RU2448663C1 - Method of osteosynthesis with ortho-suv apparatus for treating injuries of distal one-third of femur - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics. Ostheosynthesis is supported by ¾ of the ring. A distal support is arranged at a level of VII femur, while a proximal one - on an optimal distance 150-200 mm from the distal support. The strata 1 is fixed on the proximal support with using the position 2, the strata 3 - a place between the positions 5 and 6, the strata 5 - the position 10. The strata 2 is fixed on the distal support with using the position 4, the strata 4 - the position 8, the strata 6 - the position 12. The strata 1 and 5 are fastened by Z-pads.

EFFECT: method provides highest possible reduction facilities of the Ortho-SUV apparatus with preserving minimal sizes of the structure, corrected deformation with restored biomechanical axis of the lower extremity.

1 ex, 3 tbl, 21 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to correct deformities or treat fractures of the distal third of the femur.

A known method of osteosynthesis by the Ilizarov apparatus for correction of deformations of the distal third of the femur (Bloodless treatment of the false joints of the thigh (compression-distraction osteosynthesis by the Ilizarov apparatus): guidelines / compiled by G.A. Ilizarov, V.D. Makushin, L.M. Kuftyrev. - Kurgan, 1975 - 21 pp .; A.S. 538710 (USSR) Compression-distraction apparatus / G.A. Ilizarov. - Publ. - B.I. - 1976. - No. 6) (Fig. 1) .

According to this method, an Ilizarov apparatus is placed on a damaged limb segment (femur), consisting of external circular supports interconnected by unified nodes to eliminate deformation.

Unified nodes to eliminate deformation of any degree of complexity are developed in detail at the RTC "WTO" named after Acad. G.A. Ilizarova. However, their use is a rather complex and time-consuming process, requiring the skills and extensive experience of the surgeon. Therefore, the disadvantages of using this device are:

1. The need for partial remounting of the apparatus to eliminate multi-plane multicomponent deformations, which is associated with the need to replace unified nodes (Vilensky, VA Development of the fundamentals of a new technology for treating patients with diaphyseal injuries of long bones based on transosseous apparatus with the properties of passive computer navigation: dis .... Candidate of Medical Sciences / Vilensky Victor Aleksandrovich. - St. Petersburg, 2009. - 284 p .; Paley D. Principles of deformity correction / D. Paley. New York: Springer-Verlag, 2005. - 806 p.). This increases labor costs, increases the patient's hospital stay or the number of outpatient visits.

2. When eliminating each component of the deformation, x-ray control is necessary, which increases the radiation dose to the patient and medical personnel.

3. The relative bulkiness of the design used.

Closest to the proposed device is Ortho-SUV, operating on the basis of computer navigation (Solomin L.N., Vilensky V.A., Utekhin A.I. Ortho-SUV - a new transosseous device based on computer navigation // ASAMI Russian Congress. - Kurgan, 2009. - P.129-130) (figure 2).

According to the method of using this apparatus for the correction of deformations, the proximal and distal transosseous modules are connected by six telescopic rods of the original design (striations). 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 device Ortho-SUV in the correction of deformities of the distal third of the femur are:

1. The location of the supports at an unsatisfactory distance, the fixation of the strata at not optimal positions can lead to the inability to perform correction of the deformation of the distal third of the femur by the required amount. In addition, the risk of a conflict stratum-transosseous element, i.e. when the stratum during correction "rests" against a spoke or a screw rod.

2. The relative bulkiness of the apparatus, the use of closed external supports, which reduces the comfort of treating patients, can lead to contracture in the knee joint.

The technical result of the invention is to ensure maximum repositional capabilities of the apparatus Ortho-SUV while maintaining the minimum dimensions of the structure.

The result of the invention is achieved by using 3/4 ring supports, with the distal bearing being at level VII and the proximal one at an optimal distance of 150-200 mm from it. In addition, the following positions are used for fastening striations:

- on the proximal support for stratum 1 - position 2, for stratum 3 - between positions 5 and 6, for stratum 5 - position 10;

- on the distal support for stratum 2 - position 4, for stratum 4 - position 8, for stratum 6 - position 12. Z-shaped plates are used to fasten strata No. 1 and No. 5 (Figs. 3-4).

