RU2279856C2 - Method for treating external curvature of a great toe - Google Patents

Abstract

FIELD: medicine, orthopedics.

SUBSTANCE: the present innovation deals with treating external curvature of a great toe of the 1^st, 2^nd and 3d degree. One should cut a fascial-synovial semi-oval fragment at its bottom facing proximal end of the first metatarsal bone being above internal surface of metaphysis and epiphysis of the first metatarsal bone. Then, it is necessary to resect the caput of the first metatarsal bone, form proximal, metatarsal surface of the first metatarso-phalangeal articulation with the help of the above-mentioned fascial-synovial fragment, form the articulation due to suturing up the edges of articular surface with catgut ligatures - synovial membrane of a great toe's bottom towards the edges of a new articular, metatarsal surface developed with the above-mentioned fascial-synovial fragment. The innovation enables to prevent relapses and shortens terms of therapy.

EFFECT: higher efficiency of therapy.

1 cl, 1 dwg, 4 ex, 1 tbl

Description

Technical field

The invention relates to medicine, orthopedics, namely to surgical methods for treating external curvature of the first toe (Hallux valgus).

BACKGROUND OF THE INVENTION

There is a method of treating external curvature of the first toe by wearing special orthopedic shoes, arch support, as well as the use of special dressings, massage [1].

The method is ineffective and has the following disadvantages: it does not eliminate the basis of the disease - deformation of the head of the first metatarsal bone, leading to a displacement of the articular surface of the metatarsophalangeal joint outward; associated with the need to wear special orthopedic shoes, as well as daily bandaging of the feet, which causes constant discomfort and is often complicated by the development of bursitis in the metatarsophalangeal joint.

The closest in essence is a method of surgical treatment of external curvature of the first toe according to the method of Mayo-Wreden P.P. [2].

For its implementation, a surgical operation is performed: opening the first metatarsophalangeal joint, removing the distal head of the first metatarsal bone, cutting a fascial flap from local tissues and closing the base of the first finger, removing sesamoid bones located in the metatarsophalangeal joint.

The method is effective, but has several disadvantages: 10-20% of patients develop a relapse of the disease; prolonged (over 8 weeks) gypsum limb immobilization after surgery is needed; prolonged disability due to treatment.

Disclosure of invention

The objective of the invention is to increase the effectiveness of treatment of external curvature of the first toe, to prevent relapse of the disease, reducing the time of temporary disability in connection with treatment.

The problem is solved as follows. During the operation, a new metatarsophalangeal joint is formed, for which the head of the first metatarsal bone is resected, and the distal surface of the resected first metatarsal bone is closed with a fascial-synovial flap cut to the resection of its head on the medial surface of the metaphysis and epiphysis of the first metatarsal bone.

The joint is formed by suturing with catgut threads the edges of the articular surface (synovial membrane) of the base of the first finger to the edges of the new articular surface on the metatarsal bone formed by the above fascial-synovial flap. The flap has a semi-oval shape and faces the proximal end of the first metatarsal bone. After the operation, gypsum immobilization of the limb is not applied.

A comparative analysis of the prototype method with the proposed method revealed that a common feature among them is a resection of the head of the first metatarsal bone.

The following differences of the new method from the prototype method are revealed:

1. A new metatarsophalangeal joint is formed, for which not just a fascial, but a fascial-synovial flap is cut out, and the base of this flap is directed to the proximal end of the first metatarsal bone, which ensures its improved blood supply. The flap is cut out on the medial surface of the metatarsal bone.

2. The distal resected end of the metatarsal bone is closed with a flap, and not the base of the thumb.

3. The edges of the base of the first finger (its articular surface) are sutured with catgut sutures to the edges of the distal end of the resected metatarsal bone, covered with the above fascial-synovial flap.

4. Plaster immobilization of the limb is not applied, but only a bandage dressing is used.

5. From the second day after surgery, the patient is allowed to walk, proceeding to the operated foot.

Brief Description of the Drawings

The invention is further explained using the drawing:

A method for the treatment of external curvature of the first toe according to Kim V.Yu.

and - the first stage of the operation - cutting a fascial-synovial flap to create a new first metatarsophalangeal joint:

1. skin incision

2. semi-oval incision of the fascia above the head of the first metatarsal bone (marked by a thick line)

3. base (articular surface with synovial membrane) of the thumb

b - the second stage of the operation - resection of the head of the first metatarsal bone

4. head of the first metatarsal bone

5. a line of resection of the head of the first metatarsal bone (the line is perpendicular to the axis of the first metatarsal bone)

6. fascial-synovial flap, separated above the head of the first metatarsal bone, designed to create a new articular surface

7. Dzhigli saw used for resection of the head of the first metatarsal bone

c - the third stage of the operation - the formation of a new metatarsophalangeal joint

8. sutures with catgut threads, fixing the outer edges of the base of the first finger to the fascial-synovial flap

9. seams with silk threads, fixing the edges of the cut fascial-synovial flap to the outer surface of the first metatarsal bone (the flap covers the resected first metatarsal bone).

