RU2294709C1 - Method for correcting the position of cotyloid cavity - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: it is necessary to conduct osteotomy of a patient's ilium in supracotyloid region, fulfill cavitary rotation downwards, outwards and to the front, carry out the second osteotomy of ilium by forming a wedge-shaped transplant, its top being in supra-acetabular area, and its bottom has the tendency towards gluteal incisure. Osseous wedge should be removed, cotyloid cavity should be rotated once more; one should introduce an osseous wedge into the space between the fragments so that its bottom to be located above the cotyloid cavity, and its top should face gluteal incisure. The innovation enables to create a full-value limb's support, keeps the shape of cotyloid cavity, provides no necessity in applying a transplant taken out of femur or any other skeletal part and excludes the necessity to apply fixing needles.

EFFECT: higher efficiency of correction.

9 dwg, 1 ex

Description

The invention relates to medicine, in particular to orthopedics. It is used to restore the support ability of the hip joint during its dysplasia due to the increase in the supporting surface of the acetabulum.

In the surgical treatment of dysplastic coxarthrosis, aseptic necrosis of the femoral head, congenital dislocation of the thigh, etc. significant difficulties arise in restoring the correct relationship between the elements of the hip joint. Only a full covering of the femoral head with the acetabulum allows us to hope for the support ability of the entire limb.

There is a method of reconstructing the roof of the acetabulum according to Salter [1], which consists in the supraclavicular osteotomy of the ilium and the subsequent tilt and turn of the cavity outward and anterior through the use of a bone autograft taken during osteotomy of the femur. However, there are a number of cases where osteotomy of the femur is not performed and the problem of the absence of a graft occurs.

Closest in technical solution to the proposed one is a method of forming a canopy of the acetabulum due to incomplete angular osteotomy of the pelvis, followed by a turn of the cavity due to the pubic joint and Y-shaped cartilage according to Tikhonenkov [2]. However, this method relates to intraarticular interventions, which increases the risk of developing an early form of arthrosis in the operated patient. In addition, in this case, it is necessary to use an autograft taken with hip osteotomy.

The invention consists in the combination of essential features that ensure the achievement of the desired technical result, such as the creation of a full support of the limb with dysplastic underdevelopment of the acetabulum.

The essential features of the invention are that they produce a double supraclavicular osteotomy of the ilium with the formation of a bone graft in the form of a wedge (hereinafter referred to as the bone wedge), the apex of which is located in the nadacetular region, and the base is directed to the sciatic notch, the acetabulum is bent downward, outward and anteriorly , deploy the formed bone wedge in a horizontal plane so that its base falls above the acetabulum, and the apex faces the sciatic notch.

The advantages of this method are:

- There is no need to use a graft taken from the femur or other part of the skeleton.

- A tight fit of the deployed graft eliminates the need for retaining needles, and therefore, repeated intervention.

- Pelvic osteotomies are performed extra-articularly, which reduces the risk of developing early forms of arthrosis.

- The preoperative calculation of the size of the excised bone wedge and the corresponding operative allow you to correct the position of the acetabulum by the desired angular value.

- The method allows you to save the shape of the acetabulum.

- As a result of using the proposed method, the acetabulum is medialized, which significantly improves the biomechanical parameters of the joint and reduces the compression of the elements of the joint.

The technique for performing acetabular correction according to the claimed method is illustrated by drawings.

- The pelvic bone after the upper (first) osteotomy:

Figure 1 is a front view.

Figure 2 is a rear side view.

Figure 3 is a rear view.

The arrow indicates the line of osteotomy.

- The pelvic bone after the lower (second) osteotomy:

Figure 4 is a front view.

A thin arrow indicates the base of the formed bone wedge, and a wide arrow indicates the direction of rotation of the bone wedge in the horizontal plane.

5 is a rear side view.

The arrow indicates the top of the formed bone wedge.

6 is a rear view.

Arrows indicate osteotomy lines.