To determine the attachment positions of the strata, the coordinate system “Method for the unified designation of transosseous osteosynthesis” was used (Method for the unified designation of transosseous osteosynthesis of long bones: method, recommendations No. 2002/134 / comp .: L.N. Solomin [et al.]. - St. Petersburg, 2004. - 21 p.) (Figs. 5-9).

To substantiate the method, 260 bench studies were conducted (26 models). We studied the dependence of repositional capabilities (distraction, translation, angulation, torsion) of the Ortho-SUV apparatus on the diameter of the external supports, the distance between them and the places of fixation of the striations on the supports. The results of the study made it possible to establish that the layouts with the distance between the supports of 150-200 mm have the greatest repositioning capabilities (Table 1). With a greater distance, the bulkiness of the apparatus increases, and with a shorter repositioning capabilities. The above-indicated arrangement of strata in this arrangement provides the maximum reposition capabilities of the Ortho-SUV apparatus (Table 2), and the use of Z-shaped plates for attaching strata 1 and 5 allows additionally increasing reposition capabilities by an average of 11.4-25.5% (tab. .3).

The figures depict:

Figure 1: Ilizarov apparatus for the treatment of injuries of the distal third of the femur.

Figure 2: Ortho-SUV apparatus.

Figure 3: The optimal layout of the apparatus Ortho-SUV for correction of deformities of the distal third of the femur, front view.

Figure 4: The optimal layout of the apparatus Ortho-SUV for correction of deformities of the distal third of the femur, side view.

Figure 5: Diagram of the division of the femur into levels.

6: Diagram for determining positions on the example of the hip.

7: An example of the designation of the spokes.

Fig: Example of a designation of the rod.

Fig. 9: An example of a support designation.

Figure 10: Photos of the patient before the correction of deformation, front view.

11: Photos of the patient before the correction of deformation, side view.

Fig: Photographs of the patient to the correction of deformation in direct projection.

Fig. 13: Patient x-ray before correction of deformation in lateral projection.

Fig: Photograph of a patient in the apparatus of Ortho-SUV, front view.

Fig: Photograph of a patient in the apparatus of Ortho-SUV, side view.

Fig: Photographs of the patient in the process of correction of deformation in direct projection.

Fig: Photographs of the patient in the process of correction of deformation in the lateral projection.

Fig. 18: Patient x-ray after correction of deformation in a direct projection.

Fig: Photographs of the patient after correction of deformation in the lateral projection.

Fig: Photograph of the patient after removal of the apparatus Ortho-SUV, front view.

Fig: Photograph of the patient after removal of the apparatus Ortho-SUV, side view.

The tables show:

Table 1: Dependence of the repositioning capabilities of the Ortho-SUV apparatus on the distance between the supports.

Table 2: Dependence of the repositioning capabilities of the Ortho-SUV apparatus on the location of the strata, where:

- layout No. 1: stratum No. 1 at position 2, stratum No. 2 at position 4, stratum No. 3 at position 6, stratum No. 4 at position 8, stratum No. 5 at position 10, stratum No. 6 at position 12;

- layout No. 2: stratum No. 1 at position 2, stratum No. 2 at position 4, stratum No. 3 at position 6, stratum No. 4 at position 8, stratum No. 5 between positions 10 and 11, stratum No. 6 at position 1;

- layout No. 3: stratum No. 1 at position 2, stratum No. 2 at position 4, stratum No. 3 between positions 5 and 6, stratum No. 4 at position 8, stratum No. 5 at position 10, stratum No. 6 at position 12;

- layout No. 4: stratum No. 1 at position 2, stratum No. 2 at position 4, stratum No. 3 at position 5, stratum No. 4 at position 8, stratum No. 5 between positions 10 and 11, stratum No. 6 at position 12;

- layout No. 5: stratum No. 1 at position 2, stratum No. 2 at position 4, stratum No. 3 at position 5, stratum No. 4 at position 8, stratum No. 5 between positions 10 and 11, stratum No. 6 between positions 1 and 12 .

