RU2372042C1 - Method of arthrodesed knee joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns traumatology and orthopaedics and can be applied for arthrodesed knee joint. A joint is approached in layers by front incision from lower one-third of femoral bone to tuberosity of shin bone. Tendon of quadriceps muscle of thigh is cut off from upper pole of patella which is arranged between femoral and shin bone crosswise with filling a diastasis zone, suturing patella ligament in a recess provided in epiphysis of shin bone.

EFFECT: invention allows preventing blood circulation disturbance, accelerating consolidation.

1 ex, 5 dwg

Description

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

In case of knee arthroplasty after a complication, in particular suppuration, it is necessary to remove the endoprosthesis, as a result of which a large defect is formed between the femur and tibia. In such cases, arthrodesis of the joint with shortening of the limb is performed. A known method of arthrodesis of the knee joint (Fig. 1), which consists in making an arcuate incision from the inner epicondyle of the thigh to the outer through the tibial tuberosity region, dissecting the transverse ligament of the patella, joint capsule, soft tissue along the lateral surfaces of the joint, pulling it up with a sharp hook lingual flap including patella. The lateral and cruciate ligaments of the joint are dissected with a scalpel and scissors, gradually bending the lower leg, then the synovial membrane, cruciate ligaments, menisci, adipose pad, resection of the joint ends of the femur 1 and tibia 2 and the articular surface of the patella 3 are excised. Then, with a straight bit on the upper patella 3. the surface of the tibia near the anterior edge makes a notch into which the lower pointed edge of the patella, freed from cartilage, is inserted. The back surface it is pressed to the femur, also freed from cartilage. The operation is completed by stitching the wound.

Postoperative limb immobilization can be twofold: by applying a hip plaster cast with a window in the wound area or one of the compression devices. (Operational orthopedics / Ed. By Professor I. A. Movshovich. - M., "Medicine", 1994, P.308.) This method was adopted by us as a prototype. However, as a result of the implementation of this method, shortening of the limb occurs, and the consolidation of bone fragments slows down.

The objective of the invention is to increase the effectiveness of treatment.

The technical result consists in eliminating shortening of the limb, achieving strong fixation of the knee joint without impaired blood circulation, and facilitating patient care.

This is achieved due to the fact that access to the joint is carried out in layers by the front incision from the lower third of the femur to the tuberosity of the tibia, the tendon of the quadriceps femoris is cut off from the upper pole of the patella with its subsequent placement between the femur and tibia in the transverse direction, filling the diastasis zone and your own patellar ligament is fixed with ordinary sutures in a recess made in the tibial epiphysis.

Access to the joint, carried out in layers by the front incision from the lower third of the femur to the tuberosity of the tibia, ensures the preservation of the own ligament of the patella; due to cutting off the tendon of the quadriceps femoris muscle from the upper pole of the patella, its mobilization is achieved for its subsequent placement between the femur and tibia in the transverse direction, filling the diastasis zone; the preservation of the patellar ligamentous ligament preserves its blood supply, and the fixation of the patellar ligamentous ligament in a depression made in the region of the tibial epiphysis is necessary for its stabilization.

Our proposed method is as follows: make a front incision from the lower third of the femur to the tuberosity of the tibia, expose the joint, remove scar tissue with pathological granulations, and make resection of the joint ends of the femur 1 (Fig. 2) and tibia 2 (Fig. 2) . A quadriceps tendon 4 is isolated (FIG. 3) in the proximal end of the patella 3, which is cut off (FIG. 3). Using chisels and nippers, the remnants of the articular cartilage and the anterior cortical layer are removed from the patella 3 (Fig. 4). The patella 3 is moved into the joint cavity (Fig. 5), and its own ligament 5 of the patella 3 is fixed with ordinary sutures in a recess made in the tibia 2 (Fig. 5). The cavity is sanitized with antiseptics, followed by the introduction of antibiotics. The wound is sutured in layers.

CLINICAL EXAMPLE

FULL NAME. Petruseva Z.M., 55 years old, medical history No. 3893.

Diagnosis: chronic postoperative osteomyelitis of the bones that form the right knee joint. Aggravation.

History: On January 11, 2007, a patient undergoing endoprosthetics of the right knee joint was performed for gonarthrosis. In the postoperative period, suppuration of the wound was observed, spreading to the bones that form the knee joint. After 2 months, a fistulonecrectomy was performed, but the purulent process was not completely stopped.

The operation of the proposed method was performed under spinal anesthesia in the position of the patient on the back on the operating table. A skin incision about 14 cm long was made along the anterior surface of the knee joint with excision of the old postoperative scar and fistula. Access to the joint was made in layers. An arthrotomy was performed, about 5.0 ml of synovial fluid with fibrin flakes was released. In the wound hemostasis is performed. An examination of the joint cavity revealed the presence of an extensive scarring process between the femur and tibia. Scar tissue excision was performed. After exposure of the bone, an economical resection of the articular ends of the femur and tibia was performed. During the resection, bone cement was found and removed from the articular end of the femur with an area of 1 cm × 0.8 cm. Given the presence of diastasis between the femur and tibia up to 1.5 cm and the tendency to overextend the knee joint, a decision was made to transpose the patella into the joint cavity . The tendon of the quadriceps femoris was cut off from the upper pole of the patella, mobilization of the latter. Using bits and nippers, the remnants of the articular cartilage and the anterior cortical layer were removed from the patella. The patella was moved to the area between the femur and tibia in the transverse direction and filled the diastasis zone. As a result, significant stabilization of the knee joint in the anteroposterior direction was achieved. Joint recurrence is eliminated. The wound is washed with a solution of antiseptics, drainage with a drainage tube. The wound was sutured in layers, an alcohol dressing was applied to the wound at the drainage outlet. The knee joint is fixed by the posterior plaster cast.

The postoperative wound healed by secondary intention, after 1 month a circular plaster cast was applied from the upper third of the thigh to the foot. Walking on crutches and a load on the limb was allowed after 2.5 months, after 4.5 months consolidation began. Currently, the limb is supportive.

Claims (1)

Method for arthrodesis of the knee joint, including arthrotomy of the knee joint with excision of the synovial membrane, cruciate ligaments, menisci, fat pad and resection of the articular ends of the femur and tibia and the articular surface of the patella, characterized in that the joint is accessed by the anterior layer from the lower third of the femur to the tibial tuberosity, cut the tendon of the quadriceps femoris from the upper pole of the patella, place the patella between edrene and tibia bones in a lateral direction diastase filling zone, and patellar ligament own fixed seams in a recess formed in the tibial epiphysis.

Images