RU2412661C1 - Talipes surgery - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely to orthopaedics. It involves osteotomy of an anterior heel bone in a slanting direction from a support of talus to a cuboid articular surface. A cartilage is removed therefrom, and after having formed a triangular fragment, moved upwards in platypodia. In abduction, it is rotated in a front plane with its base entoectad. In adduction, it is displaced medially with creating a synostosis of an ankle, a navicular bone, as well as a cuboid bone and a heel bone. In evident talipes or considerable cicatricial changes, an additional correction is performed by gradual distraction. ^ EFFECT: invention allows to correct any talipes, to repair a longitudinal arch, to prevent recurrent deformations, to reduce operative injures and treatment length. ^ 2 cl, 2 ex, 10 ex

Description

The invention relates to medicine, namely to orthopedics and traumatology, in particular, is intended for the treatment of patients with foot deformities.

There is a method of eliminating deformities of the hindfoot, in which, after removal of the cartilage from the articular surfaces of the subtalar joint and osteotomy of the anterior calcaneus anteriorly from the calcaneal sulcus, the calcaneus is moved posteriorly simultaneously in the sagittal and frontal planes (A.S. 1047467, application No. 3443679/28 -13, Russian Federation, publ. 1983. 10/15/83, bull. No. 38, authors: G.A. Ilizarov, S.Ya. Zyryanov).

However, the known method does not allow to stabilize the transverse joint of the tarsus and to eliminate the deformation of the middle part of the foot.

A known method for the operative correction of foot deformities, in which a wedge-shaped excision of the bone is carried out together with the articular surfaces of the talno-calcaneo-navicular, calcaneo-cuboid and subtalar joints with simultaneous correction of deformation p.335-338 (I. A. Movshovich. Surgical orthopedics. Guide for doctors / I.A.Movshovich. - M .: Medicine. Publishing house. III revised and supplemented, 2006. - 445 p.).

However, the known method for the operative correction of foot deformities is traumatic, since its implementation requires a large incision of soft tissues, bone skeletonization.

Tension of the skin when correcting a flat-valgus vicious position of the foot can cause vascular disorders in the suture due to skin deficiency, especially in the presence of scars.

The minimum fixation period is from 3.5 to 4 months.

In addition, the known method, due to excision of the bone substance, anatomically shortens the foot, with unilateral pathology and already having a shortening.

The objective of the present invention is to develop a method for the operative correction of deformities of the foot, in which, along with the elimination of deformation of the distal segment of the lower limb, the transverse joint of the tarsus is stabilized.

The problem is solved in that in the method for the operative correction of foot deformities, an anterior osteotomy of the calcaneus is performed obliquely from the talus support to the cuboid articular surface, cartilage is removed from it and, having formed a triangular fragment, it is moved upward with flat feet, while abductions rotate in the frontal plane with the base outwards, and during adduction it is shifted to the medial side, while synostising the talus, scaphoid, as well as the cuboid and calcaneus.

With severe deformation or significant cicatricial changes, additional correction is carried out by gradual distraction, maintaining contact of the movable triangular bone fragment with the surrounding talus, navicular, cuboid and heel bones.

The present invention is illustrated by a detailed description and copies of x-rays in which:

Figure 1 - Scheme of flat-valgus deformation of the foot before surgery and the scheme of the incision of soft tissues.

Figure 2 - Diagram of the operation of the operative correction of the foot (moving a triangular fragment with synostosis between the talus, scaphoid, cuboid and calcaneus).

Figure 3 - Diagram of the operation of the operative correction of foot deformities (moving a triangular fragment with its rotation in the frontal plane with additional correction by gradual distraction with synostosis of the talus, scaphoid, cuboid and calcaneus between each other).

Figure 4 - X-ray of the left foot of patient M., in a lateral projection before surgery.

Figure 5 - X-ray of the left foot of patient M., in a lateral projection after surgery (Arrows indicate the displaced triangular fragment).

6 - X-ray of the left foot of the patient M., in lateral projection in the process of fixation by the Ilizarov apparatus. (The arrows indicate the displaced triangular fragment in the consolidation stage with the surrounding bones).

Fig.7 - X-ray of the left foot of patient M., in lateral projection after removal of the Ilizarov apparatus and the transition to the full functional load of the left foot.

The method is as follows.

In the operating room under epidural anesthesia, after treating the surgical field with an antiseptic, a linear incision of soft tissues along the anteroposterior side of the foot is performed in the projection of the calcaneo-cuboid joint and the anterior calcaneus 4-5 cm long (Figure 1).

Then, an osteotomy of the anterior calcaneus is carried out in an oblique direction from the talus support to the cuboid articular surface, cartilage is removed from it and a triangular bone fragment is formed.

The osteotome removes cartilage from the ram-calcaneo-navicular joint. From the same access in the anterior posterior direction, a similar manipulation is performed, removing, when indicated, cartilage from the subtalar joint, namely the presence of deforming arthrosis or looseness of this joint. In the absence of the indicated indications, no intervention is performed on the subtalar joint. The triangular fragment formed from the anterior calcaneus is moved upward with flat feet (Figure 2).

In this case, in the presence of abduction, the aforementioned triangular fragment simultaneously rotates upward in the frontal plane, rotate outward with the base, and when adducted, it is shifted to the medial side, synostising the talus, scaphoid, and also cuboid and calcaneus. With a pronounced deformation, additional correction is carried out in the postoperative period gradually with the Ilizarov apparatus (Figure 3), including the development of this fragment.

Then four crossed needles are drawn through the tibia, one of them through the fibula. The carried spokes are fixed in two rings of the Ilizarov apparatus, which are interconnected by rods.

