RU2400167C1 - Method of treating congenital dislocated hip in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to paediatric surgery, orthopaedics and can be used for treatment of said congenital pathology. An additional iliofemoral ligament is formed of an autologous joint capsule with its principal attachment point at a cavity edge to preserve blood supply and innervation that leads to its complete engraftment, performing a function of stable strong hold of the femoral head in the cavity.

EFFECT: prevented lateroposition of the femoral head.

1 ex, 6 dwg

Description

The invention relates to medicine, namely to pediatric surgery, orthopedics, and can be used to treat congenital dislocation of the thigh in children.

One of the most serious consequences of the treatment of patients with congenital dislocation of the hip is dysplastic coxarthrosis, which leads to a decrease in the working capacity and disability of patients, and these indicators acquire a steady upward trend. The prevention of lateral position and residual hip subluxation during treatment is the prevention of the development of early dysplastic coxarthrosis in children.

There is a method of treating congenital dislocation of the thigh in children by gradually dosing the hips to the level of the cavity using the overhead extension method, followed by applying a hip plaster bandage in the Lorentz-1 position / Tikhonenkov ES // Traumatology and orthopedics: A guide for doctors / Ed. Yu.G. Shaposhnikova. - M., 1997 .-- T.3. - S.245-248 /.

The disadvantage of this method is the lack of effect in cases of high dislocation of the thigh, severe forms of cavity dysplasia (teratogenic dislocation, irreversible dislocation), in the treatment of children over 2 years of age. Due to trauma to the cartilage structures, aseptic necrosis of the head and early arthrosis of the hip joint develop.

A known method of treating congenital dislocation of the thigh in children, which consists in the fact that using external fixation devices of various designs, superimposed on the ilium and femur, by means of distraction, the hip displacement is gradually eliminated until the head is projected at the level of the cavity / O. Kozhevnikov. Surgical treatment of congenital hip dislocation in young children // Bulletin of Traumatology and Orthopedics named after N.N. Priorov. - 2008. - No. 1. - S. 53-58 /.

The disadvantages of this method are the difficulty of its use in children of early childhood, the occurrence of such complications as inflammation of the soft tissues around the knitting needles, teething, maintaining the lateral position of the femoral head.

Closest to the technical result achieved is a method of treating congenital dislocation of the thigh with detorsion-varicating undertrochanteric osteotomy / Kuznechikhin EP, Ulrich E.V. // Surgical treatment of children with diseases and deformations of the musculoskeletal system. - M .: Medicine, 2004. - P.325-329 /, consisting in the intersection of the iliopsoas muscle, arthrotomy of the hip joint, excision of the round ligament and embryonic adipose tissue to the articular cartilage, dissection of the transverse ligament, mobilization of the screwed limbus with subsequent reduction of the head hips after corrective shortening of the postoperative osteotomy and excision of the excess joint capsule.

The disadvantage of this method is the low efficiency of treatment due to the development of lateral position of the femoral head relative to the cavity with the formation of a residual subluxation, which subsequently leads to early arthrosis of the hip joint.

The technical result of the proposed method is to increase the effectiveness of the treatment of congenital dislocation of the thigh due to the formation of an additional strengthening ligament that prevents lateralization of the femoral head by cutting the ligament from the hypertrophic joint capsule until it is excised.

The technical result is achieved by the fact that after open reduction of the congenital dislocation of the hip and excision of the capsule excess, the formed ligament, which has intact trophism (blood supply and innervation) and a strong connection with the edge of the cavity, strengthens the anteroposterior part of the capsule of the hip joint and thereby prevents the formation of lateral position and residual subluxation .

The method is as follows.

The method is illustrated by figures 1, 2, 3, 4, 5, 6.

