RU2339324C1 - Method for building defect of bone of limb - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: ends of fragments are processed, devitalised tissues are removed. Flat end of minimum one of the fragments is covered with a fragment of periostenum. Osteotomy of one of the fragments is performed. Dosed traction of the exposed fragment in the bone defect is performed until it comes into contact with the end of the opposite fragment.

EFFECT: enables improving blood supply in consolidation zone, decreasing resection volume of osseous tissue during processing of the ends of bone fragments.

1 ex, 5 dwg

Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients with defects of limb bones of various etiologies.

A known method of replacing a bone defect in a limb (AS USSR No. 313533, publ.: 07.09.71, bull. 27), providing for the processing of the ends of fragments, performing an osteotomy of one of them, the dosed traction of the selected fragment in the bone defect before its contact and subsequent fusion with the end of the opposite fragment using an external fixation device.

However, the use of this method, due to the sclerosis of the fused ends of the fragments, is associated with long periods of consolidation after the replacement of the defect and does not exclude the possibility of refraction in the fusion zone. In addition, when performing the method requires accurate adaptation of the surfaces of the matching ends of the fragments, which is not always possible to achieve and increases the duration of the operation.

A known method of replacing a bone defect (Methods for increasing the mechanical strength of adhesions at the junction of bone fragments. / Methodical recommendations. - Kurgan, 1984 - p.8-9), which involves splitting the opposing ends of the fragments, osteotomy of one of them and subsequent mutual immersion.

However, the use of this method is shown mainly when thinning the ends of the fragments and the small size of the bone defect, when there is the possibility of simultaneous convergence of the fragments and the subsequent restoration of the length of the segment due to the formation of bone regenerate over one of them. It is also necessary to process the ends of the fragments with the maximum possible adaptation of their mating surfaces.

The objective of the invention is to develop a method that eliminates the need for accurate adaptation of the mapped surfaces of the ends of the fragments and provides a reduction in the time of their fusion when replacing defects in the bones of the limbs due to improved blood supply to the consolidation zone.

This problem is solved in that in a method for replacing a bone defect in a limb, including processing the ends of fragments with the removal of non-viable tissues, performing an osteotomy of one of them, dosed traction of the selected fragment in the bone defect before it comes into contact and subsequent fusion with the end of the opposite fragment using an external fixation apparatus , when processing the ends of fragments, the end face of at least one of them is blocked by an adjacent fragment of the periosteum.

The invention is illustrated by a description, an example of practical use and illustrative material which depicts:

Figure 1 - radiograph of the limb of the patient before treatment;

Figure 2 - x-ray of the limb of the patient after surgery;

Figure 3 - x-ray of the limb of the patient in the process of replacing the defect;

Figure 4 - radiograph of the limb of the patient in the process of fixation;

5 is a radiograph of the limb of the patient after treatment.

The method is as follows.

After anesthesia and treatment of the surgical field, osteosynthesis of the affected segment of the limb is carried out, during which 3-4 knitting needles are transosseously transected at the level of the metaphysial departments of the bones. Through a soft tissue incision in the projection of the defect zone, access to the opposing ends of the fragments is made and, after peeling off the periosteum, they are processed to remove non-viable tissues. In the presence of osteomyelitis lesions, fistulous passages are additionally excised and sequestra removed.

Following this, from the portions of the periosteum adjacent to the ends of the fragments that were preserved during the processing of the tissues, rags are formed corresponding to the area of their processed ends. They cover the end surfaces with flaps and fix them to the fragments with the help of absorbable suture material. If it is not possible to form periosteum flaps to close both end surfaces, one of them, as a rule, the end of the fragment, is blocked to which the formed intermediate fragment of the bone is to be brought.

Next, a bone fragment is formed for the metered replacement of the defect. For this, fixing spokes are passed through the end of the longer fragment and its osteotomy is performed.

The fixing spokes are mounted on external supports installed at the appropriate level - rings, arches - which are connected with threaded rods and hinged units with the possibility of metered, multi-plane movement.

