RU2295311C2 - Method for treating foot deformations in children - Google Patents

Abstract

FIELD: medicine, orthopedics.

SUBSTANCE: the present innovation deals with surgical treatment of transversely flattened foot and valgus deformation of a great toe in children since the age of 8 in case of dysplastic alterations of lumbosacral department of vertebral column. The purpose of the present innovation deals with providing efficiency in treating children with foot deformation due to correcting all the elements of deformation and creating anatomically correct ratios of foot osseous structures, providing conditions for correct developing foot arches, excluding relapses and secondary deformations and improving foot functional capacities. The method deals with lancing the capsule of the first metatarso-phalangeal articulation at developing a fragment with distal bottom; economic resection of exostosis of the caput of the first metatarsal bone; withdrawing a great toe into the middle position followed by its fixation due to tightening the fragment with distal bottom; transverse capsulotomy; dissection of tendon of adductor muscle of great toe and transfer onto the caput of the first metatarsal bone along with fixing in osseous canal; it has been suggested to apply the route of osseous canal in direction being from inside outwards and from the bottom upwards, perform the dissection of the capsule of the first wedge-metatarsal articulation, after derotation and adducting fix the first metatarsal bone due to tightening the tendon of adductor muscle in osseous canal, the complex of sesamoid bones reset under the caput of the first metatarsal bone; fix the position achieved with the help of two Kirschner's needles applied obliquely transversely through metatarsal bones and a gypsum bandage at modeling foot arches that provides correct development of foot arches.

EFFECT: higher efficiency of therapy.

5 dwg

Description

The invention relates to medicine, in particular to orthopedics, and can be used in the surgical treatment of the transverse spread of the foot and hallux valgus deformity of the first finger in children from the age of eight with dysplastic changes in the lumbosacral spine.

The known method (Shklovsky D.E. Hallux valgus - thesis for the degree of Candidate of Medical Sciences. - L., 1937. - P.87), which consists in transplanting the tendon of the adductor muscle of the first finger and the short extensor of the first finger into the channel on the head of the first metatarsal bone with a shortened resection of the main phalanx of the first finger and resection of the exostosis of the metatarsal head. When performing this method, the first beam is shortened and the supporting ability of the anterior-inner foot is reduced.

Often used the method of Mc Bride (1954) (Hansen CE Hallux valgus treated by the McBride operation. // Acta orthop / scand. 45, 1974. - 778-792 p.), Including dissection of the tendon of the muscle leading to the I finger, deep tarsal ligament and the outer surface of the capsule I of the metatarsophalangeal joint, removal of the fibula (lateral) sesamoid bone. The tendon of the adductor muscle is carried out and fixed in the osseous canal of the head of the first metatarsal bone; a resection of the head exostosis and plastic capsule with a distal base flap is performed on the medial surface. Removal of the sesamoid bone reduces the support ability of the first metatarsophalangeal joint, and dissection of the intertarsal ligament reduces the transverse elasticity of the forefoot.

There is a method of treating hallux valgus deformity of the first toe with lateral spread of the foot (see USSR AS No. 1377064 - prototype). The method includes: transverse capsulotomy of the metatarsophalangeal joint along the lateral surface, cutting off the tendon of the adductor muscle of the first finger, removal of the fibula (lateral) sesamoid bone, bursectomy, resection of the metostasis of the metatarsal head, excision of the tendon of the abducting muscle of the first finger and transplantation into the bone duct, and the main file the adductor muscle is fixed in the channel on the head of the first metatarsal bone. This method allows you to correct the deformation of the forefoot in children, however, the removal of the sesamoid bone reduces the supportability of the first metatarsophalangeal joint, and the passage of the canal in the head of the metatarsal bone ensures that only the metatarsal bone is brought closer together, without removing the rotational component of the metatarsal bone I and without forming the transverse arch.

All the considered methods of treating foot deformities are designed for adult patients and do not take into account the plastic properties of the bone-cartilaginous structures of the children's foot, which, when anatomically correct ratios of the foot bone structures are created early, restore congruency in the metatarsal and tarsal joints, ensure the correct formation of the arch of the foot, exclude relapses and secondary deformities.

The objective of the invention is to ensure the effectiveness of the treatment of children with deformity of the foot by correcting all elements of the deformation and creating anatomically correct ratios of the bone structures of the foot, providing conditions for the correct formation of the arches of the foot, eliminating relapses and secondary deformations, improving the functionality of the foot.

The therapeutic result is achieved by the fact that in the method of treating foot deformities, including opening the capsule I of the metatarsophalangeal joint with the formation of a flap with a distal base; economical resection of exostosis of the head of the first metatarsal bone; the withdrawal of the I finger in the middle position and its fixation due to the tension of the flap with the distal base; transverse capsulotomy; cutting off the tendon of the muscle leading to the first finger, and transplantation on the head of the first metatarsal bone with fixation in the bone channel; It is proposed that the bone canal move from the inside outward and from the bottom up, to dissect the capsule of the first sphenoid-metatarsal joint, after derotation and bringing I the metatarsal bone to fix by tensioning the tendon of the adductor muscle in the bone canal, the complex of sesamoid bones should be placed under the head of the metatarsal bone I; to fix the achieved position with two Kirschner spokes held obliquely through the metatarsal bones, and a plaster cast with modeling of the arch of the foot.