Table 3: Repositional capabilities of the optimal layout when replacing direct platiks with Z-shaped ones.

The method is as follows: a distal support, which is a standard 3/4 ring, is located at the level of the VII thigh. The proximal support is placed at a distance of 150-200 mm from the distal. The supports are oriented so that the proximal support is open on the inside of the thigh, and the distal support is on the back, which, accordingly, facilitates limb adduction and does not interfere with flexion in the knee joint. Transosseous elements are carried out only in the projection of the "Recommended Positions" (L. Solomin. Fundamentals of transosseous osteosynthesis using the apparatus of G. A. Ilizarov / L. N. Solomin. - St. Petersburg: "Morsar AV", 2005. - 544 p.). This allows not only to reduce the risk of transfixation contractures, but also to avoid a conflict stratum-transosseous element, since the location of the "recommended positions" is strictly regulated.

Strata to the proximal support are attached as follows: stratum 1 - in the projection of position 2, stratum 3 - between the positions 5 and 6, stratum 5 - in the projection of position 10. On the distal support, the strata are attached as follows: stratum 2 - in the projection of position 4, stratum 4 - in the projection of position 8, stratum 6 - in the projection of position 12. The final layout of the apparatus according to the unified designation of transosseous osteosynthesis is as follows:

III, 10, 120; IV, 9.90; V, 8.70 - strata - VI, 8.90; VII, 3-9: VIII, 4.90

Clinical example

Patient B., 57 years old, was hospitalized on 05/11/2010 at the RNIITO clinic. P.P. Damaged with a diagnosis of Distraction regenerate the lower third of the diaphysis of the left femur, deformity at the regenerate level, fixation in the external fixation apparatus (Fig. 10-11). In 2006, she received a closed oblique fracture of n / 3 of the left femur with displacement of bone fragments. Treated conservatively: skeletal traction, coxite dressing. After removal of the immobilization, deformation appeared at the level of the lower third of the left thigh. 02/18/2010, the operation was performed: a corticotomy with osteoclasia at the level of the lower third of the left femur, application of an external fixation apparatus. Within 3 months, distraction was performed at the osteotomy level at a rate of 0.75 mm / day. 05/11/2010, deformation at the regenerate level was diagnosed with a violation of the biomechanical axis of the limb (Figs. 12-13). The Ortho-SUV apparatus was overlaid, deformation was corrected for 14 days with the restoration of the biomechanical axis of the lower limb (Figs. 14-19). After correction of the deformation, the strata of the Ortho-SUV apparatus were replaced by swivel joints (Figs. 20-21).

Table 1 METHOD FOR OSTEOSYNTHESIS BY ORTHO-SUV DEVICE FOR TREATING FEMAL DISEASED INJURY INJURY Displacement mm 120mm distance Distance 150 mm 200 mm distance Plane-parallel movement in the sagittal plane anterior / posterior 55.1 ± 0.5 / 54 ± 0.4 66 ± 0.4 / 69.9 ± 0.2 69.9 ± 0.5 / 55 ± 0.7 Plane-parallel movement in the frontal plane in / out 22.8 ± 0.2 / 25 ± 0.4 85 ± 0.3 / 59 ± 0.4 43 ± 0.3 / 55.3 ± 0.4 Angular movement in the frontal plane of the varus / valgus 27 ± 0.2 / 27 ± 0.3 36 ± 0.2 / 34 ± 0.2 34.7 ± 0.2 / 37.9 ± 0.3 Angular displacement in the sagittal plane antecurvation / recurrence 17 ± 0.2 / 25 ± 0.3 35 ± 0.3 / 40 ± 0.2 49.9 ± 0.3 / 45 ± 0.3 Internal rotation / External rotation 10 ± 0.3 / 15 ± 0.2 25 ± 0.3 / 30 ± 0.2 27.9 ± 0.2 / 47 ± 0.3

