RU2321367C1 - Method for treating lower extremity deformity patients for metaepiphyseal dysplasia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves destroying bone segments integrity and restoring biomechanical axis and fixing the extremity with compression-distraction apparatus. Osteosynthesis is carried out with crossed wires being introduced at the level of middle and distal femur one-third as well as proximal metaepiphysis of middle and lower crus one-third. The wires are fixed on support members, the support members being connected to each other. Then, supracondylar and subcondylar femur and crus osteotomy through soft tissue incisions. Biomechanical extremity axis is restored in one stage by rotating distal fragments of femur and crus, and compression-distraction apparatus systems are stabilized. The apparatus systems are disengaged on femur and crus in postoperative period at the fourth-sixth day. Next, longitudinal extension of selected femur and crus fragments is carried out to achieve elastic strain condition in ligamentomuscular apparatus of knee joint.

EFFECT: improved functional result of treatment.

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Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with metaepiphyseal dysplasia.

There is a method of reconstructing the lower extremities by performing an osteotomy of the femur and tibia, fixing the selected fragments and dosed traction using a compression-distraction apparatus to restore the required length and biomechanical axis of the segments (Shevtsov V.I., Popkov A.V. Surgical lengthening of the lower extremities. - M., Medicine, 1998, p.111-116).

However, distraction elimination of deformity in patients with metaepiphyseal dysplasia causes restriction of movements in the knee joints, which reduces the functional result of treatment.

A known method of treating deformities of the proximal end of the lower leg, involving knitting needles through the metaepiphysis of the tibia, performing an osteotomy and turning the distal leg in the sagittal plane to restore the axis of the limb using compression and distraction apparatus (AS USSR No. 1410961, publ. 23.07.88 Bulletin No. 27).

However, the use of this method in patients with metaepiphyseal dysplasia, due to the prevailing pathological relationships of the musculo-ligamentous apparatus, does not eliminate the "looseness" of the knee joint.

The objective of the invention is to develop a method for the treatment of patients with deformities of the lower extremities with metaepiphyseal dysplasia, which improves the functional result of treatment by increasing the stability of the ligamentous apparatus of the knee joint.

This problem is solved by the fact that in the method of treating patients with deformities of the lower extremities with metaepiphyseal dysplasia, including violation of the integrity of bone segments, restoration of the biomechanical axis and fixation of the limb using a compression-distraction apparatus, after eliminating the deformation, the possibility of active movements in the knee joint is restored to elastic tension of its musculo-ligamentous apparatus provides longitudinal traction of the selected fragments of the thigh and lower leg.

The invention is illustrated by a description, an example of its clinical use and drawings, which depict:

figure 1 - radiographs of patient E., before treatment of the left lower limb (a) in the direct and (b) lateral projections;

figure 2 (a, b) - radiographs of the left lower leg of patient E., after surgery in the direct and lateral projections;

figure 3 (a, b) - radiographs of the left lower leg of patient E., after transferring the devices to an independent independent position in the front and side projections;

figure 4 (a, b) - radiographs of the left lower leg of patient E., after removal of the apparatus.

The method is as follows.

After anesthesia and treatment of the surgical field with known techniques, osteosynthesis of the affected limb is carried out with cross spokes at the level of the middle and distal third of the thigh, as well as the proximal metaepiphysis, middle and lower third of the lower leg. In a tense state, the spokes are mounted on supports that are installed taking into account the subsequent correction. The supports installed in the projection of the thigh and lower leg with the possibility of misplanar displacement relative to each other are connected by threaded rods and articulated nodes.

Through the incisions of the soft tissues, the supracondylar and subcondylar osteotomy of the femur and tibia are performed, and the biomechanical axis of the limb is restored simultaneously by turning the distal fragments of the thigh and lower leg.

The operation is completed by performing control radiography, suturing wounds, applying aseptic dressings and stabilizing the systems of the apparatus in the achieved corrected position of the segments.

