RU2460483C1 - Method of hip joint endoprosthetics in case of bone ankylosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to orthopedics and traumatology. Roentgenogram is performed in direct projection. On roentgenogram distance from neck of lateral edge of femur to the point of intersection of neck axis with the line, drawn through upper and lower points of femur transfer into pelvis, is determined. Point located on femur neck axis is determined on the obtained distance taking into account known magnification of roentgenogram. Osteotomy of its upper half in sagittal plane is performed from the determined point at angle 35-45° to femur neck. Osteotomy of lower half of neck is performed in the same point at angle 65°-75° to femur neck. Planned osteotomy of femur is performed. In remaining proximal part of femur bed for endoprosthesis cup is formed. Endoprosthesis is installed.

EFFECT: method ensures maximal preservation of bone tissue in area of acetabular component positioning, increase of fixation reliability and creation of conditions of correct spatial orientation of endoprosthesis cup.

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Description

The invention relates to medicine, namely to orthopedics and traumatology, and can be used to treat patients with bone ankylosis of the hip joint.

There is a method of total hip arthroplasty, which consists in access to the joint, dissection of the capsule, the formation of flaps and installation of the endoprosthesis, in which anterolateral access to the joint is carried out with the mobilization of the middle-leg muscle and the muscle straining the wide fascia of the hip. Dissect the capsule crosswise with the formation of upper inner, lower inner, lower outer, upper outer capsular flaps. The upper external flap is sutured with the upper internal flap and the resulting suture is closed with the lower external flap, creating a duplicate of the suture and covering it with the iliac-lumbar muscle and the middle-leg muscle mobilized at the time of access (RF patent No. 2407475, class A61B 17/56, publ. 12/27/2010). .

The disadvantages of this method include its use only with undisturbed anatomy of the hip joint and with the satisfactory preservation of its capsule.

There is also known a method for the treatment of degenerative processes and ankylosis of the hip joint by arthroplasty with demineralized bone-cartilage allografts and their fixation to the bone bed of the femoral neck, as well as the formation of the through channel, the biological tissue through it and its fixation through which the through channel forms the perpendicular axis of the femoral neck and allograft and pass through the channel allogeneic tendon. After which it is fixed, it is circled around the distal part of the allocap and stump of the femoral neck (RF patent No. 2167624, class A61B 17/56, publ. May 27, 2001).

However, this method uses allogeneic tissue, which is the cause of allergic reactions and increases the risk of developing infectious complications. In addition, with the formation of a canal in the neck of the femur, the probability of a fracture increases significantly due to a decrease in the volume of bone tissue in the loaded area.

Closest to the proposed in its technical essence is a method of hip joint replacement for bone ankylosis by osteotomy and resection of the femoral neck with the formation of an acetabulum and installation of a total endoprosthesis in which femoral osteotomy is performed in the sagittal direction from the small trochanter to the large and trapezoid the neck of the thigh. And the acetabulum is formed in the proximal stump of the femoral neck (RF patent No. 2172148, class A61B 17/56, publ. 08.20.2001).

But in this method, there is a high probability of a defect in the roof and the posterior column of the acetabulum due to excessive resection of bone tissue, which is due to a change in bone landmarks and significantly worsens the fixation of the endoprosthesis cup in the bone bed, and also requires bone grafting.

The problem to which the claimed invention is directed is to maximize the preservation of bone tissue in the area of positioning of the acetabular component, increase the reliability of fixation and create the conditions for the correct spatial orientation of the cup of the endoprosthesis.

The technical result consists in adequate resection of bone tissue in the ankylosis zone.

The problem is solved in that in the method of hip arthroplasty for bone ankylosis by osteotomy of the femoral neck, formation of an acetabulum in her proximal stump and installation of a total endoprosthesis, a radiograph is previously performed in direct projection. Then, the x-ray determines the distance along the axis of the neck from the lateral edge of the femur to the point of intersection of the axis of the neck with a line drawn through the upper and lower points of transition of the femur into the pelvis. Find a point located on the axis of the femoral neck at a found distance, taking into account the known increase in the radiograph, from the set point at an angle of 35-45 ° to the axis of the femoral neck, osteotomy of its upper half in the sagittal plane is performed, and osteotomy of the lower half of the neck is carried out in the same point at an angle of 65-75 ° to the axis of the femoral neck. Then produce the planned osteotomy of the femur.

Using an x-ray to determine the point located on the axis of the neck of the femur of the ankylosed joint at a specified distance from the lateral edge of the femur, it allows you to determine the required level of resection of the ankylosed joint in conditions of altered bone landmarks, which ensures the preservation of a sufficient volume of bone tissue for proper positioning and reliable fixation of the cup endoprosthesis.

