RU2311884C1 - Method for treating congenital cotyloid cavity dysplasia cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves fixing hip joints in centrally aligned position using abduction splint, violating periacetabular region integrity, introducing wires therein, forming canals arranged fan-like or in chessboard order over the cotyloid cavity roof and penetrating as far as internal cortical plate of the huckle-bone. The wires are axially rotated and removed.

EFFECT: stimulated cotyloid cavity vault growth.

2 cl, 4 dwg

Description

The invention relates to medicine, in particular orthopedics, and is used in the treatment of congenital acetabular dysplasia in children from 6 months to 2 years.

A known method of treating the early stage of osteochondropathy of the hip joint, including unloading the joint using a compression-distraction apparatus, introducing the spokes into the neck from the inertia along its axis and sequentially removing them, drug therapy and physiotherapeutic treatment, in which a muscle relaxant course is prescribed before the needles are introduced, then they are introduced from the subtrochanteric region of the knitting needle into the femoral neck along its perimeter, with most of the knitting needles being inserted into the lower parts of the neck, and knitting needles with on the side of the greater trochanter at an angle to the axis of the neck, then in the process of joint unloading, the reciprocating and axial rotation of the spokes is carried out during successive courses of bone resorption inhibitors and angioprotectors, after dosed removal of the spokes inserted into the neck, a course of biostimulants is carried out (Patent No. 2255688 , Russian Federation. Published on February 27, 2003).

A known method for the treatment of acetabular dysplasia by osteotomy of the proximal femur, correction, followed by fixation of the fragments by a compression angular plate, in which the proximal end of the retainer is passed through a large skewer to the arch of the acetabulum (AS No. 1816440 of the USSR, IPC ⁶ A61B 17/56 A method for the treatment of acetabular dysplasia. Publish. 05.23.93. Bull. 19).

However, the known method involves the mandatory implementation of corrective osteotomy of the femur, the use of a osseous fixative, which increases its morbidity and makes it difficult to use in young children, when surgical correction of the femoral component of the joint is not necessary.

The objective of the present invention is to develop a less traumatic method that allows children aged 6 months to two years to stimulate the growth of the arch of the acetabulum.

The problem is solved in that in the method for the treatment of congenital acetabular dysplasia, including fixing the hip joint, violating the integrity of the periacetabular region, fixing the hip joint with the help of a retracting splint, introducing needles into the periacetabular region of the hip joint, which form 6-8 channels, which form 6-8 channels staggered along the perimeter of the roof of the acetabulum to the internal cortical plate of the ilium, then after turning each spoke they are removed.

In bilateral lesions of the hip joints, it is advisable to insert the spokes into the periacetabular region of both hip joints.

The invention is illustrated by a description, an example of its implementation and the attached copies of x-rays, on which:

Figure 1. - Scheme of the method: a - front view, b - side view.

Figure 2. - A copy of the patient’s radiograph before treatment.

Figure 3. - A copy of the patient’s radiograph during the spoke tunneling of the periacetabular region.

Figure 4. - A copy of the patient’s radiograph after treatment.

The method is as follows.

After anesthesia and treatment of the operative field along the outer surface of the hip joint at a distance of 0.5 cm upward from the outer edge of the cavity in the oblique-frontal plane in the direction from the outside inward to the inner cortical plate, a control needle with a spear-shaped sharpening with a diameter of 1.8 mm is carried out. The depth of immersion and the inclination of the spokes are determined in preoperative design. The direction of the spokes should correspond to a tangent line drawn from the Y-shaped cartilage to the outer edge of the cavity (Figa). As an external guide to the degree of immersion of the spokes, a rubber stopper is used. A control x-ray is taken to determine the location of the spokes. In accordance with the data obtained, an additional 5-7 spokes are drawn through the anterior and external sections of the supraclavicular region. The places of injection of the spokes are arranged along the perimeter of the acetabulum in a checkerboard pattern at a distance of 2-3 mm from each other (Fig.1b). Carry out axial rotation of the spokes, after which they are removed. Apply an aseptic dressing.

An example of the method.

Patient D., 1 year, East. bol. No. 43717. Diagnosis: Congenital dislocation of the left thigh. On examination, it was noted: asymmetry of the inguinal, gluteal and femoral folds, shortening of the left lower limb by 1 cm, limitation of abduction of the left thigh by 30 °. On the x-ray of the pelvis in a direct projection (Figure 2), the marginal dislocation of the left thigh, the violation of the Shanton line by 1 cm, the left acetabulum are flattened: acetabular index (AI) 37 °, index of the thickness of the bottom of the cavity (ITDV) 2.0. A closed reduction of the dislocation of the left thigh was performed after preliminary vertical skeletal traction, the hip joints were fixed with a coxite plaster cast for three months. Then, under intravenous anesthesia in the operating room, the plaster cast was removed, the surgical field was treated three times with chlorhexidine solution, on the outer surface of the hip joint, 0.5 cm upward from the edge of the acetabulum in an oblique plane at an angle of 35-40 °, a control needle with a spear-shaped sharpening was performed with a diameter of 1.8 mm to a depth of 1.5 cm. Radiography of the pelvis in direct projection was made, the position of the spokes corresponds to the planned. Along the perimeter of the roof of the acetabulum, another 7 knitting needles were staggered fan-shaped at a distance of 2-3 mm from each other. Produced control x-ray (Figure 3). The axial rotation of the spokes was carried out, then they were removed. An aseptic dressing is applied. Further fixation of the hip joints was carried out by the Vilensky splint. The day after surgery, the dressings were removed, the wounds from the needles were treated with a solution of brilliant green. A day later, the patient was discharged for outpatient monitoring. A similar intervention was performed again after three months.

One year after the treatment, the patient walks without limp. The length of the lower extremities is the same, the range of motion in the hip joints is complete, there is no atrophy of the soft tissues. On the control x-ray of the pelvis in direct projection (Figure 4): the head of the left thigh is centered in the cavity, the left acetabulum has an oval shape, the angle of inclination of the arch (AI 23 °) has decreased and the depth of the acetabulum has increased (ITDV 3.0).

The proposed method is less traumatic, allows you to stimulate the growth of the vault of the acetabulum with dysplasia in children under 2 years of age, which makes it possible in the future to refrain from radical surgery on the ilium or to delay its implementation.

The proposed method is used in FGUN RSC "WTO" them. Acad. G.A. Ilizarova in the orthopedic department No. 9 in children from 6 months to 2 years after reduction of the congenital subluxation and dislocation of the hip with hip dysplasia without decentration of the femoral head in the cavity.

Claims (2)

1. A method of treating congenital acetabular dysplasia, including fixation of the hip joint, violation of the integrity of the periacetabular region, characterized in that the joint is fixed by the abduction splint, spokes are inserted through the front and outer divisions of the acetabular region at a distance of 2-3 mm from each other forming channels in a checkerboard pattern along the perimeter of the roof of the acetabulum to the internal cortical plate of the ilium, carry out axial rotation of the spokes, followed by knitting needles. 2. The method according to claim 1, characterized in that the spokes are inserted into the periacetabular region of both hip joints.

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