table 2 METHOD FOR OSTEOSYNTHESIS BY ORTO-SUV DEVICE FOR TREATING DISTAL THREE FEMORAL INJURY Displacement mm Layout number 1 Layout number 2 Layout number 3 Layout number 4 Layout number 5 Plane-parallel movement in the sagittal plane anterior / posterior 45.9 ± 0.4 / 59.9 ± 0.4 55 ± 0.3 / 60.1 ± 0.4 65.9 ± 0.4 / 69.8 ± 0.6 70.2 ± 0.4 / 94 ± 0.5 67 ± 0.4 / 85 ± 0.6 Plane-parallel movement in the frontal plane in / out 85.5 ± 0.2 / 66 ± 0.6 40 ± 0.3 / 40.5 ± 0.4 85 ± 0.5 / 59.9 ± 0.4 67.9 ± 0.3 / 45 ± 0.3 67.9 ± 0.4 / 45 ± 0.5 Angular movement in the frontal plane of the varus / valgus 37 ± 0.2 / 34.9 ± 0.2 20 ± 0.2 / 41.9 ± 0.2 35 ± 0.3 / 35 ± 0.2 37.1 ± 0.2 / 35 ± 0.3 35 ± 0.2 / 44 ± 0.4 Angular displacement in the sagittal plane antecurvation / recurrence 34 ± 0.3 / 40 ± 0.2 35 ± 0.3 / 10 ± 0.4 34.9 ± 0.2 / 40 ± 0.2 35 ± 0.4 / 25 ± 0.2 34 ± 0.2 / 25 ± 0.3 Internal rotation / External rotation 27 ± 0.2 / 30 ± 0.2 10 ± 0.2 / 25 ± 0.2 26.9 ± 0.2 / 29.5 ± 0.2 10 ± 0.2 / 23 ± 0.2 14 ± 0.3 / 29.9 ± 0.2

Table 3 METHOD FOR OSTEOSYNTHESIS BY ORTHO-SUV DEVICE FOR TREATING FEMAL DISEASED INJURY INJURY Displacement mm Z-plate number 1 Z-plate number 4 Z-plate number 5 Z-plate number 6 Plane-parallel movement in the sagittal plane anterior / posterior 79.9 ± 0.3 / 50.5 ± 0.3 80 ± 0.2 / 50.3 ± 0.3 68.1 ± 0.2 / 65.2 + 0.6 61.4 ± 0.3 / 64.8 ± 0.4 Plane-parallel movement in the frontal plane in / out 110.2 ± 0.5 / 80.5 ± 0.4 70.2 ± 0.4 / 80 ± 0.4 74.3 ± 0.4 / 90 ± 0.5 74.1 ± 0.5 / 70 ± 0.6 Angular movement in the frontal plane of the varus / valgus 42.8 ± 0.2 / 20.2 ± 0.4 34.5 ± 0.2 / 40.3 ± 0.3 37.7 ± 0.2 / 50.3 ± 0.5 30.2 ± 0.3 / 24.7 ± 0.2 Angular displacement in the sagittal plane antecurvation / recurrence 36.9 ± 0.2 / 39.8 ± 0.3 38 ± 0.2 / 40.5 ± 0.4 30 ± 0.2 / 42.2 ± 0.2 36.8 ± 0.2 / 35.2 ± 0.3 Internal rotation / External rotation 30 ± 0.2 / 31.9 ± 0.2 16 ± 0.2 / 12.7 ± 0.2 43.4 ± 0.3 / 38 ± 0.2 28.4 ± 0.3 / 37.7 ± 0.2

Claims (1)

The method of osteosynthesis with the Ortho-SUV apparatus for correction of deformations of the distal third of the femur by applying transosseous modules to the proximal and distal bone fragments of the femur and connecting them with six strata, characterized in that they use 3/4 ring supports, the distal support is located at the level of the VII thigh, proximal at an optimal distance of 150-200 mm, on proximal support, stratum 1 is fixed in position 2, stratum 3 is between positions 5 and 6, stratum 5 is in position 10, and on the distal support stratum 2 is fixed in position 4, stratum 4 - 8 in position, the stratum 6 - at position 12, wherein for fastening strata 1 and 5 use the Z-shaped shelfplasty.

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