Carry out endotracheal anesthesia. The child's position on a healthy half-side. Soft tissue is cut through the anterior external access to the projection of the hip joint with a transition to the lateral surface of the thigh. The gluteus maximus muscle is mobilized; at the attachment point, the gluteus maximus muscle is also mobilized. Cut off the top of the greater trochanter with muscles attached to it (Fig. 1). A hypertrophied capsule of the hip joint is mobilized to the edge of the cavity, dissected longitudinally, departing from the place of attachment to the neck by 0.5-0.6 cm.Then, the capsule is transversely cut across the front surface of the femoral neck to the lower edge, adhering to the deviation from the place of its attachment to the bone. Slightly lower than the first longitudinal section of the capsule (1.0-1.5 cm), a second section is performed to the edge of the cavity, the formed flap is taken on the holders, focusing on the vascular architectonics of this area. After underfloor osteotomy of the femur, the head is removed to the wound. The round ligament is cut off and removed, the bottom of the cavity is freed from the embryonic adipose tissue, the transverse ligament and the soldered lower edge of the capsule are cut (elimination of the “lower block”), the limbus is mobilized with suture-holders applied to its edges. If necessary, deepen the bottom of the cavity with a Bogdanov frez. After a trial reposition of the femoral head into the cavity, the femur is shortened to the calculated length, followed by fixation by the plate, taking into account the correction of pathological anversion and the specified cervical-diaphyseal angle (Fig. 2). The head is set into the cavity. The excess capsule is excised, its edges are sutured with atraumatic material. On top of the sutured capsule, a cut flap is placed (an additional iliac-femoral ligament formed) diagonally in the anteroposterior direction from top to bottom and is sutured to the intertrochanteric region of the femur (Fig. 3). The large skewer is fixed in its former place with U-shaped nylon seams. Suture layers are applied to the wound, leaving drainage. Plaster immobilization is carried out with a one and a half hip bandage.

The high efficiency of the method is ensured by the fact that, during the growth of the child, the formed ligament strengthens the anteroposterior joint capsule and partly assumes the function of the crossed ileo-lumbar muscle, holding the femoral head in the cavity, which contributes to the harmonious development of the joint and prevents the formation of lateroposition and relaxation.

Clinical example.

Patient M., 2 years 10 months, medical history No. 477, diagnosis: congenital bilateral dislocation of the hips (figure 4 - before surgery). From the anamnesis it is known that the child did not receive treatment until the moment of receipt of treatment.

Under endotracheal anesthesia, the child underwent surgery - an open reduction of a congenital dislocation of the right thigh. Access Olie-Murphy-Lexer layered layer skewer, the top of a large skewer cut off with the muscles attached to it. Stupidly and sharply, the muscles are dissected from the capsule of the hip joint, the latter is dissected along the external, posterior and anterior surfaces, departing 1.0 cm from the place of attachment to the neck. A section of a hypertrophied capsule with a width of about 0.6 cm was cut, taken to the holders (for the formation of the ileo-femoral ligament). The limbus is mobilized. An intertrochanteric osteotomy was performed. The bottom of the cavity is freed from embryonic and connective tissue, the round ligament of the femoral head is excised, the transverse ligament is dissected, the bottom is deepened by the Bogdanov cutter. The femur was shortened by 1.0 cm, the Lena plate was fixed with the correction of pathological antetorsia and the formation of the SJE ≈115 °, stably. The head is set. The capsule is partially excised. The additional ileo-femoral ligament formed from the capsule is hemmed diagonally to the intertrochanteric region. Layered stitches on the wound. Drainage tube. Extremity is fixed by one and a half hip plaster bandage. The postoperative period was uneventful. Sutures were removed on the 10th day after surgery, healing by first intention. After 1 month, the child was hospitalized for a comprehensive rehabilitation treatment. Rehabilitation measures included exercise therapy (at the initial stage of a passive nature in the hip plaster bed), massage, physiotherapy. After 3 weeks, the child was discharged with a completely restored range of motion in the right hip joint. After 3 months, the Lena fixing plate was removed. Subsequently, the child was hospitalized after 8 months, medical history No. 4276, for planned surgical treatment of dislocation of the left thigh. A similar operation is performed on the left (figure 5). The postoperative period was uneventful. Regularly carried out rehabilitation measures. The locking plate is removed after 3 months. Control clinical and radiological examinations carried out 1 time in 6 months to 5 years of age and 1 time per year to 10 years of age, no relaxation and lateroposition with signs of early arthrosis were detected (Fig.6).

The inventive method is highly effective and can reliably prevent the development of lateral position and residual subluxation of the thigh, which ensures a stable location of the femoral head in the cavity and in the future their harmonious development and recovery of the patient.

Claims (1)

A method of treating congenital dislocation of the femur in children, consisting in the open positioning of the femoral head with corrective shortening of the invert osteotomy of the femur and excision of the excess capsule of the joint, characterized in that it additionally form the iliac-femoral ligament by cutting the flap from the anterior section of the hypertrophic capsule before its 0.5-0.6 cm to the attachment point at the upper edge of the cavity and then laying the formed ligament diagonally in the anteroposterior direction top-down with hemming to the intertrochanteric region of the femur after excising the excess capsule and stitching its edges with atraumatic material.

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