RU2301037C2 - Method for treating severe clubfoot cases in 4 months old babies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making incision on internal crural surface along back edge of medial anklebone, following its distal fragment with some indent downwards making transition to back foot surface of the second metatarsus head. Anterior tibial muscle tendon is excised near the distal attachment point. Capsule between the first and the second wedge-like bone and interosseous ligament between the first and the second metatarsal bones are dissected. Incision on the crural back surface is carried out along posteroexterior edge of Achilles tendon. Ankle bone derotation is carried out from an internal incision with its reposition into ankle joint fork. Navicular bone is medialized with its rotation on ankle bone head. The first wedge-like bone and metatarsal bone are medialized. The achieved position is fixed with wire introduced through the first metatarsus, the first wedge-like, navicular and ankle bones. Anterior tibial muscle tendon is fixed on the second wedge-like bone.

EFFECT: full deformity correction; eliminated posteroexterior ankle bone rotation; created favorable anatomical interrelations.

6 dwg

Description

The invention relates to medicine and can be used in the surgical treatment of severe clubfoot in children aged 4 months.

A known method of treating severe clubfoot in children over two years of age, including incisions: on the inner surface of the foot in the projection of the first metatarsal bone to dissect the muscle that removes the first finger; semi-oval on the plantar surface of the foot for dissection of the plantar aponeurosis; along the back surface of the lower leg along the edge of the Achilles tendon to lengthen and extend the tendon of the long flexor of the first toe and dissection of the posterior capsules of the ankle and subtalar joints; along the inner surface of the lower leg for lengthening the tendons of the posterior tibial muscle, common flexor of the fingers, capsulotomy of the ankle, subtalar, ram-navicular, scaphoid-wedge-shaped, metatarsopharyngeal joints with subsequent fixation of the foot / Kuznechikhin EP, Ulrich E.V. "Surgical treatment of children with diseases and deformations of the musculoskeletal system." - M .: Medicine, 2004, p. 480-483, Fig. 5.116, operation on the tendon-ligamentous apparatus according to T.S.Zatsepin /.

This method allows you to eliminate varus and equinus deformity of the foot, however, the decentration of the talus, scaphoid, 1 sphenoid and 1 metatarsal bones is preserved, the reduction of the anterior section is not fully corrected, respectively, this method is not effective enough, since there are no correct ratios of the talus and scaphoid bones, it is not eliminated rotational subluxation of the talus in the ankle joint, which leads to the preservation of residual phenomena of clubfoot, and therefore its relapse, is not enough physiologist -screw section of the inner surface of the foot causes contractible scar in the transition zone in the region of the sole.

The objective of the invention is to achieve complete correction of equino-cavovar deformity of the foot of a severe degree by tendon-muscle plastic surgery in combination with derotation of the talus and its adjustment into the ankle joint, medialization of the scaphoid and its rotation on the head of the talus, medialization of the first sphenoid and metatarsal bones.

The technical result of the task is achieved by the fact that in the method of treating a severe degree of clubfoot in children from 4 months of age, including incisions: along the inner surface of the foot in the projection of the first metatarsal bone to dissect the muscle that removes the first finger; semi-oval on the plantar surface of the foot for dissection of the plantar aponeurosis; along the back surface of the tibia along the edge of the Achilles tendon to lengthen and lengthen the tendon of the long flexor of the first toe; dissection of the posterior capsules of the ankle and subtalar joints on the inner surface of the lower leg to lengthen the tendons of the posterior tibial muscle; of the common flexor of the fingers, capsulotomy of the ankle, subtalar, ram-navicular, scaphoid-wedge-shaped, plus-wedge-shaped joints with subsequent fixation of the foot, an incision along the inner surface of the lower leg is proposed to be made along the posterior edge of the medial ankle, indenting its distal fragment with a downward transition to the back surface of the foot to the head of the second metatarsal bone, then perform: cutting the tendon of the anterior tibial muscle at the distal point of attachment, dissecting the capsule between the first and second wedge-shaped bones; dissection of the interosseous ligament between the first and second metatarsal bones; an incision along the posterior surface of the lower leg is performed along the posterior-outer edge of the Achilles tendon; further, from the internal incision, carry out derotation of the talus with its reduction into the ankle fork, medialization of the scaphoid with its rotation on the head of the talus, medialization of the first sphenoid and metatarsal bones with fixation of the position reached by the spoke, made through the first metatarsal, first sphenoid, scaphoid and talus bones; fixation of the anterior tibial muscle tendon on the second sphenoid bone.

