RU2345723C2 - Method of elimination of tibia deformation in children - Google Patents

Abstract

FIELD: medicine; orthopaedics.

SUBSTANCE: osteotomia of fibula in front plane in upper third is performed, in subcondylar region of tibia ostetomia is carried out on the peak of deformation, lower than growth area and perpendicularly to base of tibia deformation with V-shaped rounding of own kneecap ligament and tibia tuberosity, formation of V-shaped bone tenon. Transposition of tibial shaft onto unaffected condyle with further fixation of fragments with pins or Ilizarov apparatus is carried out.

EFFECT: elimination of limb deformation, early splinter consolidation, reduction of traumaticity, elimination of post-operational complications, shortening of treatment terms.

5 dwg, 2 ex

Description

The invention relates to medicine, namely to orthopedics.

A known method of corrective derotational osteotomy of the lower leg bones, which consists in the intersection of the fibula in the middle third, the proximal metaphysis of the tibia with Gigli’s saw from the outside outwards, sawing a wedge from a distal fragment, comparing the longitudinal axes of the fragments relative to the mechanical axis of the limb (Shargorodsky BC Influence of biomechanical and outcomes of treatment of lateral curvatures of the knee joint: Abstract of thesis ... Candidate of Medical Sciences. - Kiev, 1965. - 19 pp.).

There is also known a method of corrective pericondymal decompressive osteotomy of the lower leg bones, which consists in crossing the fibula in the upper third, isolating the patellar ligament, cutting off the tuberosity of the tibia, transverse osteotomy of the proximal tibia metaphysis below the articular fissure by 2.5-3 cm, forming spike from the proximal fragment and resection of the trapezoid fragment by the amount of deformation with shortening of the bone to 1 cm with subsequent open reposition, fixation of torsion tuberosity nodes and plaster cast immobilization (Kotelnikov G.P., Chernov A.P. Surgical correction of knee joint deformities. - Samara, 1999. - P.122-124).

However, in the first case, the osteotomy line does not provide a high bone cross section, which leads to the development of bayonet-like deformation, and cutting off the tibial tuberosity in the second described method leads to aseptic necrosis of the tibial tuberosity in children.

The objective of the invention is to increase the effectiveness of surgical treatment by performing corrective submandibular osteotomy of the tibia with angular deformities of the knee at the top of the deformity while maintaining the growth zone and tuberosity of the tibia, with the elimination of all components of the tibia deformity, the transposition of the diaphysis of the tibia to the uninjured and fixation with needles or in the Ilizarov apparatus.

The technical result of the task is achieved by the fact that in the upper third of the leg, oblique osteotomy of the tibia is performed in the frontal plane, and in the submandibular region of the tibia, the osteotomy is performed at the top of the deformity below the growth zone and perpendicular to the base of the deformation of the tibia with a V-shaped envelope of the patellar ligament and tuberosity of the tibia, the formation of a V-shaped spine with a transposition of the diaphysis of the tibia to the unaffected condyle and eduyuschey fixing needles or fragments Ilizarov.

Figure 1 pos.1 shows the cut line of the skin, subcutaneous tissue, own fascia in the upper third of the leg, figure 2 pos.1 - the dissection line of the periosteum and the level of the V-shaped osteotomy of the tibia at the apex of deformation, Fig.3 pos .1 - comparison of fragments with the subsequent transposition of the diaphysis onto the unaffected tibial condyle and fixation of the fragments by knitting needles, Fig. 4 clinical example: patient P., 5 years old, item 1. - transposition of the distal fragment relative to the proximal, Fig. 5 clinical example: patient M., 2.5 years old, item 1 - transposition of the distal fragment relative to the proximal

The method is as follows.

In the upper third of the leg on the outer surface in the projection of the fibula, a skin incision of up to 5 cm is performed. Subcutaneous tissue and intrinsic fascia are dissected in layers. The subperiosteally isolated fibula is intersected by a chisel in an oblique direction in the frontal plane with a shortening calculated according to skygrams. Layered suture of the wound.

On the front surface of the upper third of the leg in the midline, a C-shaped incision is made of the skin, subcutaneous adipose tissue, own fascia to the periosteum, up to 7 cm long, with a bulge outward (figure 1). Below the growth zone and perpendicular to the base of the deformation of the tibia, calculated according to the skygrams, an osteotomy of the tibia is made with a V-shaped envelope of the patellar ligament and tuberosity of the tibia and the formation of a V-shaped bone spike (figure 2). An open reposition of fragments is carried out with the removal of deformation of the tibia in the frontal plane and hypercorrection by 5-10 ° in order to prevent recurrence of deformation and the development of deformation of the opposite direction, and in the sagittal and horizontal planes to completely eliminate the flexion and torsion components of the deformation, followed by the transposition of the axis of the tibial diaphysis bones on her unaffected condyle. Adaptation of the distal fragment relative to the contour of the proximal fragment with the formation of a V-shaped groove for the bone spike of the tibial tuberosity and fixation of the fragments with Kirschner cross knitting needles and a plaster hip bandage or external fixation apparatus.

The method can be applied for the purpose of simultaneous correction of varus or hallux valgus deformities, combined with a torsion component and angular deformation in the sagittal plane.

The method is used in the treatment of patient P., 5 years old, and patient M., 2.5 l.

A good anatomical and functional result was obtained.

Patient P., 5 years old. Diagnosis: consequences of acute hematogenous osteomyelitis with lesions of the proximal femur metaepiphysis, distal femoral and proximal tibia metaepiphysis on the left, shortening of the left lower limb by 8 cm, varus deformity of the left thigh, varus-aneurysore-left aneurysure.

On radiographs, varus deformity of the tibia 24 °, antecurvation 52 °, excessive internal torsion of the tibia.

On control radiographs after 17 months. varus deformity of the tibia up to 14 ° is noted, antecurvation deformation up to 11 °.

Patient M., 2.5 years old. Diagnosis: the consequences of a meningococcal infection with lesions of the distal metaepiphyses of the femur, proximal tibial mataepiphysis on the left, varus-antecurvature internal torsion bone deformation of the left tibia, 1 cm shortening of the left tibia.

On radiographs, varus deformity of the tibia is 24 °, antecurvature deformation is 41 °, and excess internal torsion of the tibia.

On control radiographs: varus deformity with hypercorrection, torsion and antecurvature deformity, transposition of the tibia diaphysis to the unaffected tibial condyle were eliminated.

Claims (1)

A method for eliminating deformation of the tibia in children by corrective submandibular osteotomy with angular deformities of the knee joint in children, characterized in that an oblique osteotomy of the tibia is performed in the frontal plane in the upper third of the leg and an osteotomy in the submaxillary region of the tibia below the growth zone below the growth zone and perpendicular to the base of the deformation of the tibia with a V-shaped envelope of the own ligament of the patella and tuberosity of the tibia, f rmirovaniem V-shaped cleat with transposition bone diaphysis of the tibia condyle on unlesioned and then fixing two Kirschner wires fragments or Ilizarov.

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