a movement can be performed, in particular, by creating distraction forces at a rate of 0.5-1.0 mm per day in series across all the rods connecting the supports of the apparatus. Moving along the indicated trajectory has a stimulating effect on the distraction bone regenerate formed between the fragments, which consists in a sequential effect on the peripheral areas around the perimeter. This leads to its uniform development over the entire length in a volume exceeding the diameter of the maternal fragments. This movement of the fragments is carried out until the required longitudinal dimensions of the bone segment are achieved. The duration of the subsequent fixation period is set depending on the timing of the reconstruction of the sections of the formed regenerate into mature bone tissue.

After dismantling the apparatus, additional immobilization of the limb, as a rule, is not required. The patient is prescribed a course of exercise therapy.

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

Patient K., 20 years old, was admitted to the clinic of the State Research Center "WTO" named after Acad. G.A. Ilizarova with a diagnosis of subjectively low growth.

To increase the longitudinal dimensions of the lower legs, the patient underwent surgery: osteotomy of the tibia; osteosynthesis by Ilizarov apparatus.

During the operation, four knitting needles were inserted through the proximal and distal metaepiphyses of the tibia and two through the middle part of their diaphysis to fix fragments of the tibia bones. In a tense state, the spokes were fixed on the external supports of the apparatus, which were connected to each other with the possibility of a metered, multi-plane movement with the help of threaded rods and hinge assemblies. Tibia osteotomy was performed through soft tissue incisions in the proximal tibia.

In the postoperative period, starting from the 4th day after the operation, dosed longitudinal distraction of the fragments was carried out with an average rate of 0.5-1.0 mm per day. At the same time, the selected distal fragments of the tibia were moved along a spiral-shaped trajectory with a 5-10 ° partial deviation from the longitudinal axis. The specified movement was carried out by alternately, sequentially creating traction forces along the rods connecting the supports with the spokes fixing the proximal and distal fragments of the tibia. The total duration of traction in the above manner was 92 days.

On control radiographs performed during the entire period of distraction, as well as during the subsequent fixation period of 84 days, the formation of distraction bone regenerate was uniform throughout the area of contact with the maternal fragments. Its diameter in the middle part exceeded, on average, 1-2 mm on each side of the diameter of the maternal bone, and the optical density, with the exception of the zone of active osteogenesis, approached the optical density of the adjacent areas of the bone.

As a result of treatment, the total duration of which was 181 days, an increase in the longitudinal dimensions of both legs was achieved by 7.8 cm. At the time of dismantling the apparatus: the axis of the segment is correct, the movements in the knee and ankle joints are within normal limits, the patient walks with a full load on the operated limb .

At the control examination after 1 year, the achieved treatment result is fully preserved. The patient works as an economist in a commercial company.

Using the proposed method provides the prevention of postoperative complications due to the formation of a full volume bone regenerate in areas of distraction lengthening of the segment.

Claims (1)

A method of lengthening the tubular bone, including violation of the integrity of the segment and the dosed longitudinal movement of the selected fragments by the necessary amount using an external fixation device, characterized in that the dosed movement of the fragments is carried out along a spiral path with their deviation from the longitudinal axis.

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