RU2463012C1 - Method of plasty of defects of long tubular bones - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology. Application of apparatus of external fixation is performed. Surgical access to defect area is realised. Periosteum is dissected and detached in area of defect on 2/3 of bone diameter. Processing of defect area is performed by carrying out resection of fragment ends to bleeding layer and opening bone marrow canals of fragments providing formation of open holes from the side of ends of bone fragments in defect area. Filling bone marrow canals of bone fragments by filling formed holes with hemostatic sponge and reposition of fragments by means of apparatus of external fixation are carried out. Defect area is filled with bone-plastic material. Hemostatic sponge is applied above bone-plastic material with possibility of ensuring recovery of anatomical shape of bone and replacement of destroyed cortical layer of bone and periosteum. Edges of hemostatic sponge are fixed subperiosteally.

EFFECT: method makes it possible to reduce value of intra-operation blood loss and reduce risk of development of post-operation purulent-septic complications, providing optimal conditions for change of bone-plastic material.

1 ex, 5 dwg

Description

The invention relates to medicine, namely to traumatology. It can be used for plastic surgery of extensive defects of long tubular bones in the surgical treatment of acute fractures and consequences.

Replacing defects in long bones is one of the most difficult problems of reconstructive surgery and traumatology. The most common methods of treating this pathology are compression-distraction osteosynthesis according to Ilizarov and osteoplastic surgery.

Known methods for plastic surgery of defects of long tubular bones [SU certificate of invention for inventions No. 313533, 1526666, RU patent for invention No. 2150905], including osteotomy, dosed movement of the selected fragment in the defect until it contacts the end of the opposite fragment, followed by fixation using a compression-distraction apparatus conducting metered distraction to restore segment length.

However, the use of the compression-distraction method requires a rather long time, and is also fraught with great difficulties in the case of a large defect size.

There are also known methods of autoplasty of defects of long tubular bones [RU patents for inventions No. 2063184, 2082342], including the implementation of sampling of an autograft and replacing a defect of a long tubular bone by it.

However, these treatment methods are most traumatic, since their use requires the autograft to be taken through an additional incision.

There is also known a method of replacing defects of long tubular bones [Kesyan G.A. et al. The use of the domestic biocomposite drug “Collapan” in the complex treatment of fractures and false joints of long bones of the extremities, website: collapan.ru> files / news / news_417 / Kesyan-88.doc], in which, after removing scar tissue, freshening the ends of bone fragments, autopsy bone marrow channels fragments fill the area of the defect with the drug "Kollapan" in the form of granules or gel.

However, when using this method, the migration of plastic material from the defect zone is possible, which, in turn, can lead to postoperative complications.

The closest analogue to the claimed invention is a method for plastic surgery of defects of long tubular bones [Goryachev AN et al. Use of Tutoplast to replace defects after performing edge resections of bones in the surgical treatment of bone tumors // Traumatology and Orthopedics. Collection of abstracts of the VIII Congress of Orthopedic Traumatologists of Russia. June 6-8, 2006. Volume II. Ed. S.P. Mironov and G.P. Kotelnikov. Samara 2006. P.1043]. The method is characterized in that after resection of the bone, the cavity of the defect is filled with the Tutoplast preparation. Then, the destroyed cortical layer of the bone and periosteum is replaced with a hemostatic collagen sponge.

However, when using this method, the penetration of bone-plastic material into the bone marrow cavity and its distribution into the bloodstream is possible, which can lead to postoperative purulent-septic complications.

The task of the invention is to reduce intraoperative blood loss and reduce the risk of postoperative purulent-septic complications while providing optimal conditions for the reconstruction of osteoplastic material and restoration of the anatomical forms of long tubular bones with a minimal cosmetic defect.

The essence of the claimed invention lies in the fact that in the method of plastic surgery of defects of long tubular bones, including performing surgical access to the defect area, processing the defect area by resection of the ends of the fragments to the bleeding layer, filling the defect area with bone-plastic material, laying on top of the bone-plastic hemostatic sponge material with the ability to ensure the replacement of the destroyed cortical layer of the bone and periosteum, before performing surgical UPA, the external fixation apparatus is superimposed, after the dissection and exfoliation of the periosteum in the defect area by 2/3 of the bone diameter, the bone marrow channels of the fragments are opened during processing of the defect with the formation of open holes from the ends of the bone fragments in the defect area, then the filling is performed bone marrow channels of bone fragments by filling the formed holes with a hemostatic sponge and reposition of fragments by means of an external fixation device; the hemostatic sponge is laid on top of the osteoplastic material with the possibility of restoring the anatomical shape of the bone, and its edges are fixed subperiosteally.

The technical result of the claimed invention consists in solving the problem posed earlier. Sealing the area of the replaced defect by filling the bone marrow canals on one side and laying a hemostatic sponge on the other hand over the bone-plastic material prevents the penetration of the bone-plastic material into the bone marrow cavity and soft tissues, reliably holding it in the region of the defect and ensuring its maximum density laying, which helps to ensure optimal conditions for the reconstruction of osteoplastic material and to reduce the healing time of bone wounds.

