RU2332948C2 - Method of revascularisation of large joints bone fragments - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: channel in a recipient bone is formed consequently according the size of coupling containing feed vessels with their branches. The bed having the size of a periosteal-cortical plate is formed in the bottom of the channel. Then, the beveled edge of the channel is formed for placing an auto-transplant vascular pedicle. After placing and fixating the auto-transplant in the bed, the vascular pedicle is backed out, through the cut in the capsule, in the direction of the restructured bone diaphysis, and the joint capsule is taken in above the auto-transplant.

EFFECT: reduction of time revascularisation and restructuring of bony tissue, decrease of risk of losing the form of transplant due to bony tissue resorption.

5 dwg, 1 ex

Description

The invention relates to the field of reconstructive surgery and traumatology, i.e. to a method of revascularization of bone fragments of large joints, and can be used in specialized departments of reconstructive microsurgery.

In reconstructive surgery and traumatology, a method is known for reconstructing the distal shoulder in case of abnormally fused and non-fused intraarticular fractures, when an osteotomy is performed along the line of an abnormally fused fracture and reposition of bone fragments with skeletonization and separation of the periosteum of the displaced fragment, fixation of the fragment with the creation of a congruent articular surface above the microscope -cortical flap on the surface of the repaired avascular fragment (RU Pat nt №2206287 from 20.06.2003).

However, the known method has significant disadvantages.

A free revascularizable periosteal-cortical autograft has properties that can, to a certain extent, influence osteoreparative processes. The implementation of these properties can be considered in the form of two main processes: the formation of the combined vascular bed of the contacting tissues - the periosteal-cortical autograft and the recipient area; and the participation of living bone cells in the formation and rearrangement of bone tissue. Obvious for large bone fragments with impaired blood supply is the remoteness of the autograft tissue from most of the bone fragment tissue at its surface location. As a result, the autograft performs its function either not fully, or with some delay, required for the formation of vascular connections with distant areas of bone tissue. Of particular importance in the reconstruction, for example, of the knee joint is the restoration of the joint capsule with the ligamentous apparatus to restore the functional stability of the joint and delimit the joint cavity, which is technically impossible when performing the known method.

The objective of the proposed method of forming a bed for a revascularizable periosteal-cortical autograft is to increase the effectiveness of surgical treatment, reduce surgical risk, and also reduce the duration of treatment.

The problem in the method of revascularization of bone fragments of large joints, including reposition of a bone fragment with impaired blood supply and microsurgical autotransplantation of a periosteal-cortical autograft, is achieved by sequentially forming a channel in the recipient bone according to the size of the coupling containing the supply vessels with their branches, the bed is the size of the periosteal-cortical plate and then the beveled edge of the canal for laying the vascular pedicle of the autograft, after laying and the transplantation of the autograft in the bed the vascular pedicle is removed through an incision in the direction of the diaphysis of the reconstructed bone and the joint capsule is sutured on top of the autograft.

The proposed method and features that distinguish it from those known in the medical and patent literature are not found, which allows us to conclude that its criterion of "novelty" is met.

The essence of the invention lies in the fact that they consistently form a channel in the recipient bone according to the size of the sleeve containing the supply vessels with their branches, at the bottom of the channel there is a bed of the size of the periosteal-cortical plate and then the beveled edge of the channel for laying the vascular leg of the autograft, after laying and fixing the autograft in the bed, the vascular pedicle is removed through an incision in the direction of the diaphysis of the reconstructed bone, and the joint capsule is sutured on top of the autograft.

It is the sequential formation of the canal in the recipient bone according to the size of the sleeve containing the supply vessels with their branches, and then the formation of a bed of the size of the periosteal-cortical plate on the bottom of the canal allows the periosteal-cortical autograft to be immersed deep into the bone fragment with adequate contact of the autograft with the cortical plate . This makes it possible to rationally use the reparative properties of the autograft, which results in a reduction in the time of revascularization and bone remodeling, and for avascular bone fragments, a significant reduction in the risk of volume and shape loss due to bone resorption processes. In turn, the formation of the channel in the recipient bone according to the size of the sleeve containing the supply vessels with their branches, and the beveled edge of the channel for laying the vascular pedicle of the autograft allows immersing the autograft in the formed bed and avoiding hemodynamic disturbances, loss of the autograft due to bending and compression of the supply vessels .

