RU2351292C2 - Method of metatarsophalangeal joints arthroplasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine area, namely traumatology and orthopedy, and can be used for arthroplasty of metatarsophalangeal joints. Essence of invention consists in access to the metatarsophalangeal joints, allocation of tendon of long extensor of fingers, crossing of the tendons of long and short extensors of fingers, osteotomy of basic phalanxes of the damaged fingers and subsequent stitching of distal part of the crossed tendons to tendons of flexors of the corresponding fingers. Thus arched cut at level metatarsophalangeal joints is formed; tendons of long and short flexors of fingers are crossed at level of proximal third of metatarsal bones. Distal part of the crossed tendons is stitched to the flexor tendons, corresponding to the fingers at level of proximal one-third of the metatarsal bones. Then their spokes are fixed to the metatarsal bones.

EFFECT: restoration of parities in metatarsophalangeal joints at the expense of formation of neoarthroses of metatarsophalangeal joints, to eliminate hammertoe deformation, to stop painful syndrome.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for arthroplasty of the metatarsophalangeal joints.

In the structure of dystrophic lesions of the skeleton, foot diseases are of great importance. To date, the literature describes more than 300 surgical methods for reconstruction of the forefoot. Many methods of surgical treatment of foot deformity as a whole are pathogenetically not justified due to the fact that there is no unified theory of treatment for foot deformity depending on the stage and nature of the process. B.Sh. Minasov proposes to correct the milky deformation of the toes of the foot by crossing the antagonist muscles (short extensor and long flexor of the fingers). (Surgical reconstruction during destructive-dystrophic deformities of the forefoot. B.Sh. Minasov, S.P. Gutov, A.R. Bilyalov, E.I. Kulova. Ufa, 2005. - 48 p.) The method is as follows. A skin incision is made in the tarsal space 3-4 cm long closer to the tarsal space, subcutaneous tissue is dissected, interdigital vessels and nerves are secreted. The skin is pulled out by the hook, the tendon of the short extensor of the changed finger is highlighted, the latter is crossed with a scalpel at the level of the PPS. From the same access, the skin is retracted inside, the tendon of the long flexor of the affected finger is allocated. The long flexor is crossed by a scalpel at the level of the middle phalanx. The wound is sutured tightly.

However, this method has the following disadvantages: there is no restoration of the ratios in the metatarsophalangeal joints, only a temporary effect is achieved, which can subsequently turn into more severe deformations of the forefoot, in all cases of this operation, pain occurs in the future, the cosmetic effect is temporary.

The closest in technical essence and functional purpose is the GDStainsby method, PBBriggs Modified Keller's procedure for the lateral four toes. J.Bone Joint Surg. 1990; 72B: 530), which is performed by an angular incision above each metatarsal bone of the affected fingers, the metatarsophalangeal joints are exposed. The extraction of the long extensor of the fingers is performed, the tendons of the long and short extensors of the fingers intersect at the level of the distal third of the metatarsal bones. Osteotomy of the main phalanges of the affected fingers. The distal part of the crossed tendons is sutured to the flexor tendons of the corresponding fingers. The wound is sutured.

This method also has several disadvantages: the position of the tendons on the heads of the metatarsal bones is unstable, and the formation of a scar, including the tendon, fixes the non-directed position, which can lead to finger instability in the postoperative period.

The technical result of the invention is: restoration of ratios in the metatarsophalangeal joints due to the formation of neoarthrosis of the metatarsophalangeal joints, the elimination of hammer-like deformation, the relief of pain.

The drawings show:

Figure 1 - suturing the tendon of the long extensor of the fingers to the tendons of the flexors.

Figure 2 - holding knitting needles in the phalanges, fixing them to the metatarsal bones.

The result of the invention is achieved in that an arcuate incision is formed in the interphalangeal gap of the affected fingers, a tendon of the long extensor of the fingers is released, it is sutured to the tendons of the flexors of the corresponding fingers, and knitting to the metatarsal bones is performed.

