RU2440058C2 - METHOD OF SUV-Frame APPARATUS OSTEOSYNTHESIS IN KNEE JOINT CONTRACTURE - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics. Oval supports are applied to a femoral bone and a shin bone. The supports are coupled by six strata. A proximal strata is arranged at 200-210 mm from a knee joint fissure, while a distal strata - at 120-130 mm from the knee joint. The proximal support shall be inclined 90° in a sagittal plane, while the distal support - 60°.

EFFECT: method enables tibial displacement with respect to the femoral bone according to the physiological amplitude of knee joint motions, eliminated risk of trophic disorders caused by the apparatus supports or strata compressing skin.

1 ex, 16 dwg, 1 tbl

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to increase the amplitude of movements in the knee joint and (or) eliminate persistent vicious installations in the knee joint.

Known articulated apparatus Ilizarov for the development of movements in the knee joint (Treatment of flexion contractures of the knee and ankle joints. Method. Recommendations / Compiled by G.A. Ilizarov, A.A. Devyatov. - Kurgan, 1971. - 13 pp., Treatment of extensor contractures of the knee joint by the Ilizarov method.Method.Recommendations / MH RSFSR, VKTTS "WTO"; Comp .: A.V. Popkov, A.E. Yugay, G.V. Dyachkova. - Kurgan, 1991. - 17 p.). When applying it, one (proximal) transosseous module is applied to the thigh, and a second (distal) transosseous module is applied to the shin. The modules are connected by a pair of axial and swivel joints (Fig. 1, Fig. 2, Fig. 3). The installation diagram of the axial joints is shown in figure 4. In the postoperative period, by rotating the nuts of the swivel joint, the lower leg is bent.

The disadvantages of using this device are:

1. The impossibility of reproducing an individual trajectory of motion for each knee joint, which is determined by its anatomical features.

2. When moving in a semicircle, either overstretching of the ligamentous apparatus of the knee joint or crushing of the articular surfaces occurs.

The well-known articulated apparatus of Volkov-Hovhannisyan for the development of movements in the knee joint (Oganesyan OV Restoration of the shape and function of joints and bones (apparatuses of the authors) / OV Oganesyan., MV Volkov. - M .: Medicine, 1986 - 256 p .; Oganesyan O.V. Fundamentals of external transosseous fixation / O.V. Oganesyan. - M .: Medicine, 2004. - 432 p.). It is designed similarly to the Ilizarov apparatus, but transosseous modules in it are connected using a “gear” hinge (Fig. 5), which allows movements in the knee joint to be made along a certain curve (centroid).

The disadvantages of using this device are:

1. Holding an axial spoke in the joint cavity.

2. The inability to mathematically accurately reproduce the amplitude of movements in the knee joint individually for each joint.

Closest to the proposed is a method of using the apparatus SUV-Frame, operating on the basis of computer navigation (RU No. 2336842 dated 10.27.08) (Fig.6). According to the method of using this apparatus for fractures and deformations, the proximal and distal transosseous modules are connected with telescopic rods (striations) of a special design. In this case, circular supports are used, which are located perpendicular to the anatomical axes of the bone fragments. Changing the lengths of each of the strata provides the movement of one support relative to another in six degrees of freedom. The necessary change in the lengths of each of the strata is determined by a special computer program.

The disadvantages of the method of using the SUV-Frame apparatus in this arrangement are:

1. The maximum range of motion in the knee joint is possible between 70 ° -80 °. To further increase the amplitude, it is necessary to use external supports of a larger diameter, which will lead to the bulkiness of the structure.

2. When the external supports are located perpendicular to the anatomical axes of the femur and tibia in the sagittal plane, the external supports "lie" on the soft tissues. With an increase in the standard sizes of the supports, the amplitude of movements in the knee joint increases slightly.

The technical result of the invention is to ensure the movement of the tibia relative to the femur in accordance with the physiological range of motion in the knee joint (120/0/0), eliminating the risk of trophic disturbances due to the pressure of the supports or strata of the apparatus on the skin.