The operation is completed by performing control radiography, suturing the wound and stabilizing the systems of the apparatus.

In the postoperative period, starting from 5-7 days, the selected intermediate fragment of the bone is metered in the defect until it comes into contact with the end of the opposite fragment. The pace of movement varies between 0.5-1.0 mm per day. Upon reaching the contact of fragments (overlapping the ends of the periosteum flaps) and, thereby, replacing the bone defect, the apparatus systems are transferred to the mode of stable fixation and supporting compression at the junction of the fragments. Upon achieving bone consolidation and reconstruction of the site of the formed bone regenerate into mature bone tissue, the apparatus is dismantled. Additional immobilization of the limb, as a rule, is not required; the patient is prescribed a course of exercise therapy.

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

Patient Sh., 58 years old, (IKSB No. 51125) was admitted to the hospital with a diagnosis of Postoperative osteomyelitis of the left leg, fistulous form; foreign body of the left tibia.

To eliminate the osteomyelitis process and restore bone integrity, the patient underwent surgery: removal of a foreign body (system of osseous osteosynthesis), sequestrecture of the left leg, osteotomy of the left tibia; osteosynthesis with an external fixation apparatus.

During the operation, at the level of the metaphysical departments of the bones, transosseously, the crosshair was carried out by 3 spokes. Through a soft tissue incision in the projection of the defect zone, access to the tibia was made and the system of bone osteosynthesis was removed. A sequestrectomy was performed with excision of the fistulous passages and, after peeling the periosteum, the ends of the fragments were processed with the removal of non-viable tissues. As a result of this, a defect of the tibia of 8.5 cm was formed.

From the part of the periosteum adjacent to the end of the distal fragment that was preserved during tissue processing, a flap was formed and the end of the distal fragment was blocked with it, fixing it with absorbable suture material.

Then through the end of the proximal fragment held fixing spokes and performed his osteotomy, forming a fragment of bone for dosed replacement of the defect. The fixing bone fragments and the formed fragment of the knitting needles were fixed on the external supports, which, with the possibility of metered, multi-plane movement, were connected by threaded rods and hinged nodes.

The operation was completed by performing control radiography, suturing the wound and stabilizing the systems of the apparatus.

In the postoperative period, starting from day 7, the selected intermediate fragment of the bone was metered in the defect until it comes into contact with the end of the opposite fragment. The rate of movement ranged from 0.5-1.0 mm per day. The duration of traction until contact with the end face of the opposite, blocked by a flap of the periosteum, fragment and, thereby, replacement of the bone defect, was 103 days after which the apparatus systems were transferred to the mode of stable fixation and supporting compression at the junction of the fragments, which was maintained for 122 days. In this case, radiological consolidation of the bone at the junction of the fragments was noted on the 52nd day of fixation. Upon reaching the restructuring of the site of the formed bone regenerate into mature bone tissue, the apparatus was dismantled. Additional limb immobilization was not performed; the patient underwent a course of exercise therapy.

As a result of treatment, the osteomyelitis process was eliminated, the integrity and supportability of the bony skeleton of the lower leg with the compensation of the tibial defect of 8.5 cm was restored.

At the control examination after 1 year, the achieved treatment result is saved; there are no signs of nonunion and recurrence of osteomyelitis, the patient walks with a full load on the operated limb, movements in the joints are within normal limits.

Using the method in the clinic "FGUN RSC" WTO "them. Acad. GA Ilizarova Roszdrav "showed that its use eliminates the need for accurate adaptation of the mating surfaces of the ends of the fragments and reduces the time of their fusion when replacing defects in the bones of the limbs due to improved blood supply to the consolidation zone.

Claims (1)

A method for replacing a limb bone defect, including processing the ends of fragments with the removal of non-viable tissues, performing an osteotomy of one of them, dosed traction of the selected fragment in the bone defect until it contacts and subsequent fusion with the end of the opposite fragment using an external fixation device, characterized in that during processing the ends of the fragments, the end face of at least one of them is blocked by an adjacent fragment of the periosteum.

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