A method for the treatment of severe clubfoot in children from 4 months of age is illustrated by the following figures:

Figure 1 is a section along the inner surface of the lower leg, made on the posterior edge of the medial ankle, enveloping the indented down of its distal fragment with the transition to the back surface of the foot to the head of the second metatarsal bone.

Figure 2. - an incision along the posterior surface of the tibia along the posterior-outer edge of the Achilles tendon.

Figure 3 - schematic representation of surgical interventions performed on the tendon-ligamentous apparatus of the foot.

Position 1 - incision for dissection of the muscle that removes the first finger;

Position 2 - section for dissection of the plantar aponeurosis;

Position 3 - lengthening of the Achilles tendon;

Position 4 - lengthening the tendon of the long flexor of 1 finger;

Position 5 - dissection of the posterior capsule of the ankle joint;

Position 6 - dissection of the posterior capsule of the subtalar joint;

Position 7 - lengthening the tendon of the posterior tibial muscle;

Position 8 - lengthening the tendon of the common flexor of the fingers;

Position 9 - dissection of the capsule of the ankle joint on the inner surface;

Position 10 - dissection of the capsule of the subtalar joint on the inner surface;

Position 11 - dissection of the capsule of the ram-navicular joint;

Position 12 - dissection of the capsule of the scaphoid-wedge-shaped joint;

Position 13 - dissection of the capsule of the first sphenoid-metatarsal joint.

Figure 4 - schematic representation of surgical interventions performed on the bone-cartilage components of the anterior and middle foot.

Position 14 - cutting off the tendon of the anterior tibial muscle at the distal point of attachment;

Position 15 - dissection of the capsule between the first and second sphenoid bones;

Position 16 - Dissection of the ligament between the first and second metatarsal bones;

Position 17 - derotation of the talus and its reduction into the fork of the ankle joint;

Position 18 - mediation of the scaphoid and its rotation on the head of the talus;

Position 19 - medialization of the first sphenoid bone;

Position 20 - medialization of the first metatarsal bone;

Position 21 - fixation of the achieved position with a spoke held through the first metatarsal, first sphenoid scaphoid and talus;

Position 22 - fixation of the tendon of the anterior tibial muscle on the second sphenoid bone.

Figure 5. Radiographs of the patient’s foot Stepanova A. before surgery.

6. Radiographs of the patient’s foot Stepanova A. after surgery.

A method for the treatment of severe clubfoot in children from 4 months of age is as follows:

- on the inner surface of the foot in the projection of the first metatarsal bone, a tendon of the muscle that removes 1 finger is allocated and dissected in the transverse direction (Fig. 3, p. 1);

- from the semi-oval incision along the plantar surface of the foot, the plantar aponeurosis is cut transversely at the site of attachment to the calcaneus / Fig. 3, p. 2 /;

- from the incision along the posterior surface of the tibia, the Achilles tendon is lengthened according to Bayer with cutting off its inner edge at the place of attachment to the calcaneus (Fig. 3, p. 3), and Z-shaped - the tendon of the long flexor of 1 finger / Fig. 3, p. 4 /, dissects the posterior capsule of the ankle / Fig. 3, p. 5 / and subtalar joints / Fig. 3, p. 6 /;