The removal of the vascular pedicle towards the diaphysis of the reconstructed bone through the capsule incision allows the joint capsule to be sutured on top of the autograft without disturbing the blood supply to restore the functional stability of the joint and delimit the joint cavity.

The combination of these factors not only reduces surgical risk, but also increases the effectiveness of surgical treatment, as well as reduces the treatment time due to the full realization of the potential of a well-supplied, osteogenetically active cortical graft.

Thus, the totality of all the distinguishing features allows you to achieve your goal and get a positive result.

The implementation of the method is illustrated by drawings.

Figure 1 - The position of the displaced condyle of the lateral condyle of the femur.

Figure 2 - Avascular bone fragment of the condyle of the femur repaired and fixed in the correct position.

Figure 3 - A channel is formed in the recipient bone according to the size of the coupling of the periosteal-cortical autograft containing the supply vessels with their branches. At the bottom of the canal there is a bed the size of the periosteal-cortical plate and then the beveled edge of the canal for laying the vascular pedicle of the autograft.

Figure 4 - Free revascularizable autograft placed in the formed bed.

Figure 5 - Vascular leg is removed through the incision in the direction of the diaphysis of the reconstructed bone. The step of suturing the joint capsule on top of the autograft.

The method is as follows: in a patient with impaired blood supply to large bone fragments of the joint, reposition is performed with restoration of joint congruency and osteosynthesis. The periosteal-cortical autograft on the vascular pedicle is taken. Then, in the recipient bone with impaired blood supply, a channel is sequentially formed according to the size of the autograft coupling containing the supply vessels with their branches, and at the bottom of the channel, a bed according to the size of the periosteal-cortical plate. To lay the vascular pedicle of the autograft according to its size, a beveled edge of the channel is formed. An autograft is placed and fixed in a bed. The vascular leg of the autograft is removed through the incision in the direction of the diaphysis of the reconstructed bone. The joint capsule is sutured on top of the autograft. Microanastomoses of autograft vessels are performed with vessels of the recipient area. The wound is sutured and drained.

Clinical example.

Patient I., 26 years old. East the disease No. 618683. Clinical diagnosis. Improperly healed fracture of the lateral condyle of the left thigh with displacement.

From the anamnesis. As a result of an accident, he received a fracture of the base of the skull, a closed fracture of the right humerus with an offset, a fracture of the sciatic and pubic bones on the right, an open fracture of the lateral condyle of the left femur, with the displacement of fragments. For a long time was in a coma. An open lateral condyle fracture was treated in a cast. The fusion occurred with the displacement of the fragment in the proximal direction and rotation of 15 ° outwards.

The patient underwent surgery. Reconstruction of the left distal metaepiphysis of the femur with transplantation of a free revascularizable periosteal-cortical radial autograft, i.e. during the operation according to our method, a channel is formed in the recipient bone according to the size of the sleeve containing the supply vessels with their branches, at the bottom of the channel there is a bed of the size of the periosteal-cortical plate and then the beveled edge of the channel for laying the vascular leg of the autograft. A revascularizable periosteal-cortical autograft is placed in the formed bed and fixed. The vascular leg of the autograft is removed through the incision in the direction of the diaphysis of the reconstructed bone. The joint capsule is sutured over the autograft. Blood circulation in the autograft restored. The wound is sutured and drained. Fusion of bone fragments occurred 3 months after surgery. The range of motion in the knee joint is restored. The limb is supportive. The patient is professionally fit.

The proposed method is implemented in the department of reconstructive microsurgery RSCH RAMS and will find application in clinical practice.

Using the proposed method of revascularization of bone fragments of large joints allows you to:

1 increase the effectiveness of surgical treatment;

2 reduce surgical risk;

3 to reduce treatment time.

Claims (1)

A method of revascularization of bone fragments of large joints, including reposition of a bone fragment with impaired blood supply and microsurgical autotransplantation of a periosteal-cortical autograft, characterized in that a channel is formed in the recipient bone sequentially according to the size of the sleeve containing the supply vessels with their branches, along the channel bottom periosteal-cortical plate and then the beveled edge of the canal for laying the vascular pedicle of the autograft, after the autograft is laid and fixed tata in the bed, the vascular pedicle is removed through the incision of the capsule towards the diaphysis of the reconstructed bone, and the joint capsule is sutured on top of the autograft.

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