RU2289339C2 - Method for surgical treatment of cotyloid cavity defects in case of total endoprosthetics of hip joint - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: the present innovation deals with preparing an osseous bottom of cotyloid cavity to fill the defect with an alloimplant followed by fixing it with reinforcing metal device with screws and applying a cotyloid component of hip joint's endoprosthesis. Moreover, as the alloimplant one should apply "Perfoost-S" to cut out the fragments according to the shape of osseous defect to apply them layer-by-layer onto prepared bottom, moreover, the upper layer overlaps underlying layers and the edges of osseous defect of cotyloid cavity by about 0.5-1 cm, as for the screws of reinforcing metal device, they should be introduced into valuable bone of cotyloid cavity at the distance of 0.5-1 cm against the edge of alloimplant's upper layer that provides steady filling of cotyloid cavity.

EFFECT: higher efficiency of therapy.

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Description

acquisition belongs to the field of medicine, in particular to orthopedics and traumatology and can be used in the surgical treatment of acetabular defects in total hip arthroplasty.

Total hip replacement in conditions of deficiency of the bone structures of the acetabulum is a complex and not completely resolved problem. The anatomical and structural insufficiency of the acetabulum lies at the heart of the technical difficulties associated with the creation of full bone coverage and strong primary fixation of the acetabular component of the hip joint prosthesis. The anatomical and structural insufficiency of the acetabulum in the form of its defects of various localization, shape and size accompanies most severe lesions of the hip joint, in which both primary and revision hip joint replacements are indicated.

A known method for the surgical treatment of acetabular defects in total hip arthroplasty, including preparing the acetabular bone bed, filling the defect with an allograft, fixing it with a reinforcing metal device with screws and installing the acetabular component of the hip joint endoprosthesis (Gross, A.E .; Allan, D; Catre, M .; Garbuz, DS and Stockley, I .: Bone grafts in hip replacement surgery. The pelvic side. Orthop Clin North America, 24: 679-695,1993).

In this method, bone fragments are used as an allograft, which fill the defect in the acetabulum cavity, the allograft is fixed with a reinforcing metal device, the screws of which are usually inserted into the allograft.

The disadvantage of this method is the uneven filling of the cavity of the bone defect, which leads to insufficiently strong fixation of the acetabular component of the hip joint endoprosthesis.

In addition, for the reconstruction and survival of this allograft, considerable time is required, which increases the time of postoperative rehabilitation of patients.

In accordance with this, a task was set aimed at the effectiveness of the method of surgical treatment of acetabular defects due to the use of a material having plasticity properties as an allograft, which will ensure filling of defects of various configurations, as well as the ability to quickly rebuild and engraft it to the bone bed, which will create reliable support for the acetabular component at the site of a pre-existing defect and will reduce the time for postoperative rehabilitation of patients.

In the MONIKI Department of Traumatology and Orthopedics, for the first time, an allograft prepared from the Perfoost-S demineralized bone allograft was used in 3 cases for osteoplastic filling of extensive acetabular defects. The plastic properties of this allograft made it possible to effectively fill in extensive defects of the bottom (2 cases) and combined defects (1 case) of the acetabulum during the audit replacement of the acetabular component of the endoprosthesis. The use of this material is known for cranial bone grafting (MV Lekishvili et al. "Skeleton defect grafting in children with a demineralized bone allograft. // Pediatric Surgery - 2004. - No. 5. P.9-12.).

The method is as follows. A bone bed is prepared for an allograft in the area of the bone defect, while excision of the scar tissue is performed, milling until the bleeding bone around the bone defect is reached.

Using measuring tools to determine the shape and size of the acetabulum. Layers are cut out from the Perfoost-S allograft, which is made of demineralized skull bones in the form of plates, with a thickness of 1 to 1.5 cm, in shape and dimensions of the acetabulum defect.

In this case, one of the layers is cut out in such a size that, when applied to the bone defect, it overlaps the edges of the bone defect of the acetabulum by 0.5-1 cm.