- from an incision along the inner surface of the tibia along the posterior edge of the medial ankle, indenting down its distal fragment with the transition to the dorsum of the foot to the head of the second metatarsal bone, the following is performed: lengthening the tendon of the posterior tibial muscle / Fig. 3, p. 7 /; tendons of the common flexor of the fingers, / Fig. 3. p. 8 /; dissection of the capsule of the ankle joint on the inner surface / Fig.3, p.9 /; subtalar joint on the rear-inner surface / Fig.3, p.10 /; ram-navicular / Fig. 3, p. 11 /; scaphoid-wedge-shaped / Fig.3, p.12 / and the first metatarsal-wedge-shaped joints / Fig.3, p.13 /; cutting the tendon of the anterior tibial muscle at the distal point of attachment / Fig. 4, p. 14 /, dissection of the capsule between the first and second sphenoid bones / Fig. 45, p. 15 /; dissection of the interosseous ligament between the first and second metatarsal bones (Fig. 4, p. 16), deletion of the talus with its reduction into the ankle joint fork (Fig. 4, p. 17), medialization of the scaphoid with its rotation to the head of the talus / Fig. 4, p. 18 /, the medialization of the first sphenoid / Fig. 4, p. 19 / and the metatarsal bones / Fig. 4, p. 20 / with fixation of the achieved position by a spoke held through the first metatarsal, first sphenoid, scaphoid and the talus bone / Fig. 4, p. 21 /; fixation of the tendon of the anterior tibial muscle on the second sphenoid bone with the lavsan suture / Fig. 4, p. 22 /.

The spokes are removed after a month, fixation with a circular plaster cast continues for 4-5 months after surgery.

Performing a complex of these interventions on the tendon-ligamentous and capsular apparatus in combination with a change in the spatial location of the talus, scaphoid, sphenoid and metatarsal bones allows completely correcting congenital clubfoot of a severe degree in children, starting from 4 months of age, to create the correct ratio not only in the ankle and subtalar joints, but also at the level of bones of the tarsus and metatarsus.

The proposed method allows to obtain favorable results in the treatment of severe clubfoot in children from 4 months of age and to avoid permanent deformation - bringing the front section after surgical correction, including in the long term. Patients have no gait disturbances, it is possible to use ordinary shoes, there are no scuffs in the area of postoperative scars, the quality of life is improved, the choice of work and active sports activities is expanded.

Claims (1)

A method of treating severe clubfoot in children from 4 months of age, including cuts along the inner surface of the foot in the projection of the first metatarsal bone for dissecting the muscle that removes the first finger, semi-oval on the plantar surface of the foot for dissection of the plantar aponeurosis, on the back surface of the lower leg along the edge of the Achilles tendon for lengthening and lengthening the tendon of the long flexor of the first toe and dissecting the posterior capsules of the ankle and subtalar joints, on the inner surface of the lower leg for lengthening tendons of the posterior tibial muscle, common flexor of the fingers, capsulotomy of the ankle, subtalar, ram-navicular, scaphoid-wedge-shaped, metatarsopharyngeal joints, followed by fixation of the foot, characterized in that the incision along the inner surface of the lower leg is made along the posterior margin of the medial ankle around down its distal fragment with the transition to the dorsal surface of the foot to the head of the second metatarsal bone, then the anterior tibial muscle tendon is cut off at the distal point Reconstruction, dissection of the capsule between the first and second sphenoid bones, dissection of the interosseous ligament between the first and second metatarsal bones, an incision along the posterior surface of the lower leg is performed along the posterior-outer edge of the Achilles tendon, then the talus is rotated from the internal incision with its placement into the ankle fork. medialization of the scaphoid bone with its rotation on the head of the talus bone, medialization of the first sphenoid and metatarsal bones with fixation of the achieved position by a spoke drawn through the first metatarsal, first sphenoid, scaphoid and talus, fixation of the tendon of the anterior tibial muscle is carried out on the second sphenoid bone.

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