RU2437625C1 - Method of surgical treatment of perthes disease - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Fixation of femoral bone fragments is performed by means of metal constructions. Into proximal fragment of femoral bone transcervically thread rods are introduced and into distal fragment at the level of middle third at an angle to longitudinal axis of femoral bone - one thread rod. Through distal fragment at the level of lower third two crossed pins are passed and fixed outside metal construction in supports of apparatus for external fixation. After that, osteotomy is performed in interthrochanteric area with formation of bed in distal fragment of femoral bone for carrying out rotational displacement. Then, greater trochanter with attached muscles is cut off with their displacement with possibility to provide tension of gluteal muscles. In postoperative period stage-by-stage dosed rotational displacement of neck nad head of femoral bone is carried out. ^ EFFECT: method ensures complete recovery of biomechanically correct shape of femoral bone head with reduction of rehabilitation period terms. ^ 3 cl, 1 ex, 1 dwg

Description

The invention relates to medicine, namely to pediatric orthopedics, and can be used in the surgical treatment of Perthes disease.

A known method for the surgical treatment of Perthes disease [SU copyright certificate for invention No. 1050672], including distraction lateralization of the trochanter, decompression of the hip joint, tenotomy of the adductor muscles of the thigh, cross-shaped dissection of the broad fascia of the thigh.

There is also known a method for the surgical treatment of Perthes disease [patent RU for the invention No. 2108761], which consists in cutting off from the small trochanter of the lumbar-iliac muscle, resection of its tendon and hemming it between the sheets of the capsule of the hip joint.

However, when using this method, there is insufficient improvement of blood circulation in the affected hip epiphysis, which leads to an increase in the duration of the rehabilitation period.

There is also a method of surgical treatment of Perthes disease [RU patent for the invention No. 20122265]. In this method, the joint is decompressed using a hinged distraction apparatus and displacement of the femoral head relative to the cavity. After centering the femoral head, distraction is performed to control the width of the joint space. After applying the distraction apparatus, channels are formed from the undervert region along the axis of the femoral neck along the epiphyseal plate with Kirschner spokes. The latter are removed in stages, creating a hotbed of prolonged irritation.

However, in this method, the process of stimulation of the femoral head is quite long, which, in turn, leads to an increase in the time of surgery.

The closest analogue to the claimed invention is the "Method of surgical treatment of Perthes disease" [RU patent for the invention No. 2127089]. It produces transverse subtrochanteric osteotomy to the depth of the cortical layer. Then form a fragment of a rectangular shape. Screw threaded rods are inserted into the main bone and cortical fragment, which are fixed to the support plate. Then produce repeated alternating distraction and compression of the fragment perpendicular to the axis of the femur.

However, when using this method, there is no excretion of the focus of necrosis of the femoral head during partial injury, due to which insufficiently effective circulation stimulation in this area may occur. The above method does not allow dynamic correction of the pathology of the pineal gland in the postoperative period, which, in turn, increases the recovery time of the femoral head. This method also does not provide compensation for shortening of the femur during joint unloading due to a decrease in the cervical-diaphyseal angle.

The task of the invention is to reduce the rehabilitation period while ensuring complete restoration of the biomechanically correct shape of the femoral head.

The essence of the claimed invention lies in the fact that in the method of surgical treatment of Perthes disease, including osteotomy of the femur and fixation of its fragments using metal structures, fixation is performed before osteotomy by introducing transcervical threaded rods into the proximal fragment of the femur and into the distal fragment at the middle third below angle to the longitudinal axis of the femur - one threaded rod, passing through the distal fragment at the level of the lower third of two cross-located pizzas and fastening of all steel structures in supports external fixation device; then an osteotomy is performed in the intertrochanteric region with the formation of a bed in the distal fragment of the femur for rotational displacement; after they carry out the clipping of the greater trochanter with attached muscles and their displacement with the possibility of tensioning the gluteal muscles; in the postoperative period produce a phased dosed rotational displacement of the neck and femoral head.

A method for surgical treatment of Perthes disease with the above features, in which the fixation of the proximal fragment of the femur is carried out by at least three threaded rods, is also claimed.

In addition, there is also claimed a method for the surgical treatment of Perthes disease with the above features, in which the value of the phased dosed rotational displacement carried out in the postoperative period is about 40-60 °.

