RU2445032C1 - Method of treating patients with chronic, incorrectly fused fractures of femoral bone - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Osteotomy is carried out. Processing of fragments ends is carried out with reconstruction of bone marrow cavity. During processing of fragments eburnated parts of opposite ends are resected. Separated fragments are displaced on their opposite side surfaces. Osteosynthesis and dosed reposition are carried out by apparatus of external fixation. After that, intramedullary osteosynthesis of affected segment is performed.

EFFECT: method insures recovery of support ability and femoral bone axis, exact matching of fragments, prevention of non-fusion of fragments.

1 ex, 4 dwg

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used in the treatment of patients with the consequences of traumatic injuries of the femur.

There is a method of treating patients with improperly healed fractures of limb bones, which involves performing an osteotomy, processing the ends of fragments, their reposition and fixation using a compression-distraction apparatus. (Shevtsov V.I., Shved S.I., Sysenko Yu.M. Treatment of patients with fractures of the humerus and their consequences by transosseous osteosynthesis. - Kurgan, 1995. - 223 p.).

However, this method is associated with the need for long periods of hardware fixation.

A known method of treating chronic, improperly fused bone fractures, including performing an osteotomy, processing the ends of fragments with the restoration of the bone marrow cavity, their reposition and subsequent intramedullary fixation. (Osteosynthesis: a guide for doctors / Edited by S.S. Tkachenko. - L.: Medicine, 1987, - 272 p.).

However, this method does not exclude nonunion of fragments, especially in cases of sclerotization of their fused ends, and, as a result, the formation of a false joint of the bone.

The objective of the invention is to develop a method that prevents the nonunion of fragments.

This problem is solved by the fact that in the method of treating patients with old, improperly healed fractures of the femur, including performing an osteotomy, processing the ends of the fragments with the restoration of the bone marrow cavity, their reposition and subsequent intramedullary fixation, the fragments of the opposing ends are resected during treatment of fragments, the selected fragments on their opposite lateral surfaces, perform osteosynthesis and dosed reposition using an external fixation device, and then intrame ullyarny osteosynthesis of the affected segment.

The invention is illustrated by a description, an example of practical use and illustrative material, which shows:

Figure 1 - radiograph of the thigh of the patient before treatment;

Figure 2 - the same, during a dosed reposition of fragments using an external fixation apparatus;

Figure 3 - the same, after performing intramedullary osteosynthesis;

Figure 4 - radiographs of the hip of the patient a year after treatment.

The method is as follows.

After anesthesia and treatment of the surgical field, through the incision of the soft tissues, access to the area of the abnormally fractured femur fracture is performed. By means of an osteotomy, the fragments are separated along the fusion line and their processing is performed, during which the end eburned sections are resected, thereby ensuring restoration of the bone marrow cavity along its entire length. The fragments isolated as a result of resection are displaced onto the lateral surface of the proximal and distal fragments, respectively, from their opposite sides.

Following these well-known techniques, osteosynthesis of the affected segment is performed using an external fixation apparatus, during which bone fragments in the position they occupy are fixed with needles and / or rods that are performed transversely at different levels. In this case, the resected fragments displaced to the lateral surfaces of the fragments are left intact.

The operation is completed by suturing the wound, performing control radiography and stabilization of the apparatus.

In the postoperative period, starting from 2-3 days, a metered reposition of the fragments is carried out, eliminating their displacement “in length”, “in width”, and, if necessary, rotational rotation relative to each other. These manipulations will be performed at a pace of 2-4 mm per day for 2-4 doses. At the same time, in the course of dosed reduction, due to the tension of the muscular case, the resected fragments shift along the lateral surface of the fragments in the direction of the fracture zone, which stimulates the periosteal reaction and positively affects bone consolidation.

Upon achieving accurate reposition of the fragments, in the operating room, the external fixation apparatus is removed with the fixing spokes removed, after which the position of the fragments is stabilized using an intramedullary fixation rod.

The introduction of the latter is carried out from the side of the trochanteric region through an additionally formed channel communicating with the bone marrow cavity.

15-20 days after the second operation, the patient is discharged for outpatient treatment.

The practical use of the method is illustrated by the following clinical observation.

Patient K., 23, was admitted to the clinic of the RRC "WTO" named after Acad. G.A. Ilizarova with a diagnosis of chronic, improperly fused in the position of the duplicate ends of the fragments of a fracture of the left femur in the middle third, shortening 7 cm (Figure 1).

To restore the support ability and the axis of the femur, the patient underwent surgery: osteotomy of the thigh along the line of incorrectly fused fragments, resection of the ends of the fragments; osteosynthesis with an external fixation apparatus followed by intramedullary osteosynthesis.

During the operation, after anesthesia and treatment of the surgical field, through an incision of the soft tissues, access was made to the area of the abnormally fractured hip fracture and, after performing an osteotomy, bone fragments were disconnected. The emburned end sections of the fragments were resected and the fragments selected as a result were displaced onto the lateral surface of the proximal and distal fragments, respectively, from their opposite sides.

Following this, through the proximal and distal thirds of the thigh at several levels held fixing spokes, the ends of which were fixed on the supports of the external fixation apparatus. At the same time, the fragments were stabilized in the position they occupied, and their resected and displaced end fragments were left intact (Figure 2).

In the postoperative period, starting from 2 days, a metered reposition of fragments was carried out, eliminating their displacement “in length” and “in width”. The reposition was performed for 43 days at a rate of 2-3 mm per day for 2-4 doses.

After an exact comparison of the fragments, in the operating room, the external fixation apparatus was dismantled. Through a soft tissue incision in the trochanteric region, a channel communicating with the bone marrow cavity was formed, through which a blocked GHM rod was introduced into the cavity, for its entire length. (Figure 3)

20 days after the second operation, the patient was discharged for outpatient treatment.

On the control examination after 1 year, a complete consolidation of the left femur was observed (Figure 4); the patient walks with full load on the operated limb without additional support, movement in adjacent joints within normal limits.

Using the proposed method in the clinic RSC "WTO" them. Acad. G.A. Ilizarova showed that its use prevents fragmentation in the treatment of old, improperly fused femoral fractures, including in the conditions of sclerotically altered ends of fused fragments.

Claims (1)

A method of treating patients with chronic, improperly healed fractures of the femur, including performing an osteotomy, processing the ends of fragments with restoration of the bone marrow cavity, their reposition and subsequent intramedullary fixation, characterized in that during the processing of fragments resorbed sections of opposing ends are resected, the selected fragments are shifted to their opposite lateral surfaces, perform osteosynthesis and dosed reposition using an external fixation device, and then an intramedullary osteo synthesis of the lesion.

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