An osteotomy of the upper half of the femoral neck from an established point at an angle of 35-45 ° provides sufficient bone coverage and provides reliable support for the acetabular component in the most loaded area, significantly reducing the likelihood of developing aseptic instability.

Osteotomy of the lower part of the femoral neck, taking into account the formation of an obtuse angle of 65-75 ° with the apex at the set point, serves as a guide for the planned positioning of the endoprosthesis cup with altered bone landmarks, provides complete bone coverage, contributes to reliable primary fixation and creates conditions for the osteointegration of the acetabular component.

Performing the final osteotomy of the femur after excision eliminates accidental damage to the greater trochanter and muscle attachment zones (especially in cases of transposition), provides maximum efficiency in the preparation of the femur for channel development and implantation of the femoral component of the endoprosthesis, which leads to a decrease in the morbidity of the operation and the speedy functional recovery of the patient.

The method is as follows.

Previously, the patient undergoes a panoramic x-ray of the pelvic bones with the capture of the proximal hips in a direct projection. In standard preoperative planning of an operation according to an x-ray, with a known increase, the distance along the axis of the neck from the lateral edge of the femur to the point of intersection of the axis of the neck with the line drawn through the upper and lower points of transition of the femur into the pelvis is determined. In the treatment of patients using total hip arthroplasty, approved for use in clinical practice. In the operating room, observing the rules of aseptic-antiseptic with anesthetics in the patient’s position on the healthy side, layered anterolateral access to the hip joint is performed. Perform thorough hemostasis. After longitudinal opening of the joint capsule, a point located at the planned distance from the lateral edge of the femur is determined along the axis of the neck. From this point, an osteotomy of the upper half of it in the sagittal plane is performed at an angle of 35-45 ° to the axis of the neck, while an osteotomy of the lower half of the neck is performed taking into account the formation of an obtuse angle of 65-75 ° with the vertex at the set point. After elimination, the final femur osteotomy is performed. Then, through the preserved proximal femur, a bed for the endoprosthesis cup is formed by treatment with special cutters until they are completely immersed. The acetabular component of the endoprosthesis is installed according to the standard scheme. After that, excess bone is removed with a chisel along the edge of the cup. The following stages of hip replacement surgery are performed according to generally accepted methods. The wound is washed with antiseptic solutions, complete hemostasis is performed, layered sutures are applied to the wound, the sutures on the skin are closed with an aseptic dressing.

Rehabilitation of patients is carried out as follows: they are allowed to get up without load on the operated limb the day after surgery. Walking with crutches is allowed no earlier than 3 days after surgery with a dosed load, a full load on the operated limb is allowed 3-4 months after the operation.

Example

Patient K., 42 years old, was admitted to the orthopedic department of the Saratov Research Institute of Traumatology and Orthopedics (SarNIIITO) with a diagnosis of bone ankylosis of the left hip joint. Condition after arthrodesis.

After a clinical and radiological examination, the patient underwent endoprosthesis replacement using the claimed method of the left hip joint with a cementless endoprosthesis with fixation of a press-fit cup.

The patient is activated on the first day after the operation, the dosed load on the operated leg is allowed on the third day, full load - after 16 weeks. When examining the patient after 1 year of shortening and pain, there is no movement in the left hip joint in the amount of: flexion / extension - 90 ° / 0 ° / 20 °; abduction / reduction - 20 ° / 0 ° / 30 °; external rotation / internal rotation - 30 ° / 0 ° / 25 °.

Radiologically after 1 year: the position of the components of the endoprosthesis is anatomically satisfactory, stable. Full coverage of the acetabular component with bone tissue, the absence of resorption zones, a clear trabecular structure, oriented in accordance with the lines of power load.

Thus, the proposed method provides the necessary resection of bone tissue in the area of arthrodesis, promotes the correct positioning of the pelvic component with altered bone landmarks, provides complete coverage and reliable fixation of the acetabular component of the endoprosthesis, creates conditions for the fastest osseointegration, reduces the invasiveness of the intervention and leads to the speedy recovery of the patient.

Claims (1)

The method of hip joint arthroplasty for bone ankylosis by osteotomy of the femoral neck, formation of an acetabulum in its proximal stump and installation of a total endoprosthesis, characterized in that the radiograph is first performed in direct projection, then the distance along the neck axis from the lateral edge of the femur to the point is determined on the radiograph the intersection of the axis of the neck with the line drawn through the upper and lower points of transition of the femur into the pelvis, find the point located on the axis of the femoral neck to spine, at a found distance, taking into account the known increase in the roentgenogram from the established point at an angle of 35-45 ° to the axis of the femoral neck, osteotomy of its upper half in the sagittal plane is performed, and the osteotomy of the lower half of the neck is performed at the same point at an angle of 65-75 ° to axis of the femoral neck, after which the planned femur osteotomy is performed.