Two spokes with thrust pads are passed through the talus and fixed to the external support of the Ilizarov apparatus.

Two more knitting needles with thrust pads are passed through the calcaneus. They are fixed in the second semicircle of the Ilizarov apparatus. This external support is connected to the rings on the lower legs using rods and hinges.

Through the metatarsal bones, a spoke is held, which is fixed in a semicircle. The latter is connected to the rings on the lower leg using rods.

To fix the middle part of the foot, a needle is passed through the cuboid and scaphoid bones, which are fixed to the external support of the Ilizarov apparatus. The external support fixing the knitting needles drawn through the bones of the foot is connected to the rings on the lower legs with the help of rods and hinges, which are mounted from the brackets.

In those cases when the simultaneous correction is carried out in full, support compression is performed between the supports on the foot. If additional elimination of the components of the vicious position of the departments of the foot is necessary, five days after the operation, distraction of 1 mm per day begins to normalize the position of the departments of the foot.

Clinical observation.

Patient M., 45 years old, resident of the city of Tyumen, was operated on by us for congenital flat valgus deformity of the left foot, deforming arthrosis of the transverse tarsal joint and subtalar joint of the II st. (Figure 4).

We performed an operation under epidural anesthesia. A linear incision of soft tissues 4 cm long was made along the anteroposterior surface of the foot in the projection of the heel-cuboid joint.

After accessing the osteotome, the transarticular joint of the tarsus and subtalar joint was decartilaginated.

Then, an osteotomy of the anterior calcaneus was performed obliquely from the talus support to the cuboid articular surface of the calcaneus with the formation of a triangular bone fragment (Figure 5).

The triangular fragment formed from the calcaneus was moved upward, simulating the longitudinal arch of the foot. At the same time, to eliminate abduction, this triangular fragment was turned in the frontal plane with the base outward (Figure 5). Correction achieved in full.

Then they placed the Ilizarov apparatus of two external supports on the shin. The talus, as well as the bones of the front and middle sections of the foot and the heel were fixed in the external supports of the Ilizarov apparatus.

In the postoperative period, compression was performed at 1 mm once a week (Fig.6). The fixation period was 45 days. Additional immobilization after removal of the Ilizarov apparatus was not carried out.

28 days after removal of the Ilizarov apparatus, the patient switched to a full load on the operated limb using ordinary shoes (Fig. 7).

The proposed method allows to obtain the following positive effects.

Firstly, this method can significantly reduce the invasiveness of the operation, since it is carried out through minimal operational access.

In addition, there is no need for the use of autotransplates from other bones, and therefore additional surgical interventions.

Secondly, since wedge-shaped resections of the foot bones are not used, the proposed method not only does not shorten the foot, but, on the contrary, makes it possible to equalize the length of the feet, and also reduces the invasiveness of the operation.

Thirdly, this method allows to prevent recurrence of deformation, since the blood-supplying, movable bone fragment grows together with the talus, navicular, calcaneus and cuboid bones, creates a synostosis between them and bone ankylosis in the most transformable part of the foot.

Fourthly, with skin deficiency in the correction of pronounced flat-valgus deformity of the foot, the proposed method eliminates the possibility of trophic disturbances in the suture area.

Fifth, this method allows you to normalize the longitudinal arch of the foot and stabilize it, eliminating the possibility of relapse.

In addition, the proposed method is used in the Tyumen regional trauma and orthopedic center.

Clinical observation.

Patient K., 30 years old, a resident of the Tyumen region, was operated on by us regarding bilateral congenital relapsing clubfoot (Fig. 8).

We performed an operation under epidural anesthesia. A linear incision of soft tissues 5 cm long was made along the front-outer surface of the right foot in the projection of the heel-cuboid joint.

After accessing the osteotome, cartilage was removed from the transverse joint of the tarsus and subtalar joint.

Then, an osteotomy of the anterior calcaneus was performed in an oblique direction from the talus support to the cuboid articular surface of the calcaneus, cartilage was removed from it, forming a triangular fragment.

After that, the Ilizarov apparatus of two rings was placed on the shin. Then they held three knitting needles through the calcaneus, which were fixed in a semicircle. It was connected by rods with rings on the lower leg.

Crossing spokes were drawn through the bones of the tarsus, one of them with a thrust pad outside, through a triangular fragment. One spoke is inserted through the metatarsal bones. These spokes are fixed in the second semicircle of the Ilizarov apparatus, articulated by brackets with external supports on the lower leg (Fig. 9).

On the fourth day of the postoperative period, gradual dosed distraction was started to eliminate adduction, maintaining contact of the movable triangular bone fragment with the surrounding talus, scaphoid, cuboid, and calcaneus.

The distraction period lasted 28 days. Subsequent fixation by Ilizarov apparatus for 35 days. After the dismantling of the Ilizarov apparatus, additional immobilization was not carried out.

X-ray result (Figure 10).

Claims (2)

1. The method of correction of foot deformities by compression arthrodesis of the transverse joint of the tarsus and subtalar joint, characterized in that an osteotomy of the anterior calcaneus is carried out obliquely from the talus support to the cuboid articular surface, cartilage is removed from it and, having formed a triangular fragment, it is moved with flat feet up, while in the presence of abduction, they rotate simultaneously in the frontal plane with the base outwards, and with adduction it is shifted to the medial side, synostising In this case, the talus, scaphoid, as well as the cuboid and heel bones. 2. The method according to claim 1, characterized in that with severe deformation or significant cicatricial changes, additional correction is carried out in the postoperative period by gradual metered distraction, maintaining contact of the movable triangular bone fragment with the surrounding talus, scaphoid, cuboid and heel bones.

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