RU2392897C1 - Method of treating juvenile slipped femoral epiphysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics. A wire-nail apparatus is used for fixation. Two threaded nails are transcervically delivered to the whirlbone through its neck, and one threaded nail is passed is the subtrochanteric region, while another two threaded nails are provided in a middle third of femur. It is followed with intertrochanteric cup-and-ball osteotomy. The greater trochanter with attached muscles is transplanted to a posterior surface of the trochanteric region. The femoral fragments are put together. A base of an external fixator is formed, and the lower third of femur is fixed in the different planes in crisscross manner with two K-wires that is followed with rotational deformity of the proximal thigh in the external fixator to remove the epiphysis to normocorrection.

EFFECT: method provides elimination of epiphysis displacement and ensures complete congruence in hip joint.

Description

The invention relates to medicine, in particular pediatric orthopedics, and can be used to treat juvenile epiphysiolysis of the femoral head with a significant displacement.

A known method of treating epiphysiolysis of the femoral head by repositioning it with subsequent fixation. A channel is formed in the neck of the femur perpendicular to the epiphyseal surface of the head and a reponator is inserted into it in the femoral head until it stops. Next, diastasis is created between the epiphysis of the femoral head and its distal part 0.5-0.7 cm wide. The reponator is taken to the level of the epiphyseal line and after repositioning of the femoral head the reponator is removed (USSR author's certificate No. 724132, class A61B 17/00. March 30, 1980 Bull. No. 2).

The disadvantage of this method is the diastasis between the pineal gland of the femoral head and its distal part, contributing to damage to the blood supply to the pineal gland and the sprout zone and insufficiently strong knitting.

There is also a method of treating the early stages of juvenile epiphysiolysis of the femoral head in children by reposition and surgical treatment: they perform a corticotomy, establish a proximal fragment in the plane opposite to the initial shift of the pineal gland, simultaneously eliminating its retroversion. An excess epimetaphyseal deformation advance angle is created and stabilized by an external fixation device until complete consolidation (RF patent No. 2192195, class AB 17/56. Publish. November 10, 2002).

The disadvantage of this method is the simultaneous removal of the pineal gland of the femur, leading to complications such as dysplastic coxarthrosis due to vasodilation and twisting, as well as the inability to dynamically correct the pineal gland in the postoperative period.

Closest to the claimed one is a method of treating youthful epiphysiolysis of the femoral head, including reposition of femoral fragments, fixation of the latter by a bundle of spokes, femoral and iliac bones using an external fixation device with the creation of unloading conditions in the hip joint until the fragments are consolidated. During reposition, after external rotation, extension and adduction of the thigh, the position of the pineal gland is fixed with transacetabularly introduced knitting needles. Next, the thigh is bent, rotated inwards and retracted, and then fragments matched as a result of this are fixed with a bunch of knitting needles. The spokes previously entered previously are removed and the transacetabularly inserted needles are placed in the correct position, and the femur and ilium are osteosynthesized by an external fixation device (RF patent No. 2256418, class A61B 17/56. Publish. July 20, 2005).

However, this method does not allow for complete congruence in the hip joint due to the displacement of the pineal gland of the femur.

The problem to which the claimed invention is directed is to eliminate the displacement of the pineal gland of the femur and achieve complete congruency in the hip joint.

The problem is solved in that in the method of treating juvenile epiphysiolysis of the femoral head, including fixing the epiphysis of the femur with an external fixation device, performing osteosynthesis of the femur, fixing is carried out by a spoke-rod apparatus. At the same time, two threaded rods and one threaded rod are transdermally along the axis of the femoral neck, and two threaded rods are inserted into the head of the femur through its neck and two threaded rods are made in the middle third of the femur and an intertrochanteric osteotomy is performed. After that, a large trochanter is transplanted with attached muscles to the posterior surface of the trochanteric region, fragments of the femur are compared, and the base of the external fixation apparatus is formed. The lower third of the femur is fixed in different planes crosswise with two Kirschner spokes with the subsequent rotational displacement of the proximal femur in the external fixation apparatus until the pineal gland is brought into normal correction.

The implementation of fixation with a spoke-rod apparatus, an external fixation apparatus (AVF) makes it possible to gradually remove the pineal gland until the hip joint is completely congruent with the help of distraction, as well as to manipulate the proximal fragment of the femur at any postoperative stage.

Two threaded rods held into the femoral head through its neck transcervically fix the pineal gland.

A threaded rod inserted subvertially along the axis of the femoral neck serves as the center of rotation of the proximal fragment, which allows distraction.

Two threaded rods drawn into the middle third of the femur stabilize the distal fragment of the femur in the AVF.

The intertrochanteric articulated osteotomy creates the conditions for the rotational displacement of the fixed neck and femoral head.

The transplantation of a large trochanter with attached muscles to the posterior surface of the trochanteric region prevents recurrence of deformation and excessive stretching of the middle gluteal muscles, and allows the proximal fragment to be freely excreted by rotation in the AFV.

A comparison of the fragments of the femur and the formation of the base of the external fixation apparatus leads to fixation and stabilization of the proximal and distal fragments of the femur.

Fixation of the lower third of the femur in different planes crosswise with two Kirschner spokes additionally fixes and stabilizes the AFF.

The rotational displacement of the proximal femur in the external fixation apparatus serves to exclude the proximal femoral fragment by means of distraction to complete congruence of the hip joint.

The technical result is to increase the effectiveness of treatment.

The method is as follows.

After appropriate skin treatment and anesthesia, a skin incision is made 5-6 cm long along the outer surface of the thigh in the region of the greater trochanter. Then they acutely and bluntly make subperiosteal access to the intertrochanteric region and the greater trochanter. Under the control of the electro-optical transducer, two threaded rods and one threaded rod along the axis of the neck are transcervically transcervically inserted into the epiphysis in different planes through the neck of the femur in order to further stabilize the proximal fragment of the femur. All three rods are fixed in the sector of the external fixation apparatus. The distal femur fragment at the middle third is fixed with two threaded rods. In the lower third of the femur, two Kirschner spokes with a diameter of 1.8 mm are held crosswise with their subsequent fixation in the ring of the external fixation apparatus. Mount the external fixation device. Then, using the grooved chisel, they perform intertrochanteric articulation of the femur with the formation of a bed for possible rotational displacement of the fixed neck and femoral head. Using a direct bit, a large trochanter with attached muscles is cut off and displaced onto the back surface of the trochanteric region. Spend R-control. The wound is sutured in layers. In the postoperative period, on the 3-4th day, the neck and femoral head begin to rotationally shift to remove the femoral head from the posterior subluxation. After the removal of the pineal gland, the external fixation apparatus is put into stabilization mode. After 7-9 days, the patient adapts to walking on crutches. Dosed load - after 3 weeks.

Claims (1)

A method for the treatment of juvenile epiphysiolysis of the femoral head, including fixing the femoral epiphysis by an external fixation device and performing osteosynthesis of the femur, characterized in that the fixation is carried out by a spoke-rod apparatus, while two threaded rods and one threaded rod are inserted into the femoral head through its neck the rod is subvertible along the axis of the femoral neck, and in the middle third of the femur - two threaded rods and produce an intertrochanteric articulated osteotomy, after which I transplant a large trochanter with attached muscles to the posterior surface of the trochanteric region, fragments of the femur are compared, the base of the external fixation apparatus is formed and the lower third of the femur is fixed in different planes crosswise with two Kirschner spokes with the subsequent rotational displacement of the proximal femur in the external fixation apparatus until the pineal gland is removed standard correction.