The result of the invention is achieved by using oval-shaped supports, a proximal support located at a distance of 200-210 mm from the knee joint gap, a distal support at a distance of 120-130 mm from the knee joint, while the angle of inclination of the proximal support in the sagittal plane should be 90 °, and distal support - 60 °.

The figures depict:

Figure 1: Installation option of the hinges according to Ilizarov-1.

Figure 2: Installation option of the hinges according to Ilizarov-2.

Figure 3: Option for installing hinges according to Ilizarov-3.

Figure 4: Installation diagram of the swivel and axial joints.

Figure 5: Toothed hinge of the Volkov-Hovhannisyan apparatus.

6: SUV-Frame apparatus.

7: The optimal layout of the SUV-Frame apparatus for the development of movements in the knee joint, position 0 ° / 0 ° / 0 °.

Fig: The optimal layout of the SUV-Frame apparatus for the development of movements in the knee joint, position 90 ° / 90 ° / 0 °.

Fig.9: The optimal layout of the SUV-Frame apparatus for the development of movements in the knee joint, position 120 ° / 120 ° / 0 °.

Figure 10: Photograph of the patient before surgery.

11: X-ray diffraction patterns of the patient after surgery: lateral projection.

Fig: Photographs of the patient during treatment.

Fig: Photographs of the patient in the apparatus of the SUV-Frame: direct projection.

Fig: Photographs of the patient in the apparatus SUV-Frame: lateral projection.

Fig: Photographs of the patient after removal of the external fixation apparatus: direct projection.

Fig: Photographs of the patient after removal of the external fixation apparatus: lateral projection.

On Fig shows a graph of the rigidity of fixation of the femur and tibia in the apparatus SUV-Frame and Volkov-Hovhannisyan in the sagittal plane. 1 - device SUV-Frame. 2 - Volkov-Oganesyan apparatus. The abscissa is the load in N. The ordinate is the displacement in mm.

The method is as follows. Standard half rings are connected through slats for 2-4 holes, thereby obtaining oval shaped supports. The use of oval supports allows you to increase the amplitude of movements in the knee joint, while the soft tissues are as far removed as possible from the external supports.

The location of the proximal support at a distance of 200-210 mm from the gap of the knee joint, the distal at a distance of 120-130 mm from the knee joint provides the maximum range of motion in the knee joint, while minimizing the risk of pressure on the soft tissue by structural elements.

The angle of inclination of the proximal support in the sagittal plane is 90 °, and the distal support - 60 ° (the angle is open in the proximal direction) is used to increase the amplitude of motion in the knee joint.

Clinical example

Patient P., 46 years old (figure 10). Diagnosis: Persistent extensor contracture of the left knee joint, fused fracture of the left femur. Injury 7 years ago as a result of an accident. She underwent 9 operations on the left thigh, as a result of which contracture of the left knee joint was formed 15 ° / 0 ° / 0 °. 04/20/09, the operation was performed: arthrolysis, tenolysis, myolysis of the left knee joint, application of the SUV-Frame apparatus (Fig. 11, Fig. 12, Fig. 13, Fig. 14). From the 5th day, the development of movements in the left knee joint began. For 40 days, a complete cycle of staged bending to an angle of 90 ° / 90 ° / 0 ° (according to the functional needs of the patient) and extension (0 ° / 0 ° / 0 °) was carried out. Thus, the range of motion in the knee joint was 90 ° / 0 ° / 0 °. AVF dismantled 07/10/09, (Fig.15, Fig.16).

Claims (1)

The method of osteosynthesis with the SUV-Frame device for contractures of the knee joint by applying transosseous modules on the femur and lower leg bones and connecting them with six strata, characterized in that they use oval shaped supports, the proximal support is located at a distance of 200-210 mm from the knee joint gap, distal support - at a distance of 120-130 mm from the knee joint, while the angle of inclination of the proximal support in the sagittal plane should be 90 °, and the distal support - 60 °.

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