Then these layers are fixed with a reinforcing metal device with screws, while the screws are inserted into a full bone of the acetabulum at a distance of 0.5-1 cm from the edge of the upper layer of the allograft.

Acetabular structures such as a Muller ring or a Burch-Schneider construction are used as a reinforcing metal device. A feature of reinforcing the acetabulum with acetabular structures under conditions of filling defects with an allograft made of Perfoost-S material is the introduction of screws fixing the design of the bone outside the bone grafting into a full bone at a distance of 0.5-1 cm from the edge of the upper layer of the allograft. The number of screws for the Muller ring must be at least 4, and for the Burch-Schneider design at least 7. Then the acetabular component of the hip joint endoprosthesis is installed on the prepared base, which is strengthened with bone cement.

A concrete example of the implementation of the method Patient M., born in 1966, was admitted to the GRT MONIKA on 05.20.04 with a diagnosis of Aseptic loosening of the acetabular component of the right hip joint prosthesis with protrusion into the pelvis. 06/03/04; Patient M. underwent surgery: Replacing the acetabular component and the endoprosthesis head of the right hip joint with bone alloplasty of the pelvic bone defect, installing a reinforcing structure and cement fixation of the cup.

During the operation, the acetabular component is deeply immersed in the pelvis, its mobility in the amount of minimal swinging movements. The sciatic bone was partially resected to remove the component. The acetabulum is sclerosed from the inside, it does not have a scar layer, the medial wall is thinned by its central defect 2.5 × 2.5 cm, when applied to a bone defect, it overlaps the edges of the bone defect of the acetabulum by 0.5-1 cm.

The inner surface of the cavity is freshened with a mill 58 mm to the bleeding bone. Allografts are placed in two layers at the bottom of the cavity, one of which has a size of 2.5 × 2.5, and the top layer, when applied to the bone defect, overlaps the edges of the bone defect of the acetabulum by 0.5-1 cm.

Tightly fitted RRM ID 54 mm. (Muller ring), which is additionally fixed with 3 screws along the edge and 4 screws on the inner surface of the acetabulum outside the bone allograft. Gentazyment bone cement has a 49/28 full-profile polyethylene cup (Walter, Czech Republic). Made reduction with a test head, there is no tendency to dislocation and impeachment with passive movements. Reposition of the endoprosthesis with a metal head 28L (Beznoska). Movement in physiological volume.

In the postoperative period, the patient is activated on crutches with partial support on the right leg on the 3rd day, the postoperative wound healed by primary intention. The patient was discharged from the hospital on the 10th day after the operation. The patient started walking with full support on her right leg 14 weeks after surgery. There is no pain syndrome in the area of the operated hip, and slight lameness is determined when walking. The range of motion in the right hip joint is a total of 200 °.

As a result of using this method, a solid foundation will be formed for the installation of the acetabular component, the anatomy of the walls of the acetabulum will be restored. After filling the acetabulum defect with an allograft, its shape and plasticity do not require additional resection modeling of the acetabulum for the selected acetabular component.

A method for the surgical treatment of acetabular defects during total hip arthroplasty by filling with a bone allograft from a Demofluralized allograft "Perfoost-S" will optimize the technique of endoprosthetics, speed up surgery, and reduce postoperative rehabilitation of patients.

Claims (1)

A method for the surgical treatment of acetabular defects in total hip arthroplasty, including preparing the acetabular bone bed, filling the defect with an allograft, fixing it with a reinforcing metal device with screws, and installing the acetabular component of the hip joint prosthesis, characterized in that they are used as an allo implant ", from the plates of which fragments are cut in the shape of a bone defect, lay them layer by layer on the prepared bed, p and the upper layer covers the lower layers and the acetabulum bone defect edges by 0.5-1 cm, and the metal reinforcing screws tool introduced into a complete bone of the acetabulum at a distance of 0.5-1 cm from the upper layer alloimplantata edge.