RU2326613C1 - Plastic surgery of cotyloid cavity roof associated with dysontogenetic coxarthrosis - Google Patents

Abstract

FIELD: medicine; traumatology.

SUBSTANCE: iliac bone is approached. Transverse osteotomy of iliac bone is performed in above-cotyloid cavity from side of ilium wing subperiosteally: for 1/3 from side of greater sciatic notch with Jigli saw and for 2/3 form outside with gouge matching to half-round of cotyloid cavity roof. Distal fragment is medially moved together with cotyloid cavity. Sphenoconcave transplant taken of ilium wing is introduced in sliver. Transplantation is performed by concave side to whirlbone.

EFFECT: provides achievement of articular surface congruence; reduced trauma number; eliminated postoperative complications.

2 dwg, 1 ex

Description

The invention relates to medicine, namely to orthopedics, and can be used for the surgical treatment of dysplastic coxarthrosis.

A known method of reconstructing the roof of the acetabulum using bone grafting (A.P. Biezin, "Pelvic osteotomy, plastic of the upper edge of the acetabulum", J. Orthopedics, traumatology and prosthetics. 1966, No. 10, p. 83.)

In this method, external access to the supraclavicular region is carried out from a longitudinal section in the region of the greater trochanter with cutting off the middle and partially large gluteal muscles from the outer surface of the ilium wing. Then, bone tissue is excised above the cavity, and several grafts are implanted into the niche formed, most often from the tibia.

When carrying out treatment with this method for the first time after the operation, the thigh support is achieved without reducing the range of movements.

However, over time, due to the lack of congruence between the femoral head and the canopy, due to the growth of the child, fracture and resorption of transplants of the newly formed roof, circulatory disorders due to traumatic access, there is a loss of the achieved support ability of the hip, the formation of its subluxation as a result of upward displacement of the formed the roof.

Closest to the proposed one is a method for plastic surgery of the roof of the acetabulum with dysplastic coxarthrosis, including access, transverse osteotomy of the ilium in the supraclavicular region, and medial displacement of the distal fragment along with the hollow (P. Ya. Fischenko. Supraclavicular ototomy for congenital dislocation of the hip, 1957 Bulletin of Surgery. No. 12, vol. 99, pp. 109-110).

The advantage of this method is the formation of a powerful new roof of the cavity proximal fragment of the ilium without the use of grafts.

However, in this method, traumatic external access is also carried out, with the transverse section of the ilium after its extraction is made with a flat chisel on the outside of the ilium, while the flat cross section of the ilium remains and the semicircular congruence of the joint surfaces between the head and the roof is not restored. The head, when loaded with emphasis on a flat section, flattenes over time and assumes a mushroom shape, the operation does not prevent the progression of the disease, but rather - coxarthrosis progresses more rapidly, while external access with cutting off the middle and partially large gluteal muscles is extremely traumatic and can lead to disruption blood circulation in this area, and performing a cross section of the ilium from the outside with a flat chisel is fraught with danger of damage to the vessels of the pelvis.

In accordance with this, the task aimed at reducing the morbidity is to improve the congruence between the head and the formed roof, which will eliminate the progression of coxarthrosis and ensure long-term remission or complete recovery of the patient.

To solve this problem, in the method of plastic surgery of the roof of the acetabulum with dysplastic coxarthrosis, including access, transverse osteotomy of the ilium in the supraclavicular region and the medial displacement of the distal fragment along with the hollow, it is proposed to perform osteotomy of the ilium from the wing of the subperiosteal 1/3 from the side of the seats Gigli’s saw and 2/3 from the outside with a gold-plated bit corresponding to the roof semicircle, and the introduction of a wedge-concave graft taken from the roof into the cleft and ilium carry the concave side of the head.

Figure 1 shows the implementation of the method. Taking a wedge-concave graft and introducing it into the ileal cleft.

Figure 2 - diagram of the subperiosteal osteotomy of the ilium with a saw Gigli from the side of the sciatic indentation and a gold-plated chisel from the outside.

The method is as follows.

Under general anesthesia, in the patient’s position on the back, with a cut of the skin along the iliac crest from the middle third to the anterior superior spine with extension along the anterior surface of the thigh to the level of the greater trochanter, we cut off the anterior superior iliac spine, stupidly divide the muscles to the anterior inferior spine from it selection. The external and internal surfaces of the iliac wing to the level of the roof and the upper edge of the large sciatic fossa are isolated with a raster using a periosteum. At the site of the greatest concavity of the iliac wing, a wedge-concave transplant of 2 × 3 cm, corresponding to the size of the roof, is carved from the inner surface using a chisel (Figure 1). An osteotomy is made of 1/3 of the ilium from the side of the sciatic notch with a Gigli saw held around it with the help of Fedorov's curved liver clamp, and 2/3 from the outside below the lower anterior spine - with a gold-plated chisel corresponding to the roundness of the roof (Figure 2). The roof is formed by displacement of the distal bone fragment together with the cavity medially. The previously prepared wedge-concave graft is introduced into the cleft with a concave side to the head (Fig. 1).

Using this method allowed to improve the congruence of the joint surfaces of the head and roof of the joint, reduce the invasiveness of surgery and possible injury to the pelvic vessels, thereby reducing the progression of coxarthrosis in more than 60% of cases. This method currently operated on more than 200 patients.

A specific example of the method.

Patient B.A., born in 1972, medical history 859, was treated in the clinic from 08/01/78 to 12/07/78. Diagnosis: dysplastic coxarthrosis on the right. Wiberg angle before surgery 17 degrees. Operation: supraclavicular osteotomy of the pelvis with plastic surgery of the roof by a wedge-concave transplant from the ilium wing on 10/05/78. The Vieberg angle after the operation is 39 degrees. The operation protocol is identical to the above method.

Using this method allowed to improve the congruence of the joint surfaces of the head and roof of the joint, reduce the invasiveness of surgery and possible injury to the pelvic vessels, thereby reducing the progression of coxarthrosis in more than 60% of cases.

Claims (1)

Method for plastic surgery of the acetabular roof in dysplastic coxarthrosis, including access, transverse osteotomy of the ilium in the supraclavicular region, and medial displacement of the distal fragment with the acetabulum, characterized in that the iliac osteotomy is performed on the 1/3 side of the iliac wing from the periosteal a large sciatic notch with a saw of Gigli and 2/3 from the outside with a grooved bit corresponding to the semicircle of the roof of the acetabulum, and the introduction of a wedge into the cleft a non-concave graft taken from the iliac wing is carried out with the concave side to the femoral head.

Images