RU2290118C1 - Method for stabilizing talocrural joint when its articulation end has defect - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves subjecting lateral malleolus to osteotomy from its apex along longitudinal axis and from talocrural joint fissure level. The formed lateral malleolus fragment is to bent backwards and outwards. Medial lateral malleolus fragment is placed on periosteal graft into the articulation end defect. The proximal end of the medial lateral malleolus fragment is introduced into the proximal one, and then the lateral fragment of the lateral malleolus. Ilizarov apparatus is set. The external fragment of the lateral malleolus is to be fixed with bulb-tipped pin to the lateral malleolus surface of the ankle bone and on external support member of the apparatus.

EFFECT: provided congruency of surfaces under arthrodesis; avoided extremity shortening.

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Description

The invention relates to medicine, in particular to orthopedics and traumatology, in particular, it is intended for the treatment of an ankle joint.

A known method of treating deforming arthrosis of the ankle joint is degenerative-dystrophic or post-traumatic in nature, in which oblique osteotomy of the ankles is performed for their subsequent distraction in an external fixation apparatus (Application No. 96109118, RF. Publish. 1998.07.10).

There is a method of reconstruction of ankle joint arthrodesis after astragallectomy, which involves osteotomy of the tibia, the formation of fragments from the inner and outer ankles, the metered movement of the distal fragment of the tibia to the heel bone and the displacement of the ankle fragments distally and in width until the formation of the bone regenerate and overlap the junction of the tibia and calcaneus with subsequent fixation using a distraction and compression apparatus (Application No. 93019435, RF. Publ. 1996.04.10).

However, the known method provides ankylosing of the joint due to synostosis of the ankles with the calcaneus and does not provide congruency with the end stop.

There is a method of extra-articular arthrodesis of the joints of the foot by cutting off the graft from the bone of the graft on the feeding leg and dosing it until it contacts the bones of the foot. Then, the graft is cut off from the external ankle, it is moved along an arcuate trajectory, along the outer surface of the ankle joint, the talon-calcaneal, calcaneal-cuboid joints and the graft is fixed to the cuboid bone with simultaneous longitudinal compression of the closed joints (A.S. 1169633, USSR. Publ. 07/30/85. Bull. 28).

However, the known method of extra-articular arthrodesis of the joints of the foot does not provide supportability of the distal segment of the lower limb in the presence of a defect in the articular end of the ankle joint, since in the latter case ankylosis of the ankle joint does not occur.

The present invention is to develop a method of stabilization of the ankle joint with a defect in its articular end, which allows to reduce the invasiveness of the operation, to ensure congruence of arthrodesis surfaces without resection of the articular end and to prevent shortening of the limb.

The problem is solved in that in the method of stabilization of the ankle joint with a defect in its articular end, including an osteotomy of the external ankle and compression between the articular ends of the ankle joint, osteotomy of the external ankle from its top along the longitudinal axis and from the level of the ankle joint gap is formed, a formed fragment of the ankle the ankles are bent posteriorly and outwardly, and the medial fragment of the external ankle, having previously removed the cartilage from it, is placed on the periosteal flap jointly end, while the proximal end of the medial fragment of the external ankle is inserted into the lateral part of the latter.

The present invention is illustrated by a detailed description, diagram and copies of x-rays, on which:

Figure 1 illustrates the stabilization scheme of the ankle joint;

Figure 2 - copy of the x-ray of the left ankle joint and foot before surgery (A - direct projection; B - lateral projection);

Figure 3 is a copy of the x-ray of the left ankle joint and foot after surgery (A - direct projection; B - lateral projection);

Figure 4 - copy of the x-ray of the left ankle joint and foot after removal of the Ilizarov apparatus (A - direct projection; B - lateral projection).

The method is as follows.

In the operating room under epidural anesthesia, after processing the surgical field, an arcuate incision of soft tissues is performed, enveloping the outer ankle. The arcuate incision is placed two centimeters posterior and lower than the apex of the outer ankle, and, enveloping the latter, continue the incision along its front edge and end 3 cm higher than the ankle joint.

