RU2375006C1 - Method of treating long-healing fractures and false long bones joints - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to traumatology and orthopedics. Into intramedullary canal of one of fragments, rod Fixion, whose diametre is 15% smaller than intramedullary canal, is introduced not reaching the false joint level. On fragments at the distance 0.5-3.0 cm from their ends through canals are made, located at 45° angle to rod Fixion stiffening ribs. Fragments are approached to each other till their full contact. After that rod is introduced into other fragment. Wound is sewn hermetically. After that physiological solution is supplied into rod under gradually growing pressure to 80 bars, transplanting bone marrow from fragments to injury zone through canals.

EFFECT: method ensures reduction of traumaticity and labour consumption, stimulation and acceleration of regeneration processes, prophylaxis of thromboembolism.

5 dwg, 1 ex

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used to accelerate the regeneration of long-growing fractures and false joints of long bones.

A known method of treating long-growing fractures and false joints of long bones by osteomy of a damaged limb segment using compression osteosynthesis in an external fixation apparatus, in which, after fixation of a limb segment in a transosseous apparatus, a skin incision is made outside the projection of the pathological zone and the periosteum is detached above and below the false zone joint or nonunion no more than 3 cm long. Then a longitudinal dissection of the bone through the pathological zone in two mutually perpendi ulyarnyh planes (RF patent №2181267, cl. A61V 17/56. Publ. of 20.04.2002).

The disadvantage of this method is its invasiveness when processing ends and fragments, including a two-plane osteotomy. In addition, the method is not applicable for intramedullary osteosynthesis.

There is also a method of treating a false joint of a long tubular bone, including reposition of bone fragments and performing an osteotomy of the end of one of them with subsequent stable fixation to restore bone integrity using a compression-distraction apparatus. The end of the distal bone fragment is osteotomized along a line passing obliquely through its sclerotic and healthy areas, and during reposition, the opposing ends of the main fragments are centered, leaving the selected fragment intact (RF patent No. 2257170, class А61В 17/56. Publish. 07.27.2005. )

But this method is time-consuming and requires a lot of time to implant the sclerotized osteotomy end of one of the fragments (autograft).

Closest to the proposed in its technical essence is a method of treating false joints of long bones, including the introduction and stabilization of the rod in the medullary canal (Korhov V.V. Surgical treatment of false joints: intraosseous metal osteosynthesis. - L .: Publishing House "Medicine", 1966, S.122-126; Klyuchevsky VV Surgery of injuries. - Yaroslavl: DIA-press, 1999, S.311-316).

However, this method is traumatic, because reaming of the medullary canal deprives fragments of blood supply by a. nutricia, which slows down bone formation. And the introduction of the rod increases intraosseous pressure, which, in turn, increases the risk of thromboembolism. An additional blocking creates the prerequisites for longitudinal fractures.

The task to be solved by the claimed method is directed is to reduce the morbidity, stimulate bone formation and prevent thromboembolism.

The problem is solved in that in the method for treating false joints of long bones, including the introduction and stabilization of the rod in the medullary canal, the Fixion rod, whose diameter is 15% less than the diameter of the medullary canal, is inserted into the medullary canal of one of the fragments. Through channels are carried out in fragments at a distance of 0.5-3.0 cm from their ends, placing them at an angle of 45 ° to the stiffeners of the Fixion rod. The fragments are brought together to their full contact, then the rod is inserted into another fragment and the wound is sutured tightly. Then, physiological solution is supplied to the rod under pressure gradually increasing to 80 bar, transplanting bone marrow from the fragments through the channels into the damage zone.

The Fixion core introduced into the bone marrow canal of the bone fragment provides rigid fixation of bone fragments due to intraosseous blocking throughout the bone marrow channel by expanding stiffeners.

The introduction of a fixion rod fragment into the bone marrow canal, without reaching the level of the false joint, creates the conditions for visual control of the location of stiffeners and eliminates the spatial error in the formation of channels in the fragments.

The choice of the diameter of the Fixion rod less than the diameter of the medullary canal reduces the trauma of the intraosseous vascular system by 15% and does not create increased intraosseous pressure, which prevents thromboembolism.

And made through channels in the fragments at a distance of 0.5-3.0 cm from their ends determine the area (zone) of the content of the bone marrow canal.

