RU2272591C1 - Method for stabilizing lateral knee joint ligament apparatus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves suturing collateral fibular ligament, a part of patellar femur surface and fibrous capsule 2-3 cm higher and lower than joint space. Indent and pierce pass through the same hole in skin. Next, opposite thread ends are simultaneously stretched, shortening lateral stabilizing apparatus, fixed to each other with interrupted sutures immersed under the skin.

EFFECT: enhanced effectiveness in correcting lateral stabilizing structures; reduced risk of traumatic complications.

4 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to treat an imbalance of the lateral ligamentous apparatus during knee replacement.

During the operation of total knee arthroplasty, with deforming osteoarthrosis of the III-IV stage with varus or valgus deformity, there is an imbalance in the lateral ligamentous apparatus. This is due to the shortening of the internal with varus or external with hallux valgus deformity of the lateral ligamentous apparatus and stretching from the opposite side, respectively. At the same time, we have two lateral joint stabilizers of different lengths, after the operation “total knee joint replacement with an unrelated endoprosthesis”, this leads to instability of the lateral ligamentous apparatus with axial load on the limb, which can lead to faster implant wear.

To avoid this, balancing (bringing both stabilizers to the same length) of the lateral retaining structures is required to avoid premature wear of the implant, with its subsequent revision and replacement.

To eliminate the imbalance of the side stabilizing structures, two methods can be used. The first is aimed at lengthening the shorter side, which is achieved by the gradual mobilization of the lateral ligamentous apparatus. The second method involves shortening the most elongated section of the ligamentous apparatus.

The known method of A.F. Krasnov, A.P. Chernov "Wedge-shaped osteotomy of the tibia with dosed transposition of fragments and corrugation of overgrown ligaments" (see, for example, Krasnov A.F., Kotelnikov G.P., Ivanova K.A. Orthopedics: A textbook for postgraduate doctors and senior students. - Samara: Samara. Press House, 1998, - 305-306 p.). This shortening (corrugation) of the longest lateral ligamentous apparatus is carried out through a separate incision in this area.

This method is adopted as a prototype.

However, the known method is quite traumatic, has a risk of increased likelihood of postoperative complications (divergence of postoperative sutures, superficial and deep suppuration) due to an additional incision in the region of the lateral ligamentous apparatus.

The problem to be solved is the elimination of an imbalance of the lateral ligamentous apparatus of the knee joint during its endoprosthetics with a minimal risk of postoperative complications, in order to exclude premature implant wear.

The technical result is achieved by the fact that subcutaneous stitching is performed with a cruciform suture above and below the joint space.

The essence of the invention lies in the fact that there is a closed shortening of the most extended lateral section, as a result of which the created cicatricial changes in this area provide the necessary stability of the joint.

The proposed method for stabilizing the lateral ligamentous apparatus of the knee joint is as follows.

Under general or spinal anesthesia in the position of the patient on the back after arthrotomy of the joint through the median or internal peri-patellar access, the marginal bone-cartilaginous growths are excised, and the joint ends of the femur and tibia are resected according to the corresponding patterns.

Next, they begin balancing the lateral stabilizing structures of the joint, perform subcutaneous flashing with varus deformity of the collateral fibular ligament, part of the external patellar extension and the fibrous joint capsule with lavsan sutures above and below the joint gap, departing from it by 2-3 cm (Fig. 1). Injection and puncture in this case is carried out through the same hole in the skin. At the same time, the injections and punctures of the proximal and distal threads should coincide at the level of the joint space (Fig. 2). Sewing of side stabilizers of the joint with lavsan is carried out through all the structures described above (see 2 pages, 3 to 4 lines from the bottom), in a single block.

Further, the opposite ends of the threads are simultaneously pulled, shortening (crimping) the side stabilizing apparatus. In this case, the balance is controlled on the fitting components of the total knee joint endoprosthesis (Fig. 3).

With the achievement of stability, the threads are fixed among themselves with interrupted sutures, which are then immersed under the skin (Fig. 4).

In a similar way, the internal lateral stabilizing structures of the knee joint are shortened during hallux valgus.

This method is intended for the operational correction of the imbalance of the lateral stabilizing structures of the joint.

Its use in trauma and orthopedic clinics can reduce the invasiveness of the operation and the likelihood of postoperative complications.

Claims (1)

A method of stabilizing the lateral ligamentous apparatus of the knee joint with total arthroplasty, including eliminating the imbalance of the lateral ligamentous apparatus by shortening the stretched ligament, characterized in that the collateral fibular ligament is stitched, part of the tendon patellar extension, fibrous joint capsule with lavsan sutures above and below the joint space 3 cm, and the injection and puncture is carried out through the same hole in the skin, the opposite ends of the threads are simultaneously pulled, shortening laterally the stabilizing apparatus is fixed between an interrupted sutures, sutures dipped below the skin.

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