RU2423087C2 - Method of treating deforming osteoarthrosis of knee joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to orthopedics. Correction of extremity axis is performed. After that, subchondrally, in joint ends of femoral bone and tibia parallel to joint surfaces not fewer than two tunnels, reaching opposite cortical layer, are formed. Tunnels are directed in forms of rays, coming from the side of most loaded condyles of femoral bone and tibia, or parallel to each other. After that, in each tunnel introduced is drug solution, as such, for instance, pentoxyfylline is selected.

EFFECT: method ensures reduction of venous hyperemia and hypertension in proximal to joint cavity parts of bones, forming knee joint, pain relief, improvement of rheological properties of blood and microcirculation in vessels of subchondral spongy bone, creation of optimal conditions for regeneration of joint cartilage from the side of locking bone plate.

6 cl

Description

The invention relates to medicine, namely to orthopedics, and can be used to treat osteoarthrosis of the I-II stage or rheumatoid arthritis with damage to the knee joints of the I-II stage without exacerbation.

A known method of treating deforming osteoarthritis, including the effect on muscle spasm by injecting a mixture of a suspension of hydrocortisone and local anesthetic in the abdomen of the spasmodic muscle and in the transverse muscle of the intervertebral joint, corresponding to the level of innervation of the spasmodic muscle. Injections are carried out with a mixture consisting of a suspension of hydrocortisone and a 0.5% solution of novocaine, in a ratio of 1: 500, respectively, in an amount of 1-1.5 ml. In addition, traction of the muscles of the damaged joint and the transverse muscle is carried out, and they also act on the spine corresponding to the level of innervation of the spasmodic muscle using manual therapy methods (RF patent No. 2344823, CL A61K 31/573, A61K 31/245, A61P 19/02. Published on January 27, 2009).

However, this method relates to the treatment of small joints of the spine, and not loading large joints of the lower extremities and relates to vertebrology. During manual exposures, a hernia of the disc or a fracture of bone structures may occur during osteoporosis of the spine, which is very common in the elderly.

There is also a method of treating osteoarthritis of the knee joint, in which intra-articular administration of a 0.5% solution of novocaine and 1.0 ml of a suspension of hydrocortisone is carried out (Guide to Orthopedics and Traumatology. T.2 "Orthopedics". - M .: "Medicine", 1968, p. 156).

The disadvantages of this method are the possibility of suppuration of soft tissues after intraarticular administration of a glucocorticoid preparation and the occurrence of microcrystalline arthritis; catabolic effect of the hormone on articular cartilage. In addition, the administration of glucocorticoid leads to increased osteoporosis of the subchondral cancellous bone, removing inflammation only in the synovial membrane.

Closest to the proposed, in its technical essence, is a method of treating deforming arthrosis of the knee joint, including pumping fluid into the cavity of the joint and subchondral osteoperforation and tunneling of the joint ends, tibia osteotomy, fixation of fragments and subsequent correction of the extremity axis using the transosseous apparatus. After injection of novocaine under pressure into the upper inversion of the knee joint, it is reduced by 3-5-fold flexion and extension of the knee joint. Then, a partial bilateral ligamentotomy of the transverse, supporting ligaments of the patella and pterygoid ligament is performed. After that, the joint is washed sequentially with saline and novocaine to clean wash water. Subchondrally form at least three tunnels through the patella in mutually oblique directions, which reduce the intraosseous pressure in the bone marrow cavity of the tibia (RF patent No. 2193363, class A61B 17/56. Publish. November 27, 2002).

However, this method of treatment does not provide for a reduction in venous hyperemia and hypertension in the subchondral parts of the bones that form the knee joint, which may not lead to a decrease in pain. And the use of a large diameter drill for tunneling in this method increases the invasiveness of the operation.

The problem to which the claimed invention is directed is to reduce venous hyperemia and hypertension in the sections of the bones that form the knee joint proximal to the joint cavity, which helps to reduce pain, improve the rheological properties of blood and microcirculation in the vessels of the subchondral cancellous bone, and create optimal conditions for the regeneration of articular cartilage from the side of the plate of the bone.

The technical result is to stimulate the regeneration processes.

