RU2370232C2 - Method of treating pelvic ring deformity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to children's orthopedics, and can be used for correction of pelvic ring deformity, arising after disease or injuries. Essence of method consists in the following: compression-distraction apparatus containing supports in form of ring segments mounted on rods is applied. From iliac crests, parallel to their planes, two rods from each of the sides of pelvis are introduced, two rods are introduced into supracetabuloar area on deformity side, and one rod - on unaffected side. Into proximal part of hip on affected side two rods are introduced. On passed rods proximal sectoral supports are mounted on both sides of pelvis at the level of ilium wings. On affected side intermediate support at the level of supracetabular area is mounted, and distal support - on proximal hip part. From deformity side supracetabular area is marked out, oblique osteotomy of ilium between anterior-superior and anterior-inferior spine at angle of 30 degrees to sagittal plane from front backwards from top downwards and from outside inside is performed. Hinged proximal and intermediate supports are connected, centre of rotation of hinge connection being located at the level of deformity apex, and intermediate and distal supports are connected to each other in stationary way, with support, installed on unaffected pelvis side. Distal fragment is brought down with formation of distraction regenerate, with correction of pelvic ring deformity.

EFFECT: application of claimed invention allows to restore configuration of pelvic ring in the shortest time reducing operation traumaticity.

1 ex, 6 dwg

Description

The invention relates to medicine, namely to pediatric orthopedics, and is used to correct pelvic ring deformity that occurs after diseases or injuries.

Known methods for changing the configuration of the pelvic ring by conducting transverse nadiacetabular osteotomy of the pelvis with simultaneous reduction of the distal fragment forward, down and out (Salter operation) [1], or with its displacement inside (according to Chiari) [2]. Performing operations according to these methods requires either the use of bone grafts [1], or leads to deformation of the pelvic ring [2], in both cases, long-term immobilization in a plaster cast is necessary.

Closest to the technical solution, the proposed method is a method of treating displaced transverse acetabular fractures using a rod apparatus [3], which consists in fixing fragments of the ilium with subsequent reposition and stabilization. In this way, it is not possible to eliminate the nadiacetabular deformation of the pelvic ring resulting from a disease or injury.

The essence of the invention lies in the combination of essential features that ensure the achievement of the desired technical solution, such as: restoring the configuration of the pelvic ring in the least short time while reducing the invasiveness of the operation.

The essence of the invention lies in the fact that the method of treating deformations of the pelvic ring involves applying a compression-distraction apparatus containing supports in the form of segments of rings that are mounted on rods inserted into the wings of the ilium, in the nadiacetabular region and the proximal femur, and connected by threaded rods, and pelvic ileum osteotomy. In the nadiacetabular region, on the unaffected side, one rod is inserted. Proximal sectoral supports on both sides of the pelvis are mounted on rods held intraosseously through the wings of the ilium. An intermediate support - on the rods held in the nadacetular region, and a distal support - on the rods held through the proximal femur, are installed on the affected side. On the deformity side, the nadacetular region is distinguished between the posterior edge of the muscle, which stretches the broad fascia of the thigh, and the front edge of the middle gluteus maximus. An oblique osteotomy of the ilium is made between the anteroposterior and anterior-inferior spine, at an angle of 30 ° to the sagittal plane from front to back, from top to bottom and from the inside out. The proximal and intermediate supports are articulated. Intermediate and distal supports fixed between themselves are fastened with a support mounted on the unaffected side of the pelvis. In the postoperative period, the distal fragment is gradually reduced to form a distraction regenerate, with the correction of the configuration of the pelvic ring.

The introduction on the unaffected side into the nadiacetabular region of one rod reduces the invasiveness of the operation.

Oblique osteotomy of the ilium between the anteroposterior and anteroposterior spine, at an angle of 30 ° to the sagittal plane, from front to back, from top to bottom and from the inside inward, prevents osteotomized fragments from shifting during correction of pelvic ring deformation.

The articulation of the proximal and intermediate supports provides a gradual lowering of the distal ilium fragment with the formation of a distraction regenerate and restoration of the correct configuration of the pelvic ring.

Stationary fastening of the intermediate and distal supports to each other, and with a support mounted on the unaffected side of the pelvis, ensures stable fixation of fragments for the period of formation of the distraction regenerate.

The use of this method, in comparison with the prototype, allows you to get the following advantages:

- reduces the invasiveness of the operation;

- a gradual reduction of the distal ilium fragment with the formation of a distraction regenerate leads to the elimination of deformation of the pelvic ring;

- provides stable fixation of fragments for the period of formation of the distraction regenerate.

Thus, the above essential features distinguish this method from known methods and allow you to restore the correct shape of the pelvic ring and biomechanical relationships of the pelvis and lower limb.

Figure 1 shows the layout of the compression-distraction apparatus for external fixation and the level of osteotomy of the ilium.

Figure 2 shows the restored configuration of the pelvic ring with the formed distraction regenerate.

