RU2292853C2 - Method for treating unbending contracture of knee joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: the innovation deals with treating patellar pathologies appeared in post-surgical process on shin lengthening. The method includes roentgenological assay to detect the value of patellar shift with subsequent patellar fixation due to applying a needle through a patella in frontal plane being above its center and strengthening the needle in half-circle support of the apparatus and connected with the upper shin ring; then comes dissection of fibers of patellar own ligament against distal fragment of shin bone due to applying along external border of patellar ligament at the level being below the edge of proximal fragment perosseously against tenotome being parallel to ligamentous fibers for the depth of anterior cortical layer of shin bone followed by perpendicular rotation and subcutaneous incision of ligamentous fibers with subsequent removing the shift due to distracting the half circle that fixes the patella upwards against shin ring for the value of predetermined patellar shift that decreases tissue traumatism.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, in particular to the treatment of pathologies of the patella arising in the process after surgery to extend the leg.

It is known that in 3-4% of cases after an operation to lengthen the lower leg, including crossing the lower leg bones, passing through the formed fragments of knitting needles connected by distraction rods, suturing the wound and extending the rings together, pathology of the knee joint occurs, namely extensor contracture the knee joint due to the persistent bonds of the fibers of the patellar ligament with the distal tibia fragment of the fibers of the patellar ligament. (see Popkov A.V., Zyryanov S.Ya. "Surgical lengthening of the lower leg by the Ilizarov method" Educational and methodological developments ", Kurgan," Soviet Zauralie ", 1991, p.1-26).

To restore the normal anatomy of the knee joint, therapeutic exercises are used, which requires a long time and does not always lead to a successful result, and then a second operation is required to lengthen the tendons and transplant ligaments, performed with a large incision of soft tissues, i.e. the disadvantage of this method of eliminating the pathology of the knee joint is its high invasiveness (see Transosseous compression and distraction osteosynthesis in traumatology and orthopedics. Collection of scientific works KNIIEKOT, Kurgan, 1972. p. 255).

The prior art methods of treating knee joint deformity, including low-traumatic methods for lengthening the tibial ligament, consisting in several stages of subcutaneous perforation, subsequent reduction of the lower leg and fixation of the achieved positions (see Russian Patent No. 2076653, A 61 V 17/56, publ. . 10.04.97) and (Russian Patent No. 2207819, A 61 B 17/56, publ. 10.04.97). However, to solve this problem - to eliminate the pathology of the knee joint that arose after the operation to remove the knee - such less traumatic methods are not used.

The technical result of the proposed method of treatment is less traumatic elimination of extensor contracture of the knee joint, as a complication that arose after surgery to extend the leg.

The specified technical result is achieved by the fact that the method of treating extensor contracture of the knee joint arising after the operation for lengthening the lower leg includes examining and determining the displacement of the patella of the joint, fixing the patella by providing the knitting needle through the patella in the frontal plane above its center and strengthening the knitting needle in the semicircular the support of the apparatus connected to the upper ring of the lower leg, cutting off the fibers of the patellar ligament from the distal tibia bones by drawing along the outer border of the patellar ligament at a level below the edge of the proximal fragment of the percutaneous tenotome parallel to the ligament fibers to the depth of the anterior cortical layer of the tibia, followed by perpendicular rotation and subcutaneous notching of the ligament, eliminating bias by distraction of the semicircle, fixing the patella upwards from the knee previously defined displacement of the patella.

The method is as follows.

After an operation to lengthen the tibia in case of detection of a complication, namely extensor contracture of the knee joint, the magnitude of the lowering of the patella is determined clinically and radiologically, and then a needle is inserted through the patella in the frontal plane above its center and strengthened in the lower semicircle. The latter is connected to the upper ring of the lower leg with 2-3 threaded rods. Then, along the outer border of the ligament of the patella with the distal tibia fragment at a level below the edge of the proximal fragment by 5-8 mm, the ligament fibers are cut off with a tenotome, introduced percutaneously parallel to the ligament fibers to a depth of 10 mm, followed by its rotation and subcutaneous incision of the ligament fibers. Then, displacement is eliminated by distraction of the semicircle fixing the patella upward from the lower leg ring by the amount of displacement.

Example.

Patient N., medical history No. 37, was hospitalized for lengthening the legs by 6 cm. On March 20, 2003, an osteotomy of the tibia of both legs was performed, and osteosynthesis was performed by Ilizarov apparatus for extension according to a typical technique. In the process of lengthening from 32 days (increase in length 3.5 cm), extensor contracture of the knee joint was noted due to lowering of the patella, which was not eliminated by manual reduction. There was a limitation of flexion of the knee joint, pain in it. On the roentgenogram, its reduction by 18 mm was found in comparison with the initial radiographs.

04/29/03, under anesthesia in the operating room, a knitting needle was inserted through the patella above its center in the frontal plane and tightly fixed in the semicircular support of the device. The last three threaded rods connected to the proximal annular leg support. Then, along the outer contour of the tibial tuberosity at the edge of the proximal fragment, the tenotome punctured the skin and subcutaneously dissected the tissues to the inner contour of the tuberosity to a depth of 0.5-0.8 cm.Thus, a closed dissection of the preserved and newly formed fibers of the patellar ligament was made.

By distraction along the threaded rods, the half-ring and with it the patella were erected 1.8 cm proximally, the displacement of the patella was eliminated. The half-ring is dismantled, the needle from the patella is removed.

In the postoperative period, the patient received exercise therapy of the knee joint, massage of the thigh muscles. The position of the patella remained normal, the range of motion of the joint was not limited.

Claims (1)

A method for treating extensor contracture of the knee joint that occurs after an operation to lengthen the tibia, including determining the amount of patellar displacement, applying an external fixation apparatus, cutting off the own ligament of the patella with a bone fragment of the tibia, distracting displacement of the patella, characterized in that the patella is fixed by holding the knitting needle through the patella in the frontal plane above its center and strengthen the spoke in the semicircular support of the apparatus connected to the upper ring On the shin, the fibers of the patellar ligament of the tibia are cut off from the distal fragment of the tibia by drawing the percutaneous tenotome parallel to the ligament fibers along the outer border of the ligament of the patella below the proximal fragment to the depth of the anterior cortical layer of the tibia, followed by a perpendicular turn of it and subcutaneous notching of the ligament fibers the patella is displaced by distraction of the patella upward from the lower leg ring by the amount of its displacement.