The supply of physiological saline to the rod under gradually increasing pressure up to 80 bar is necessary to expand it, as well as to create conditions for displacing the contents of the bone marrow through the channels into the damage zone and preventing thromboembolism.

The displacement of bone marrow tissue in the proposed method should be considered as one of the types of bone marrow transplantation.

The technical result consists in stimulating and accelerating the regeneration processes.

The method is implemented as follows.

After anesthesia and treatment of the surgical field, the area of the pseudarthrosis is exposed by known methods. The ends of the fragments are then processed to create congruency. The medullary canal is opened to the true diameter of the bone.

A Fixion rod is introduced antegrade into the proximal fragment, without reaching its end by 3-4 cm. The plane of expansion of the stiffening ribs of the rod is visually determined and the fragments of the through channels are formed in the fragments at a distance of 0.5 to 3.0 cm from them, forming them at an angle of 45 ° to the stiffener. Create on each fragment no more than 3 channels, placing them on the same line along the fragments, with a drill with a diameter of 3.5-4.0 mm. Moreover, the channel centers are located at a distance of 8 mm from each other. Then the Fixion rod is inserted into another distal fragment.

With full contact of the ends of the fragments, the surgical wound of the zone of the “false joint” is sutured and gradually growing up to 80 atm. With a manual pump, physiological saline is fed into the rod by pressure. If the pressure of 80 bar remains constant for 5-10 minutes, this indicates the stiffening of the stiffeners and their reliable fixation in the medullary canal. In this case, the pump is turned off and the wound is sutured tightly. In the postoperative period, the tactics of curating the patient are built depending on the operated segment of the limb.

Example. Patient M., 67 years old. She was injured in a traffic accident: a double diaphyseal fracture of the tibia in the upper third and lower third of the leg. She was treated in a specialized hospital for 9 months. A fracture in the lower third of the tibia fused, and in the upper third a pseudoarthrosis was formed (Fig. 1). She entered the Saratov Research Institute of Traumatology and Orthopedics (SarNIIITO), where she underwent surgery on 23.11.2007: intramedullary osteosynthesis with the Fixion shaft. Anesthesia - spinal anesthesia. After processing the surgical field in the area of the pseudoarthrosis, accesses to the tibia were made. The ends of the pseudoarthrosis are economically resected, the medullary canals are opened, an osteotomy of the fibula is performed. Full contact of the ends of the fragments is achieved.

To select the size of the rod, the isthmic part of the tibia was measured, the diameter of which was 10 mm. The sizes of the Fixion rod were determined: length - 340 mm, and diameter - 8.5 mm, which is 15% less than the narrowest part of the tibia canal. A fixion rod was inserted into the proximal fragment at a distance of 8 cm. At the ends of the fragments, through channels with a diameter of 3.5 mm were formed through holes at an angle of 45 ° to the stiffening ribs of the rod: on the proximal fragment — 2 channels, on the distal — 3. Without effort, with a tight contact between the ends of the fragments, the rod was inserted into the distal fragment. Conducted R-control (figure 2). Radiological situation is assessed as favorable. The operative wound of the pseudoarthrosis is sutured tightly. The rod was inflated under pressure gradually increasing to 80 bar until its diameter corresponded to 10-15 mm. The supply of saline was stopped, the pump was disconnected. The wound from the inserted rod was sutured. Spent R-control (figure 3). 3 days after the operation, the patient began to move independently with crutches. The load on the leg after 3 weeks - up to 50% of the patient’s body weight, after 5 weeks - full load. The fusion occurred after 2 months (figure 4). After 7 months, the formation of bone tissue is completed, there is a restructuring of the bone callus (figure 5).

Claims (1)

A method of treating false joints of long bones, including the introduction and stabilization of the rod in the medullary canal, characterized in that the Fixion rod, whose diameter is 15% less than the diameter of the medullary canal, is inserted into the medullary canal of one of the fragments, it is performed in the fragments at a distance of 0.5-3.0 cm from their ends, the through channels, positioning them at an angle of 45 ° to the stiffening ribs of the Fixion rod, bring the fragments closer to their full contact, then introduce the rod into another fragment and suture the wound tightly, after four of a rod to a gradually increasing pressure up to 80 bar is fed saline transplanting fragments of through channels in damage to the marrow zone.

Images