RU2370228C2 - Method of hip joint stabilisation in case of femoral bone head and neck absence with simultaneous hip elongation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Compression-distraction apparatus is applied on hip. Femoral bone osteotomy passing through lower part of lesser trochanter and osteotomy for femoral bone elongation in medial or lower third are carried out. Arches of compression-distraction apparatus are moved to each other at 30-40 degrees and angle of 30-40 degrees open towards cotyloid cavity is created between bone fragments. Arches are fixed. Angle apex is centred on cotyloid cavity to provide possibility of bone regenerate formation in growth period in form of femoral bone neck.

EFFECT: method ensures hip joint stability, recovering of femoral bone support ability, restoration of lower extremity length.

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Description

The invention relates to medicine, namely to traumatology and orthopedics.

There is a method of restoring support when congenital dislocation of the thigh with its simultaneous lengthening in adolescents and adults (prototype), which consists in subperiosteal discharge on the outer surface of the thigh in the upper third of the femur, cut-off from the inner part of the bone in the undervert region of the cortical plate and dosed its movement to form bone regenerate until it stops in the ischial bone with a rod fixed in the Ilizarov’s previously superimposed apparatus and moved to the thigh drilled bony tunnel. Hip lengthening is carried out after transverse osteotomy in the lower third (Abakarov A.A., Bogosyan A.B. Apparatus and methods of external fixation in traumatology and orthopedics. - Riga, 1985. - P.115-120).

There is also known a method of surgical treatment of an unsupported hip joint, which consists in applying the Ilizarov apparatus to the thigh and wing of the ilium, dosed lowering of the thigh with an apparatus followed by osteotomy of the lesser trochanter or cleavage of a fragment of the femur from the inner thigh made from a separate access, by introducing into the cleaved area of the bone through a pre-drilled hole of a spoke with a thrust pad connected to the Ilizarov apparatus, and subsequent metered movement of eotomized fragment in the acetabulum with the aim of forming a distraction regenerate that performs the function of the femoral neck (Devyatov A.A., Rudenko I.A., Tkachev V.A. Orthopedist. Traumatol. - 1991. - No. 1. - P. 54- 55).

However, these methods require significant dissection of the soft tissues in order to gain access to the lesser trochanter or the subtrochanteric region, which leads to an increase in the invasiveness of surgical intervention and an extension of the treatment time for patients. Sliding a rod or knitting needle from a split bone plate or small trochanter during their metered movement does not allow formation of a distraction regenerate to rest against the ischial bone or acetabulum, and the lack of centering of the formed “neck” of the femur on the acetabulum affects the stability of the hip joint. At the same time, both the shaft and the spoke are additional entrance gates for the development of infectious complications.

The objective of the invention is to improve the stability of the hip joint and lengthening of the thigh in patients in the absence of the head and neck of the femur, in particular after suffering hematogenous osteomyelitis, as well as improving the function of the hip joint and supporting ability of the thigh.

The technical result of the task is achieved by applying a compression-distraction apparatus to the thigh, osteotomy of the lesser trochanter and osteotomy to extend the femur in the middle (lower) third, moreover, the osteotomy of the lesser trochanter of the femur passes through the lower part of the trochanter and creates between the bone fragments an angle of 30-40 ° open to the acetabulum and is fixed by means of arches of the compression-distraction apparatus, while the apex of the angle is centered on the acetabulum to ensure possible the formation of bone regenerate during the growth period in the form of a femoral neck.

Figure 1 shows the line of the osteotomy of the femur to stabilize the hip joint (1) and the line of the osteotomy of the femur to extend the hip (2);

figure 2 - the formation of the "neck" of the femur (2) after fixing between each other arches of the compression-distraction apparatus (3).

The method is as follows

A compression-distraction apparatus of two arcs 3 (Fig. 1) and two rings 4 (Fig. 1) is applied to the thigh. Between two arches from a small incision of soft tissues along the outer surface of the thigh with a chisel, an osteotomy is performed passing through the lower part of the small trochanter of the femur 1 (Fig. 1), the arcs are brought together by 30-40 °, and an angle open between the bone fragments to the acetabulum 30-40 °, center its top on the acetabulum and fix the arc with threaded rods 1 (figure 2). During the period of growth of bone regenerate in the area of osteotomy performed on the top formed between the bone fragments of the angle from the small trochanter forms the “neck” of the femur 2 (Fig.2).

The osteotomy of the femur for lengthening the thigh 2 (figure 1) is performed between two rings 4 (figure 1) in the middle or lower third of the thigh.

A positive effect of the claimed technical solution is to improve the stability of the hip joint, improve its function and support ability of the thigh through the formation of the “neck” of the femur from the small trochanter, as well as the restoration of the length of the lower limb.

The method is used in the treatment of patients K., 10 years old, medical history No. 991845 and G., 12 years old, medical history No. 060836. A good functional result was obtained.

Claims (1)

A method of stabilizing the hip joint in the absence of a head and neck of the femur with simultaneous lengthening of the thigh, comprising applying a compression-distraction apparatus to the thigh, performing an osteotomy of the femur passing through the small trochanter, and osteotomy to lengthen the femur in the middle or lower third, characterized in that the osteotomy of the femur passes through the lower part of the lesser trochanter, bring the arches of the compression-distraction apparatus closer to each other by 30-40 ° and create between the bone fragments an angle of 30-40 ° open to the acetabulum, the arches are fixed, while the apex of the angle is centered on the acetabulum to enable the formation of bone regenerate during the growth period in the form of the femoral neck.

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