Information confirming the possibility of carrying out the invention

The main causes of external curvature of the first toe are wearing narrow shoes with high heels, a large mass of the patient, diseases of the joints of the foot of a rheumatoid or gouty character, the presence of a sesamoid bone located near the tendon of the short flexor of the first toe, displacement of the tendon of the muscle that leads the thumb, and underdevelopment of the adductor muscle of this finger, flat feet.

As a result of a dystrophic process in the head of the first metatarsal bone, the surface of the metatarsophalangeal joint changes pathologically: instead of its perpendicular orientation relative to the axis of the first metatarsal bone, it acquires an oblique direction, as a result of which an external curvature of the first finger develops. Depending on the severity of the disease, three degrees of external curvature of the first finger are distinguished: the first degree - 15 degrees, the second degree - 20 degrees, the third degree - more than 30 degrees [1], [2].

Normally, the deviation of the first finger from the axis of the first metatarsal bone does not exceed 10 degrees.

There are more than 140 methods for surgical treatment of this disease.

The method of Kim V.Yu. carried out as follows.

Under local anesthesia with novocaine or under general anesthesia along the inner surface of the foot in the area of the first metatarsophalangeal joint, an incision is made in the skin, subcutaneous fat (1, see drawing - a).

Using a scalpel and raspator with a semi-oval incision with the base facing the proximal end of the first metatarsal bone, a fascial-synovial flap is cut out (2, see drawing - a).

This direction of the base of the flap provides its significantly better blood supply than in the prototype method, where the base of such a flap faces the distal end of the first finger.

This is due to the fact that the blood supply to the metatarsal bones and tissues around them is due to the artery running along the lateral surfaces of these bones, and in the direction from the center to the periphery. Next, with the help of a dissector, the head of the first metatarsal bone is isolated from all sides. After that, around the head of this bone, in the area of its transition into the metaphysis, a Jigley saw is carried out (7, see drawing - b). The resection of the head of the first metatarsal bone is performed so that the surface formed at its distal end is strictly perpendicular to the longitudinal axis of this bone. Otherwise, if there is an angle with this axis, the curvature of the first finger may again form. After removal of the resected head of the metatarsal bone (forceps or clamp), the distal surface of the resected first metatarsal bone is covered with the previously selected fascial-synovial flap (6, see drawing - c) and its edge is fixed with silk threads at the outer edge of the distal end of the metatarsal bone (9, cm drawing - c). Thus, the proximal (metatarsal) surface of the new metatarsophalangeal joint is formed.

Then they continue to form a new metatarsophalangeal joint by suturing with catgut threads the edges of the articular surface (synovial membrane) of the base of the first finger to the edges of the new articular (metatarsal) surface formed by the above fascial-synovial flap (8, see drawing - c). The skin over the new joint is sutured with single sutures, which are removed on the 7-10th day after the operation. In the event that sesamoid bones are found in the joint during surgery, the latter are not removed if they were not the cause of the disease. A bandage dressing is applied to the postoperative wound, which is changed daily during dressings until the sutures are removed from the skin. Patients are allowed to walk starting 2 days after surgery. During the second week after surgery, patients are recommended to perform daily 15-minute foot baths with a solution of 5% potassium permanganate, and for 3 and 4 weeks - baths with a hypertonic solution of sodium chloride, 15 minutes - 1 time per day.

A corrective bandage bandage that holds the first toe in a normal position (along the axis of the first metatarsal bone) is used for 4 weeks after surgery. It is possible to perform an operation simultaneously on both first first toes when they are bent.

Examples of the method.