Filling the bone marrow channels of fragments by filling the open holes of the ends of the fragments with a hemostatic sponge ensures stopping bleeding from the bone marrow cavity, which not only reduces intraoperative blood loss, but also reduces the risk of interstitial posthemorrhagic hematomas in the operated segment of the limb, and also prevents the penetration of bone-plastic material bone marrow cavity, which may also lead to postoperative complications Nij.

Subperiosteal fixation of the edges of the hemostatic sponge laid on top of the osteoplastic material allows not only to firmly strengthen the osteoplastic material in the area of the defect, but also to restore the anatomical shape of the long tubular bone.

The invention is illustrated using Fig.1-5, which show: Fig.1 is a schematic representation of the method after filling the ends of the fragments with a hemostatic sponge and filling the defect area with bone-plastic material, Fig.2 is a schematic representation of the method after laying hemostatic sponge on top of osteoplastic material, FIG. 3 is an x-ray of the left leg of patient B. before surgery, FIG. 4 is an x-ray of the left leg of patient B. after surgery intervention, figure 5 is a radiograph of the left lower leg of patient B. after dismantling the external fixation apparatus.

The method of plastic defects of long tubular bones is as follows.

They put the patient on the operating table on his back. Perform conduction or intravenous anesthesia. Surgical intervention is carried out under radiological control. Closed transosseous osteosynthesis of the damaged segment is performed by applying an external fixation apparatus. The layout of the external fixation apparatus depends on the operated segment of the limbs and is performed according to known methods (see, for example, Barabash A. P. "Esperanto" of transosseous elements during osteosynthesis with the Ilizarov apparatus / A. Barabash, L. N. Solomin. - Novosibirsk : Science, Sib. Enterprise RANB, 1997. - P.29-43). Perform surgical access to the area of the bone defect. A revision of the area of pathology, excision of scar tissue, dissection and exfoliation of the periosteum in the defect area by 2/3 of the bone diameter are performed. The defect area is processed by resection of the ends of the fragments to the bleeding layer and opening of the bone-marrow channels of bone fragments using scans of the required diameter to ensure the formation of open holes from the ends of the bone fragments in the defect area. To prevent bleeding from the bone marrow channels of bone fragments and to prevent the penetration of bone-plastic material into the bone marrow cavity, fill the bone marrow channels of the bone by filling the openings with a hemostatic sponge. The bone fragments are repositioned by an external fixation apparatus. The defect area is filled with composite granular osteoplastic material. To seal the defect area, a hemostatic sponge is placed on top of the osteoplastic material with the possibility of restoring the anatomical shape of the bone and replacing the destroyed cortical layer of the bone and periosteum. The edges of the hemostatic sponge are fixed subperiosteally. The wound is sutured in layers tightly. Apply an aseptic dressing. After 2.5-3 months, the external fixation apparatus is dismantled.

Example.

Patient B., 61 years old, was admitted to the traumatology and orthopedic department with the diagnosis: “An overgrown fracture of the left tibia. "A marginal bone defect at the level of the border of the middle and lower third of the tibia diaphysis."

Previously, the patient underwent osteosynthesis with an intramedullary shaft, which did not lead to fracture fusion.

After preoperative preparation, the patient underwent surgery. Under conduction anesthesia, the previously installed intramedullary shaft was removed, then an external fixation apparatus of two supports was placed on the left lower leg. On the border of the middle and lower third of the tibia along the anteroposterior surface, surgical access was performed by 6 cm soft tissue incision. Tibial fracture area was exposed in layers. During the audit of the fracture area, a marginal defect of 30 × 20 × 20 mm was detected. The defect area was freed from scar tissue, autopsy was performed on the bone marrow canals by drilling with a reamer of 9 mm diameter. They resected the ends of the fragments to the bleeding layer. Filling of the bone marrow channels of fragments of the tibia with a hemostatic sponge 30 × 30 mm was performed. The defect area was filled with granules of the osteoset osteoplastic material. A 40 × 30 mm hemostatic sponge was placed on top of the osteoplastic material, the edges of which were inserted subperiostally. The wound was sutured in layers. By the end of 10 weeks after surgery, a restructuring of the osteoplastic material in the area of the substituted defect was radiologically observed. 12 weeks after surgery, the external fixation apparatus was dismantled. The patient began to move with a full load on the limb, pain was not observed.

Claims (1)

A method for plasticizing defects of long tubular bones, including performing surgical access to the defect area, processing the defect area by resecting the ends of the fragments to a bleeding layer, filling the defect area with bone-plastic material, laying a hemostatic sponge over the bone-plastic material with the possibility of replacing the destroyed cortical layer of bone and periosteum, characterized in that prior to performing surgical access, the apparatus is superimposed external fixation, after the periosteum is dissected and exfoliated in the defect area by 2/3 of the bone diameter, during the treatment of the defect area, the bone marrow channels of the fragments are opened to ensure open holes are formed from the ends of the bone fragments in the region of the defect, then the bone marrow channels of the bone fragments are filled by filling the formed holes with a hemostatic sponge and reposition of fragments by means of an external fixation device; the hemostatic sponge is laid on top of the osteoplastic material with the possibility of restoring the anatomical shape of the bone, and its edges are fixed subperiosteally.

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