The technical result of the claimed invention consists in solving the problem posed earlier. Removing the focus of necrosis into the unloaded part of the hip joint by conducting a phased dosed rotational displacement of the neck and head of the femur improves blood circulation in the proximal section, which, in turn, helps to reduce the duration of the rehabilitation period. Performing the fixation of fragments of the femur and its osteotomy by the methods described in the claimed application allow, if necessary, to correct the cervical-diaphyseal angle and eliminate the inequality of limb lengths. The set of signs of the implementation of the claimed in this application method allows for the complete restoration of the biomechanically correct shape of the femoral head.

The invention is illustrated using the drawing, which shows a schematic representation of the implementation of the claimed in this application method. In the drawing, positions 1-4 indicate:

1 - transcervically inserted threaded rods;

2 - a threaded rod inserted into the diaphyseal fragment of the femur;

3 - two cross-spokes;

4 - supports of the external fixation apparatus.

The method of carrying out the claimed invention.

The patient is placed on an orthopedic table. The external and internal surfaces of the patient's thigh are treated. Under general anesthesia, an incision is made along the outer surface of the thigh in the region of the greater trochanter about 5-6 cm long. Subperiosteal surgical access is provided to the intertrochanteric region and the greater trochanter of the femur. Fragments of the femur are fixed by an external fixation device. For this, at least three threaded rods 1 are introduced into the proximal femur fragment transcervically, and one threaded rod 2 is inserted into the distal fragment at the level of the middle third at an angle to the longitudinal axis of the femur 2. Two are passed through the distal fragment of the femur at the level of the lower third cross-spokes 3. Fasten all metal structures in the supports of the external fixation device 4. Then, using a grooved bit, an osteotomy is made in the intertrochanteric region with the formation of a bed for rotation th offset. After they carry out a direct chisel, the cutting of the greater trochanter with attached muscles and their displacement with the possibility of tensioning the gluteal muscles. If necessary, to fully unload the hip joint, the neck-diaphyseal angle is reduced to 115-120 ° by adjusting the external fixation apparatus. Final assembly of the external fixation apparatus is carried out. Carry out x-ray control. Layered stitches on the wound. In the postoperative period, the focus of necrosis is removed to the unloaded part of the hip joint by phased dosed rotational displacement of the neck and head of the femur, for example, during the week 2 times a day by an amount of about 3-5 °. After the complete removal of the focus of necrosis, the external fixation apparatus is transferred to stabilization mode. The patient is adapted to walking on crutches without loading the limb.

Example.

Patient K., 9 years old, was treated in the department of pediatric orthopedics with a diagnosis of Perthes disease, left, stage II.

Upon admission to the hospital, the patient complained of pain in the hip joint, lameness.

On the radiograph: a decrease in the height of the head of the left femur with a lesion in the anteroposterior quadrant of the pineal gland.

After preparing the patient, surgery was performed according to the method claimed in this application. In the postoperative period, on the 3rd day, they began to produce a phased dosed rotational displacement of the neck and femoral head 3-5 ° 2 times a day for a week. After the removal of the focus of necrosis in the unloaded part of the hip joint, the external fixation apparatus was transferred to stabilization mode. 7 days after the operation, the patient was adapted to walking on crutches without loading the limb. After 1.5 months, an X-ray examination showed the fusion of fragments of the femur along the line of osteotomy. After 2 months, the external fixation apparatus was dismantled. After 5 months, a partial load on the limb was allowed, which increased to full by 7 months. As a result of treatment, a complete fusion of fragments of the femur along the line of the osteotomy and the restructuring of the focus of necrosis brought to the anterior unloaded part of the joint occurred after 8 months.

Claims (3)

1. A method of surgical treatment of Perthes disease, including osteotomy of the femur and fixation of its fragments using metal structures, characterized in that the fixation is performed before osteotomy by introducing transcervical threaded rods into the proximal femur and into the distal fragment at the middle third at an angle to the longitudinal the axis of the femur - one threaded rod, passing through the distal fragment at the level of the lower third of two cross-spokes and fixing all metal ktsy in supports external fixation device; then an osteotomy is performed in the intertrochanteric region with the formation of a bed in the distal fragment of the femur for rotational displacement; after they carry out the clipping of the greater trochanter with attached muscles and their displacement with the possibility of tensioning the gluteal muscles; in the postoperative period produce a phased dosed rotational displacement of the neck and femoral head. 2. The method of surgical treatment of Perthes disease according to claim 1, characterized in that the fixation of the proximal fragment of the femur is carried out by at least three threaded rods. 3. The method of surgical treatment of Perthes disease according to claim 1, characterized in that the value of the phased dosed rotational displacement carried out in the postoperative period is about 40-60 °.

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