- The pelvic bone, after tilting the cavity and turning the graft:

7 is a front view.

Fig. 8 is a view from the outside.

Fig.9 is a rear view.

Arrows indicate osteotomy lines.

The method is as follows.

The method is carried out from anterolateral access. A skin incision is made along the iliac crest through the anterior awns with a lateral rotation towards the greater trochanter. In the supraclavicular region, with the help of rasps, the body of the ilium from the external and internal sides is isolated subperiostally. Through the upper edge of the sciatic notch, Gigli's saw is carried out and the ilium is sawn along the nameless line (Figs. 1-3).

Carry out a turn of the cavity anteriorly, outwardly and downward, calculating the required amount of divergence of the bone fragments of the supraclavicular region. Gigli's saw is again drawn over the edge of the sciatic notch. They retreat down the sciatic notch to a height equal to the size of the divergence of the fragments in the supraclavicular region, cut obliquely from the bottom up and from the inside out the ilium (Figs. 4-6). Moreover, in the supraclavicular region, the lines of the upper (first) and lower (second) osteotomy should converge (Figure 5). The bone wedge is removed from the wound.

The acetabulum is again deployed to the required size, and a bone wedge (Figure 7-9), deployed with the base outwards (Figure 4), is introduced into the gap between fragments of the supraclavicular region. The base of the bone wedge is adjusted along the contour of the external cortical plate of the supraclavicular region.

After suturing the wound, a one and a half pelvic gypsum dressing was applied for 1.5 months.

Clinical example.

Patient B. 17 years. He entered the clinic about dysplasia of the roof of the acetabulum on the right. In September 2002, the patient underwent surgery according to the claimed method.

Since earlier the patient had an open reduction of the congenital dislocation of the hip with correction of the proximal femur to normal age parameters, additional osteotomy with the inevitable shortening of the thigh was undesirable.

The anterolateral access in the supraclavicular area using the raspacs subperiosteally allocated the body of the ilium. A saw of Gigli was passed through the upper edge of the sciatic notch and sawed the ilium along the nameless line. The cavity was rotated anteriorly, anteriorly and downward, calculating the required divergence of bone fragments of the supraclavicular region, which amounted to 18 mm. Gigli saw again over the edge of the sciatic notch. Retreating downward along the sciatic notch 18 mm, the ilium was obliquely cut from the bottom up and from the inside outwards with the formation of a bone wedge. The acetabulum was again deployed to the required size and a bone wedge deployed with the base outside was introduced into the gap between fragments of the supraclavicular region. The base of the bone wedge is fitted along the contour of the external cortical plate of the supraclavicular region. After suturing the wound, a one and a half pelvic gypsum dressing was applied for 1.5 months.

After the plaster cast was removed, rehabilitation therapy was started. Limb load allowed after 6 months. Control inspection was carried out after 1 year of operation. The bone wedge is completely fused with the surrounding ilium. The centering of the femoral head in the acetabulum is normal. The patient walks without limping, no pain. Movement in the joint is not limited, and the Duchenne-Trendelenburg symptom is negative.

Thus, the proposed method allows to restore the usefulness of the support for the femoral head, ensuring the correct orientation of the acetabulum.

Information sources

1. Korzh A.A., Tikhonenkov E.S., Andrianov V.L. and others. Dysplastic coxarthrosis. M .: Medicine, 1986, - p. 88.

2. In the same place, - p. 92.

Claims (1)

A method for correcting the position of the acetabulum, including an osteotomy of the ilium in the anterosorbic region and a reversal of the acetabulum, characterized in that the osteotomy of the ilium is performed, the cavity is rotated downward, outward and anteriorly, a second iliac osteotomy is performed, forming a graft in the form of a wedge, the apex located in the nadiacetabular region, and the base is directed to the sciatic notch, the bone wedge is removed, the acetabulum is again deployed, in the interval between the fragments Yat bone wedge so that the base had over the acetabulum, and the top facing the sciatic notch.

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