The problem is solved in that in a method for the treatment of deforming arthrosis of the knee joint, including subchondral osteoperforation and tunneling of the articular ends, injection of the drug solution under pressure, correction of the extremity axis using the transosseous apparatus, first the extremity axis is corrected to normal correction. Then, at least two tunnels reaching the opposite cortical layer are formed subchondrally in the articular ends of the femur and tibia parallel to the articular surfaces. The tunnels are sent in the form of rays emanating from the side of the most loaded condyles of the femur and tibia, or parallel to each other. After that, a drug solution is injected once into each tunnel, for example, pentoxifylline. 0.1 g of drug is injected into each tunnel.

Carrying out the correction of the axis of the limb to norm correction provides the unloading of the most loaded subchondral regions of the femur and tibia.

The formation of at least two tunnels in the articular ends of the femur and tibia parallel to the articular surfaces of the at least two tunnels reaching the opposite cortical layer creates optimal conditions for the regeneration of articular cartilage from the end of the bone plate.

Carrying out tunnels in mutually oblique directions in the form of rays emanating from the side of the most loaded condyles of the femur and tibia, maximizes the microcirculation in the sections of the bones that form the knee joint proximal to the joint cavity.

Carrying out tunnels parallel to each other allows evenly activating microcirculation in the external and internal articular parts of the knee joint.

The introduction into each tunnel of a medicinal solution, for which, for example, pentoxifylline has an angioprotective effect, leads to vasodilation, a decrease in the total peripheral vascular resistance, which improves microcirculation in the zone of impaired circulation and the rheological properties of the blood.

The method is as follows.

Surgical treatment is carried out under epidural anesthesia. After processing the skin of the lower extremity with an antiseptic solution, three spokes are carried out from the outside in the proximal and distal parts of the lower leg. In the proximal tibia, the border of the knitting needles is the upper edge of the head of the fibula and the middle of the tuberosity of the tibia. A distal pair of spokes is carried out at a distance of 5-6 centimeters from the lower edge of the inner ankle. The spokes are fixed in two ring supports of the Ilizarov apparatus and tensioned. In this case, the proximal support is set perpendicular to the axis of the thigh, and the distal - perpendicular to the axis of the lower leg. Ring supports are connected by four telescopic rods. The connecting rods are oriented parallel to the crest of the tibia, and the articulated joints in the correction plane. A skin incision 2 cm long is performed along the inner surface of the lower leg in the region of the proximal metaphysis in the longitudinal direction. A transverse osteotomy of the tibia is made through a skin incision. The wound is sutured. Correction of the axis of the limb to norm correction.

Then, at least two tunnels with a diameter of 3 mm, reaching the opposite cortical layer, are formed subchondrally in the articular ends of the femur and tibia parallel to the articular surfaces. Then, a drug solution is introduced into each tunnel, for example, pentoxifylline is chosen. The tunnels direct either in the form of rays, or parallel to each other. Aseptic dressings are applied to the wounds and around the spokes of the Ilizarov apparatus.

The proposed method will be used in the Department of New Technologies in Orthopedics of the Saratov Research Institute of Traumatology and Orthopedics (SarNIIITO) for the treatment of deforming arthrosis of the knee joint of 1-2 degrees. It is less traumatic, improves microcirculation in the articular parts of the knee joint, stops degenerative-dystrophic changes, reduces intraosseous pressure and relieves pain, involves the use of well-known instruments produced by the medical industry.

The claimed method, without requiring additional accessories, devices and expensive materials, is simple to perform, improves treatment outcomes.

Claims (6)

1. A method of treating deforming osteoarthritis of the knee joint, including subchondral osteoperforation and tunneling of the articular ends, injection of the drug solution under pressure, correction of the extremity axis using the transosseous apparatus, characterized in that the limb axis is corrected before norm correction, then it is subchondrally formed in the articular ends of the femur and tibia parallel to the articular surfaces of at least two tunnels reaching the opposite cortical layer, after which each tunnel is injected once with a medicinal solution. 2. The method according to claim 1, characterized in that pentoxifylline is selected as the drug. 3. The method according to claim 1, characterized in that 0.1 g of the drug is injected into each tunnel. 4. The method according to claim 1, characterized in that the tunnels are carried out in mutually oblique directions in the form of rays emanating from the side of the most loaded condyles of the femur and tibia. 5. The method according to claim 1, characterized in that the tunnels are parallel to each other. 6. The method according to claim 1, characterized in that the diameter of the tunnels is 3 mm.