The compression-distraction apparatus consists of proximal supports 1 and 2, mounted on opposite sides of the pelvic ring, connected by threaded rods 3 and 4. The proximal support 1 installed on the affected side is connected to the intermediate support 5 by means of threaded rods 6 and hinge assemblies 7. Threaded rods 8 connect the distal support 9 to the intermediate support 5, and threaded rods 10 to the proximal support 2 mounted on the unaffected side. All supports used in the apparatus are sectoral. The fastening elements to the bones 11-16, in the form of bone rods, are attached to the respective supports with clamps (shown in the drawing without marking the positions).

The method is as follows.

From the crests of the ilium, parallel to their planes, two intraosseous rods 11 and 12 are inserted from both sides of the pelvis (Fig. 1). Intraosseous rods 13 are inserted into the nadiacetabular region, on the deformation side, and rod 14, on the opposite side. The rods 15 and 16 are inserted into the proximal femur, on the lesion side. Sectoral supports 1,2, 5, 9 are mounted on the rods.

After installation of the sectoral supports of the compression-distraction apparatus, oblique ocetabular osteotomy is performed, for which an skin incision is made to the anteroposterior spine along the outer contour of the iliac crest, the deformity side, with the extension to the apex of the greater trochanter. A nadacetular region is distinguished between the posterior edge of the muscle, which stretches the broad fascia of the thigh, and the front edge of the middle gluteus maximus. An oblique iliac osteotomy is made between the anteroposterior and anterior-inferior spine at an angle of 30 ° to the sagittal plane from front to back, from top to bottom and from the inside out. The wound is sutured to the drainage tube tightly.

Sectoral support 2 by means of threaded rods 3 and 4 and remote brackets is connected to sectoral supports 1 and 9. Sectoral support 1 by threaded rods 6 and hinge assembly 7, with the center of rotation set at the top of deformation, connected to sectoral support 5. Sectoral supports 5 and 9 are connected by threaded rods 8. After 7 days, using the threaded rods 6 and the hinge assembly 7, the osteotomized, distal fragment of the ilium 17 at a rate of 1 mm per day begins to lower, forming a distraction regenerate 18 (Fig. 2).

Clinical example.

Patient S., 12 years old, was admitted with a diagnosis of Pelvic deformity after surgical treatment of aneurysmal bone cyst of the left iliac bone with a relative shortening of the left limb by 6 cm. 06/01/2003 - operation. Under general anesthesia, on both sides of the pelvis, with the iliac crests, along their plane, two intraosseous rods were inserted into the nadacetular region, on the deformation side, two intraosseous rods were inserted, on the opposite side - one rod, in the proximal femur, on the side defeat - two more rods. Sectoral supports were mounted on the performed rods: proximal on both sides of the pelvis, two supports on the affected side - the intermediate - at the level of the nadacetabular region, and the distal - on the proximal femur. After installation of the sectoral supports of the compression-distraction apparatus, an oblique ocetabular osteotomy was performed, for which a skin incision was made to the anteroposterior spine along the outer contour of the iliac crest, the deformity side, and continued to the apex of the greater trochanter. A nadecetabular region was distinguished between the posterior edge of the muscle pulling the broad fascia of the thigh and the front edge of the middle gluteus maximus. An oblique iliac osteotomy was performed between the anteroposterior and anterior-inferior spine at an angle of 30 ° to the sagittal plane from front to back, from top to bottom and from the inside out. The wound was sutured to the drainage tube tightly. Mounted sectoral supports connected by threaded rods.

An example is illustrated by x-ray and photographs: figure 3 - view of the pelvis before surgery; figure 4 - after the operation; figure 5 presents the x-ray of the pelvis 2 years after surgery; figure 6 - functional outcome.

Information sources

1. Movshovich I.A. "Operational orthopedics." M, 1983, p. 190;

2. Movshovich I.A. "Operational orthopedics." M, 1983, pp. 192-193;

3. RF patent No. 2160066, Cl. A61B 17 \ 66, BI No. 17, 2000

Claims (1)

A method for treating pelvic ring deformations, including applying a compression-distraction apparatus containing supports in the form of ring segments mounted on intraosseous rods and connected by threaded rods, characterized in that two rods are inserted parallel to their planes from the iliac crests on two sides of the pelvis, two rods are inserted into the nadiacetabular region on the deformity side, and one rod on the non-affected side, two rods are inserted into the proximal femur on the lesion side, on the performed reapers mount proximal sectoral supports on both sides of the pelvis at the level of the wings of the ilium, on the affected side - an intermediate support at the level of the nacetabular region, and the distal support on the proximal part of the thigh, the nadacetabular region is distinguished from the deformity side, and oblique iliac osteotomy is made between the anteroposterior and anterior-inferior awn at an angle of 30 ° to the sagittal plane from front to back, from top to bottom and from the inside inward, connect the articulated proximal and intermediate supports and the center of rotation of the hinge joint is located at the level of the deformation vertex and stationary between the intermediate and distal ones with a support mounted on the unaffected side of the pelvis, the distal fragment is reduced to form a distraction regenerate, with correction of the deformation of the pelvic ring.

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