In the postoperative period, starting from 4-6 days, the systems of the apparatus on the thigh and lower leg are disconnected, thereby restoring the possibility of movements in the knee joint, and subsequently, until the tension of its musculo-ligamentous apparatus of the knee joint, longitudinal traction of the selected fragments both on the hip and and on the lower leg. The rate of traction is set within 0.75-1 mm per day on each segment.

Upon reaching a sufficient degree of tension of the musculo-ligamentous apparatus, which excludes pathological instability of the knee joint (elimination of lateral loosening), the systems of the apparatus on the thigh and lower leg are transferred to the stable fixation mode, which is maintained until the osteotomy segments of the limb are consolidated. Throughout this period, the patient is prescribed a course of exercise therapy, with the development of movements in the knee joint under conditions of gradually increasing amplitude and functional load.

After dismantling the apparatus, additional limb immobilization is not required, the patient is recommended to continue exercise therapy and, if necessary, an additional course of rehabilitation procedures is prescribed.

The practical use of the method is illustrated by the following clinical observation.

Patient E., 10 years old, medical history No. 51142, was admitted to the clinic FGUN "RRC" WTO "them. Acad. GA Ilizarova Roszdrav "with a diagnosis of metaepiphyseal dysplasia, varus deformity of the lower extremities. Height 111 cm.

Objectively: posterior-external-rotational subluxations in the knee joints, lateral looseness of the knee joints on the varus: 15-20 on the right, 20-25 degrees on the left; on valgus: on the right 5-10, on the left 10-15 degrees; a positive symptom of the "front and rear drawers", recurrence in the knee joints on the right - 15, left - 20 degrees (figure 1).

To restore the length and biomechanical axis of the lower extremities and, as a result, improve (normalize) the relationship in the lumbosacral spine and restore the stability of the ligamentous apparatus of the knee joint, the operation was performed according to the proposed technique on the left lower limb (Fig. 2).

In the postoperative period, on the “free” knee joint with an autonomous independent position from each other of the apparatus systems on the thigh and lower leg, starting from 4 days, longitudinal traction of the selected fragments on the thigh was performed at a rate of 0.75 mm per day, on the lower leg 1 mm in day, until the ligamentous apparatus of the knee joint is tensioned and excess loosening is eliminated (the appearance of stability in it). Traction lasted 14 days on the thigh and 17 days on the lower leg (figure 3).

After restoration of stability in the knee joint - elimination of lateral loosening - the devices were transferred to the stable fixation mode, which lasted 61 days.

After dismantling the apparatus, additional limb immobilization was not performed (Fig. 4), the patient underwent a course of exercise therapy and rehabilitation procedures.

After 4 months, this technique was applied on the right lower limb.

As a result of the treatment, deformations were eliminated, the biomechanical axis of the limb was restored, and stability of the knee joints was achieved. The patient walks without additional support, there is no movement in the knee joints within normal limits, there is no lateral laxity and overextension in the knee joints.

The use of the method in the clinic FGUN "RRC" WTO "them. Acad. GA Ilizarova Roszdrav "improved the functional results of treatment in patients with metaepiphyseal dysplasia by increasing the stability of the ligamentous apparatus of the knee joint.

Claims (1)

A method for the treatment of patients with lower limb deformities during metaepiphyseal dysplasia, including violation of the integrity of bone segments, restoration of the biomechanical axis and fixation of the limb using a compression-distraction apparatus, characterized in that they perform osteosynthesis with cross-spoke needles at the level of the middle and distal third of the thigh, as well as proximal metaepiphysis, middle and lower third of the tibia, the knitting needles are attached to the supports, the supports are interconnected, then through cuts of soft tissues they are performed over the condylar and subcondylar osteotomy of the femur and tibia, simultaneously restore the biomechanical axis of the limb by turning the distal fragments of the thigh and lower leg, stabilize the systems of the compression-distraction apparatus, in the postoperative period, for 4-6 days, the systems of the apparatus on the thigh and lower leg are disconnected, then they are carried out longitudinal traction of the selected fragments of the thigh and lower leg to elastic tension of the musculo-ligamentous apparatus of the knee joint.

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