A method of treating foot deformities in children is illustrated by the following figures 1-5:

figure 1 - view of the foot from the medial surface:

Pos.1 - the cut line enveloping the head of the metatarsal bone and continuing to the level of the tarsus;

pos.2 - the capsule of the joint is opened, a flap with a distal base is formed;

Pos. 3 - resected exostosis.

figure 2 is a top view of the foot:

Pos.4 - cut line in the tarsal space;

Pos. 5 - the tendon of the adducting muscle is cut off and taken to the holder;

pos.6 - transverse capsulotomy;

Pos.7 - the course of the canal in the head of the metatarsal bone.

figure 3 - diagram of the operation, view from the sole:

A - before the operation:

pos.2 - the capsule of the joint is opened, a flap with a distal base is formed;

pos.3 - resected exostosis;

Pos.5 - cutting off the tendon of the adductor muscle;

POS. 8 - dissection of the metatarsopharyngeal joint;

B - after surgery:

Pos.9 - the capsule of the metatarsophalangeal joint is sutured with tension;

Pos. 10 - the tendon is held in the bone canal.

figure 4 is a cross section at the level of the heads of the metatarsal bones:

A - before the operation:

Pos.3 - resection of exostosis of the head of the metatarsal bone;

pos.5 - incision of the tendon of the adductor muscle;

pos.6 - section capsule metatarsophalangeal joint;

Pos.7 - the course of the canal in the head of the metatarsal bone.

B - after surgery:

Pos. 10 - tendon of the adductor muscle in the bone canal;

Pos.11 - the complex of sesamoid bones is set and hemmed to the joint capsule.

figure 5 - x-ray patient S., 13 years old:

A - before the operation;

In - 8 months after the operation of the proposed method.

A method of treating foot deformities in children is as follows:

- from the incision enveloping the I metatarsophalangeal joint, on the medial surface (Fig. 1, Pos. 1), a capsule was cut with the formation of a flap with a distal base (Fig. 1, Pos. 2), an economical resection of the exostosis of the head of the I metatarsal bone (Fig. 1, pos. 3), a capsule of the sphenoid-metatarsal joint was isolated and opened (Fig. 3A, pos. 8);

- the tendon of the adductor muscle was cut from the attachment point (its diameter 0.3-0.4 cm) from the incision in the first intertarsal gap along the rear of the foot with the transition to the base of the first finger (Fig. 2, item 4) and fixed with Dacron thread ( 2, pos. 3), transverse capsulotomy was performed (the deep intertarsal ligament with the sesamoid complex remains intact) (Fig. 2, pos. 6), while the head of the metatarsal bone I became sufficiently mobile and freely set on the sesamoid bone complex with elimination pronation;

- at the level of the base of the head of the metatarsal bone I, a canal was drilled with a drill ⌀ 0.4-0.5 cm (from the inside out and from bottom to top) (Fig. 2, item 7), the tendon of the adductor muscle was guided into the canal, stretched to bring the head I metatarsal bone and was fixed to the periosteum with interrupted dacron sutures (Fig. 3B, item 9), this immediately eliminated several deformation elements: metatarsus varus, pronation of the metatarsal bone I and prolapse of the heads of the II and III metatarsal bones (formed the transverse arch);

- pulling the flap with the distal base on the outer surface - I finger was brought to the middle position and fixed (figv, pos.10), the complex of sesamoid bones was pulled from below and sutured to the capsule (figv, pos.11).

Soft tissues were sutured in layers, the achieved position was fixed with two Kirschner spokes, held obliquely through the metatarsal bones. Immobilization of the foot in the middle position with a plaster cast to the upper third of the lower leg with the formation of arches was carried out for 2-3 weeks, the load was prescribed from the second week.

Performing a set of these interventions on the osteo-articular apparatus of the foot in combination with tendon-muscle plastic surgery allows you to fully correct all deformation elements, creates the correct ratio in the bone structures of the foot, and provides the conditions for the correct formation of the arches of the foot. Early surgical treatment allows you to get better results with shorter rehabilitation periods, prevents the development of secondary deformations, allows patients to use regular shoes, and expands the opportunities for work.

Claims (1)

A method of treating foot deformities in children, including opening the capsule of the first metatarsophalangeal joint with the formation of a flap with a distal base, economical resection of the exostosis of the head of the first metatarsal bone, putting the first finger in the middle position and fixing by pulling the flap with the distal base, performed from the access from the medial surface feet, transverse capsulotomy, cutting off the tendon of the muscle leading to the first finger and transplantation on the head of the first metatarsal bone with fixation in the bone canal, performed from access to the I interpl the gap between the canals, characterized in that the bone canal is carried out from the inside outward and from bottom to top, at the level of the base of the head of the 1st metatarsal bone, the capsule of the first sphenoid-metatarsal joint is dissected, after derotation and reduction of the 1st metatarsal bone is fixed by tensioning the tendon leading muscles in the bony canal, a complex of sesamoid bones are set under the head of the first metatarsal bone I, the achieved position is fixed with two Kirschner spokes held obliquely transversely through the metatarsal bones and gypsum a new dressing with modeling of the arch of the foot.

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