RU2317035C2 - Method for autoplasty of the lesions of lateral group of talocrural joint ligaments - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation refers to the treatment of talocrural joint's instability. The end of the mobilized autotendon of a short fibular muscle should be sutured according to a certain technique by leaving two ligatures at the end of the tendon going downwards from the top of lateral ankle. One should form a hollow in the body of a heel bone, form a canal in external ankle in sagittal direction, mobilized autotendon of a short fibular muscle should be guided through the canal in external ankle to put its distal end into the hollow of a heel bone, apply two ligatures through the bottom of the hollow in a heel bone onto contralateral surface in horizontal plane, pull a ligament with the help of ligatures to fix it on the skin. The innovation provides the reconstruction of lateral group of ligaments, stabilization of the talocrural joint, the reconstruction of supporting ability of the inferior limb.

EFFECT: higher efficiency of autoplasty.

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Description

The invention relates to medicine, namely to arthrology, and is applicable for the surgical treatment of post-traumatic instability of the ankle joint.

The most common cause of the development of chronic post-traumatic instability in the ankle joint is untimely diagnosed and, as a result, untreated or insufficiently treated injuries of the anterior fibular-ram and fibular-calcaneal ligaments. With an increase in the length of the above ligaments, walking on rough terrain is accompanied by instability in the joint, multiple subluxations, which ultimately leads to the development of deforming arthrosis, the outcome of which is arthrodesis of the joint.

To eliminate instability, the method described by GD Nikitin [1] et al. Is used. in the book "Allotendoplasty in the treatment of injuries of muscles, tendons and ligaments" p. 179, in which a suitably treated allotissue of the long peroneal muscle or allotendin of the long flexor of the first finger (depending on the thickness of the limb) is carried out from the inside through the talus, external ankle, calcaneus on the inner side, where as a result of tension and fixation of the tendon by a loop, a strong duplicate (external ligaments) is created. This operation requires special care and skills of the surgeon, as is carried out through incisions in the zone of passage of blood vessels, nerves and tendons. It is laborious and traumatic, because several cuts are performed, through channels are formed in three bones (fibula, talus and calcaneus). A significant allograft is required, which is not sufficiently rigidly fixed and takes a long time to rebuild.

The prototype was an operation to restore the anterior fibular-talus and fibular-calcaneal ligaments of the ankle joint according to Whinfield [2], when a horizontal channel was drilled in the external ankle in the sagittal plane. The distal end of the mobilized tendon of the short fibular muscle is passed through it, the end of which is fixed with sutures to the calcaneus.

From our point of view, the fixation of tendon to the bone with conventional sutures is unreliable. Sufficient tension and firm fixation of the tendon is not provided.

The technical result of the proposed method is a relatively easy and reliable restoration of the lateral group of ligaments, leading to stabilization of the ankle joint, restoration of supportability of the lower limb, relief of pain, reduction of treatment and rehabilitation.

The result of the invention is achieved due to the fact that they form a recess in the calcaneus, where they immerse and fix on the opposite side using two ligatures, held in the horizontal plane, the distal end of the mobilized autologous tendon of the short fibular muscle, sewn through Kuneo, drawn through the canal in the external ankle.

The method is as follows. We perform an incision along the posterior edge of the lateral ankle 10 cm long to the base of the V metatarsal bone. Select n. suralis and take it aside. We bare the outer ankle and conduct an audit of the ligamentous apparatus, which is usually absent with this lesion. We open the fascial sheath and synovial sheath of the tendons m. peroneus longus et brevis. We single out the tendon of the short fibular muscle, which we cut off at the transition to the muscle part, after stitching the muscle fibers of the long and short fibular muscle. The end of the cut tendon is stitched according to Kuneo, leaving two long ligatures at the end of the tendon. In the body of the calcaneus, departing 1.0 cm down from the apex of the lateral ankle, we form a recess d - 5 mm, a depth of 10 mm. In the outer ankle, backing away from its apex by 10 mm, with an awl or thin drill, we form a channel d - 5 mm in the sagittal direction. The mobilized tendon of the short peroneal muscle, using two ligatures and a wire conductor, is drawn through the channel in the external ankle and immersed its end in the deepening of the calcaneus (Fig. 1). Using a special needle with a hole at the end, we draw two ligatures through the bottom of the recess in the calcaneus to the contralateral surface of the heel in a horizontal plane, in different directions, so that there is a distance of about one centimeter between the ends of the ligatures. Using a ligature, we stretch the ligament in the valgus position of the foot (hypercorrection). We fix and tie the threads on a tightly rolled gauze tupfer located on the skin (figure 2). We sew up the wound in layers. In the position of hypercorrection of the foot, we apply a plaster cast for 7 weeks, after which the threads are removed and we conduct a course of rehabilitation treatment aimed at restoring the function of the ankle joint.

The method has been applied since 2002 in 5 patients. As a result, instability of the ankle joint was eliminated in patients, pain disappeared, limb support ability was restored, and the quality of life was improved.

Clinical example. Patient F., 41 years old, medical history No. 7428. Diagnosis: Intra-articular bodies of the right ankle joint, rupture of the outer group of ligaments, post-traumatic joint instability, pain. September 27, 2004 surgical intervention was performed: Removal of intraarticular bodies, autoplasty of the outer group of ligaments of the right ankle joint (by the proposed method). The postoperative period was uneventful, on the 12th day the sutures were removed. After 7 weeks, immobilization was removed, ligatures were removed. There was a solid fusion of the autograft with the bone. Joint instability, pain completely disappeared, the ability of the right lower limb was restored.

Thus, the claimed method according to the above essential feature is an inextricable causal relationship with the achieved result, i.e. meets the criterion of "inventive step".

At the time of filing an application for an invention, such or identical to the claimed method is not known, which allows it to be considered as meeting the criterion of "novelty."

Bibliography

1. Nikitin G. D., Linnik S. A., Kornilov N. V., Efimov V. N. Allotendoplasty in the treatment of damage to muscles, tendons and ligaments, - St. Petersburg, 1994. P.179.

2. Perlman M. Chronic ankle conditions // Comprehensive textbook of foot surgery, V.1, p. 1020.

Claims (1)

The method of autoplasty of injuries of the lateral group of ligaments of the ankle joint, characterized in that the end of the mobilized autotendin of the short fibular muscle is stitched according to Kuneo, leaving two ligatures at the end of the tendon, stepping down from the top of the lateral ankle, form a recess in the body of the calcaneus, form a channel into the outer ankle in the sagittal direction, the mobilized autologous tendon of the short peroneal muscle is passed through the canal in the external ankle and the distal end is immersed in the heel in the heel th bone, carry out two ligatures through the bottom of the recess in the calcaneus on the contralateral surface in a horizontal plane, pull a ligament using ligatures and fix it on the skin.

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