Example 1

Patient Yu., 15 years old, suffered from external curvature of the first toes of the 3rd degree for 10 years. Complained of constant pain in the feet while walking, the inability to wear ordinary shoes, decreased physical activity. At the age of 15, the patient underwent surgery according to the method of Kim V.Yu. on the right foot. The duration of the operation is 25 minutes. No complications were observed. Sutures were removed on the 7th day. Healing by first intention. The patient began to walk from the second day after the operation. Disability after surgery recovered after 3 weeks. After 2 years, a similar operation was performed on the left foot. The results of the examination of the patient 3 years after the second operation - no relapse of the disease. He wears ordinary shoes. Does not experience any pain during walking. Does not note a decrease in physical activity, as it was before the operation.

The result of treatment: recovery.

Example 2

Patient S., 38 years old, suffered from external curvature of the first toes of the 2nd degree for more than 26 years. Worried about pain in the feet when walking, a feeling of rapid fatigue in the lower limbs when walking, difficulties in selecting shoes. An operation was performed according to the method of Kim V.Yu. on both feet. Disability after surgery recovered after 2 weeks. Examined after 3.5 years after surgery: no relapse, wears ordinary shoes. There is no pain.

Example 3

Patient K., 35 years old, suffered more than 15 years of bilateral external curvature of the toes of the 3rd degree. The disease was characterized by rapid progression, pain in the feet when walking, the presence of bursitis in the metatarsophalangeal joints. An operation was performed according to the method of Kim V.Yu. After the operation, disability recovered after 3.5 weeks. Survey results 3 years after surgery: no relapse of the disease. He wears high-heeled shoes. Does not note pain in the feet when walking. Conclusion: recovery.

Example 4

Patient A., 42 years old, suffered for 17 years with external curvature of the toes of the 3rd degree. Due to the disease, I was forced to leave sports (long-distance running). She noted severe pain when walking in the metatarsophalangeal joints. An operation was performed according to the method of Kim V.Yu. Disability after surgery recovered after 5 weeks. Inspection results 4 years after surgery: no relapse of the disease. He wears ordinary shoes.

He goes in for sports again (long-distance running).

Conclusion: recovery.

The results of clinical testing of the method of Kim V.Yu.

The method of treatment of external curvature of the toes according to Kim V.Yu. used in 179 patients aged 15 to 60 years. There were 9 men. 170 women. The disease duration was from 3 to 27 years. 92 patients had a 2 degree curvature of the first fingers, and 87 people. - 3 degree. In 29 of 179 patients, surgery was performed on both feet. In 157 patients, operations were performed on an outpatient basis.

The duration of disability in connection with the operation ranged from 2 to 4 weeks. Relapse of the disease was not observed at follow-up of more than 3 years.

Table 1 shows the results of the treatment of external curvature of the first fingers by the method of Kim V.Yu. and the Mayo-Wreden way.

Table 1 The results of surgical treatment of external curvature of the first toes according to the method of Kim V.Yu. and the Mayo-Wreden method Treatment results The method of Kim V.Yu. (79 patients) Mayo-Wreden method (prototype method) (100 patients) The duration of the operation, on average (minutes) 30 ± 5 * 45 ± 5 Suppuration of a postoperative wound one* 6 Duration of temporary disability in connection with the operation (days) 17 ± 2 * 56 ± 3 Relapse of the disease up to 3 years No eighteen The presence of pain in the feet, the need to wear special orthopedic shoes after surgery (for ... people) 2 * 23 Note: * - significant difference (p <0.05) of the same indicators.

As follows from Table 1, the method of Kim V.Yu. provides significantly better treatment results than the Mayo-Wreden method.

Bibliographic data

1. Handbook of traumatology and orthopedics. / Ed. A.A.Korzha, E.P. Mezhenina. - Kiev. - 1980. - S.173-174.

2. Yumashev G.S. Traumatology and orthopedics. // Moscow. - "The medicine". - 1977. - S. 481-483.

Claims (2)

1. A method for surgical treatment of external curvature of the first toe of the first, second, third degrees by resection of the head of the first metatarsal bone, characterized in that after resection of the head of the first metatarsal bone, the proximal, metatarsal surface of the first metatarsophalangeal joint is formed using a fascial-synovial flap cut out above the inner surface of the metaphysis and pineal gland of the first metatarsal bone, and the joint itself is formed by suturing with catgut sutures the edges of the articular surface - the synovial membrane Hovhan first finger against the edges of the new metatarsal joint surface formed by the above-fascial synovial flap, the shearing of the flap having a semi-oval shape, is arranged so that its base is directed towards the proximal end of the first metatarsal. 2. The method according to claim 1, characterized in that after the operation, gypsum immobilization of the lower limb is not used, and from the second day after the operation, the patient is allowed to walk, proceeding to the operated foot.