RU2452418C2 - Method of treating keller-1 disease - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Focus of navicular bone dystrophy is ablated. Transposition of tendon of posterior tibial muscle on healthy parts of navicular bone is performed.

EFFECT: method makes it possible to recover functions and longitudinal arch of foot.

2 ex, 1 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of osteochondropathy of the scaphoid of the foot, not amenable to the conservative method.

There is a method of treating equino-varus deformity of the feet with arthrogryposis (Batalov OA Patent RU No. 95103713 A1, dated January 27, 1997), which consists in securing the tendon of the posterior tibia muscle, cutting it off from the attachment point and fixing it to proximal end of the Achilles tendon. The tendon of the muscle that removes the first finger from the calcaneal tuber is cut from the incision on the plantar surface of the foot, the wounds are sutured and the Ilizarov apparatus is applied.

Another method of surgical treatment of external deviation of the first toe is also known (Batalov OA, Tenilin N.A. Patent RU No. 99103378 A, dated December 10, 2000). The treatment of the external deviation of the first toe is carried out by resection of the osteophyte of the head of the first metatarsal bone and the wedge-shaped valgizing osteotomy of its proximal metaphysis, characterized in that they additionally perform capsulotomy of the external part of the first metatarsophalangeal joint with cutting off portions of tendons of the transverse and oblique muscle heads, leading to the first finger the base of its proximal phalanx.

The closest technical solution to the claimed method and selected as a prototype is a material for osteoplasty based on processed non-fat human cadaveric bones (Malakhov O.A., Belykh S.I., Sukhikh G.T., Kozhevnikov O.V., Lekishvili M.V., Davydov A.B., Malakhova S.O. RU No. 2227037 C2, dated April 20, 2004), material of lyophilized spongy bone tissue with pore sizes from 0.05 to 5 mm, on the surface of which the composition is applied from a biocompatible copolymer and physiologically active substances in the following ratio of components in the compo position, wt.%:

Biocompatible vinylpyrrolidone-acrylate copolymer 50-99

Physiologically active substances 1-50,

the ratio of porous bone tissue and physiologically active polymer composition is, wt.%:

Bone tissue 60-99.3

Physiologically active polymer composition 0.7-40

However, these methods are technically complex, and at the same time, we met with a number of cases where these recommendations did not lead to the desired outcome.

The technical result is the rapid elimination of the pathological process in the medial pole of the scaphoid in cases where it does not lend itself to conservative therapy.

The technical solution is to remove the site of scaphoid dystrophy and transposition of the tendon of the posterior tibial muscle into healthy sections of the scaphoid.

The method is as follows.

In the patient’s position on the back with a semi-oval incision over the projection of the medial pole of the scaphoid of the foot, the bone fragment that is not consolidated with the maternal base of the scaphoid is laid out in layers and is removed by an acute route. The tendon of the posterior tibial muscle is sutured with a nylon or other strong thread, pulled to the navicular bed of the scaphoid and fixed to the latter intraossally, the method is depicted in figure 1 - removal of the "pole" of the scaphoid and transplantation of the tendon m.tibialis posterior onto the healthy part of the scaphoid. In this case, the longitudinal arch always deepens. Layered seams on the wound. The foot in this position is fixed by restorative treatment (warm baths, ozokerite, exercise therapy, wearing shoes with insoles, arch supports, electrophoresis from "Ca" to the scaphoid). Osteochondropathy of the scaphoid of the foot of the foot (Keller-1 disease) is a fairly common pathology in girls 11-12 years old.

Example I: A 12-year-old patient (IB No. 3798) was admitted to the children's surgical department of the Republican Children's Clinical Hospital of the Chechen Republic on March 12, 2008 with complaints of swelling and pain in the inner surface of the mainly right foot. To a lesser extent, these complaints were related to the left foot. She received conservative treatment (outpatient (for 4 weeks) and stationary (for 3 weeks) (warm baths, massage, electrophoresis from “Ca” to the scaphoid of both feet, wearing foot insoles in shoes, calcium diet) , however, these measures led to the disappearance of pain in the left foot, but in the right foot - they remained. On the control x-ray of the feet, a pronounced picture of Keller-1 disease, especially on the right. Moreover, clinically, the feet are flattened, obvious swelling in the scaphoid on the right.

March 16, 2008, an operation was performed on the right foot in accordance with the above technique. Immobilization with a deep back plaster cast for 3 weeks. Then for another 3 weeks - warm baths, exercise therapy for the feet, massage of the calf muscles, wearing insoles of arch support.

Currently no complaints. The shape of the right foot is better - its longitudinal arch became more pronounced. It was decided to refrain from surgery on the left foot due to the absence of complaints from the patient, but she is under observation, because some swelling along the inner edge of the foot, its flatness are preserved.

Example II A 13-year-old patient (IB No. 1410) was admitted to the children's surgical department of the Republican Children's Clinical Hospital on March 25, 2008 with complaints of pain and swelling along the inner edge of both feet. Clinical and radiological - signs of Keller-1 disease on both sides. Before entering the department I tried all measures of conservative therapy.

02/01/2008, an operation was performed on both feet according to the above technique. Plaster immobilization with deep plaster casts for up to 3 weeks, then rehabilitation treatment. The patient currently has no complaints, walks freely in shoes with insoles-arch supports. Clinical and radiological longitudinal arch of both feet has improved, their function does not suffer.

The proposed method for the treatment of osteochondropathy of the scaphoid of the foot can be used in all cases where conservative methods are unsuccessful and signs of the absence of fusion of the medial pole of the scaphoid with its main array are radiologically obvious.

Claims (1)

A method for the treatment of Keller-I disease, including the use of surgical treatment, characterized in that they remove the site of scaphoid dystrophy and transpose the tendon of the posterior tibial muscle into healthy sections of the scaphoid.

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