Then, a direct osteotome performs longitudinal dissection of the external ankle in the sagittal plane from its apex in the proximal direction (Figure 1). After that, the formed external fragment of the lateral ankle is bent posteriorly and outward from the level of the ankle joint gap, and the medial fragment of the external ankle, having previously removed the cartilage from it, is placed on the periosteal flap in the defect of the articular end.

Cartilage is removed from the outer ankle surface of the talus block. Then, the existing residues of the articular surfaces of the ankle joint are decartilaginated without excising bone tissue.

The proximal end of the medial fragment of the external ankle is inserted into the lateral part of the latter.

Then three mutually intersecting spokes are drawn through the tibia, and one of them through both bones. The carried spokes in a taut state are fixed in the ring of the Ilizarov apparatus.

Three intersecting needles are passed through the talus bone, one of them with a persistent pad from the outside through the lateral fragment of the external ankle, having previously placed the latter on the external ankle surface of the talus block, and pulling the knitting needles, they are fixed to the external support of the Ilizarov apparatus, which is assembled from two half rings, two slats and brackets.

Between the external supports, which are connected by four rods, carry out compression.

The wound is sutured in layers.

Clinical observation

Patient G., a resident of Novy Urengoy, received a pylon fracture as a result of a catastrophe, that is, a fragmented fracture of the distal articular end and tibia metaphysis with bone marrow compression. Treatment after injury was carried out at the place of residence. The outcome is deforming arthrosis of the left ankle joint with a pronounced pain syndrome. The range of motion in the left ankle joint is 20 degrees. Conducted conservative treatment is ineffective.

We performed an operation under epidural anesthesia. After access to the ankle joint in the outer part of the distal metaphysis of the tibia, a dome-shaped bone defect was clinically determined, which captured almost the entire area of the distal articular surface of the tibia. Its maximum depth was in the outer part and amounted to 3 cm (Figure 2).

We performed a longitudinal osteotomy of the external ankle and, deploying its medial fragment after removing minor cartilage residues, placed this bone in the tibia defect.

Then they placed the Ilizarov apparatus of two external supports. The outer fragment of the lateral ankle was fixed with a spoke with a thrust pad to the outer ankle surface of the talus (Figure 3).

In the postoperative period, maintenance compression was performed weekly. The fixation period was 45 days. Additional immobilization, after removal of the Ilizarov apparatus, was not carried out (Figure 4).

One month after removing the Ilizarov apparatus, the patient switched to a full load on the operated limb without limping using ordinary shoes.

The proposed method allows to obtain the following positive effects.

Firstly, it provides maximum congruence in cases of defect in the arthrodesis surfaces of the ankle joint by replacing the latter with an autograft, which is the medial fragment of the external ankle. Preservation of the periosteum provides blood supply to the medial fragment of the external ankle.

Secondly, this method allows for the congruence of articular surfaces, does not require excision of bone material, which not only reduces the invasiveness of the operation, but also does not lead to a shortening of the lower limb.

Thirdly, the proposed method reduces the time of treatment, since the fixation time with the Ilizarov apparatus when it is used is the same as with conventional open compression anklerodesis of the ankle joint, that is, 45 days.

Fourthly, if significant bone volume is excised to ensure congruence, then tibia osteotomy will be required to lengthen shortening to extend, which significantly increases the invasiveness of the operation and the duration of treatment.

In addition, the proposed method is used in the Tyumen regional trauma and orthopedic center.

Claims (1)

A method of stabilizing the ankle joint with a defect in its articular end, including an external ankle osteotomy and creating compression between the articular ends of the ankle joint, characterized in that the external ankle is osteotomy from its top along the longitudinal axis and from the level of the ankle gap, a formed fragment of the external ankle from and outside, the medial fragment of the external ankle, removing the cartilage, is placed on the periosteal flap in the defect of the articular end, while the proximal end is honey The outer ankle fragment is inserted into the lateral fragment of the outer ankle, the Ilizarov apparatus is applied, the outer fragment of the lateral ankle is fixed with a spoke with a thrust pad to the outer ankle surface of the talus and fixed on the external support of the apparatus.

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