The method is as follows. A subcutaneous tissue is dissected by a figured skin incision about 5-6 cm long in the interphalangeal gap of the affected fingers, interdigital vessels and nerves are distinguished. The skin is pulled outwards, tendons of the long and short extensor digitorum stand out. The metatarsophalangeal joints are exposed, the main phalanges of the metatarsal bones are, as a rule, in the position of a complete dorsal dislocation. A longitudinal dissection of the capsule of the metatarsophalangeal joints is performed. The main phalanges of the affected fingers are distinguished by a raspator, an transverse osteotomy is performed with an oscillatory saw. Subsequently, the tendons of the long and short extensor extensors intersect with a scalpel at the level of the proximal third of the metatarsal bones. The hemming of the distal part, crossed tendons, to the flexor tendons of the corresponding fingers is performed at the level of the proximal third of the metatarsal bones (Figure 1). Using a drill, knitting needles are held in the phalanges, fixing them to the metatarsal bones (Figure 2). The wound is sutured in layers.

The proposed method allows to obtain the formation of neoarthrosis of the metatarsophalangeal joints with interposition of the tendons of the long extensor of the fingers, helps to raise the heads of the metatarsal bones, eliminate the hammer-like deformation of the fingers and relieve pain.

Clinical example: I / B No. 55272007 Full name: Rodina Valentina Pavlovna. Age: 07/08/48 (58 years old). Address: St. Petersburg, 38 Millionnaya st., Apt. 9. Tel .: 3153898. Complaints: Violation of the support function of both feet, pain when walking. Deformation of both feet. An. morbi: Pain in the feet appeared about 17 years ago, then she noticed a deformation of the foot. She did not seek medical help until 2000. In 2000, she was consulted at RNIITO named after P.P. Harmful, surgical treatment is proposed, the patient refused the operation. In the summer of 2007, she noted increased pain, movement without additional support provoked increased pain. From 09/11/06 to 09/29/06 she was treated in 442 HECS. 09/19/06, a Schede operation was performed, correction of the first metatarsal bone according to the CITO method. St. Localis: Walks limping, with extra support. On examination: The skin of both feet of normal color. The right foot is swollen. On the right lower leg from the upper to the lower third along the medial edge of the foot there is a scar 30 cm long after phlebectomy. There is also a postoperative scar about 5 cm long on the back surface of the first toe of the right foot. There is a pronounced deformation of both feet in the region of the tarsal bones. Palpation is painful in the area of the plantar surface of the right foot. Local temperature is not changed. Active and passive movements within the physiological norm. The pulsation on the peripheral vessels is preserved. There are no sensory and motor disorders. January 17, 2007. Operation name: Osteotomy of the main phalanges of the II, III fingers. Arthroplasty. Correction of deformation of the right foot. Removal of screw I of the metatarsal bone of the right foot.

Under conduction anesthesia, in the position of the patient on the back. After processing the surgical field with a solution of lysanine, a longitudinal section was made along the medial surface of the first metatarsal bone. A screw is highlighted on the lateral surface of the I metatarsal bone, removed. Wound washing with antiseptic solutions. Hemostasis. Layered suture of the wound. A figured back incision was made in the II-III interphalangeal gap, the II-III metatarsophalangeal joints of the right foot were exposed. The revision was made: the main phalanx of the second finger in the position of a full back dislocation. Capsulotomy Performed osteotomy of the main phalanges of the II-III fingers. The tendons of the long and short extensor II-III fingers were crossed at the level of the proximal third of the metatarsal bones. Hemming the distal part, crossed tendons, to the flexor tendons of the corresponding fingers. Spokes were held in the II-III phalanges, fixing them to the metatarsal bones. Wounds washed with antiseptic solutions, sutured. An aseptic dressing is applied.

After 21 days, the stitches were removed, the wound healed by first intention, the needles were removed. The patient noted the restoration of ratios in the metatarsophalangeal joints due to the formed neoarthrosis of the metatarsophalangeal joints, the hammer-like deformation was eliminated, the pain syndrome was stopped.

Claims (1)

The method of arthroplasty of the metatarsophalangeal joints, including access to the metatarsophalangeal joints, the extraction of tendons of the long extensor of the fingers, the intersection of tendons of the long and short extensors of the fingers, the osteotomy of the main phalanges of the affected fingers and the subsequent stitching of the distal part of the crossed tendons to the tendons of the flexors of the corresponding fingers, characterized in that at the level of the metatarsophalangeal joints, the tendons of the long and short extensors of the fingers intersect at the proximal third of the metatarsal bones, the distal part of the crossed tendons are sutured to the flexor tendons of the corresponding fingers at the level of the proximal third of the metatarsal bones, after which they are fixed with needles to the metatarsal bones.

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