RU2464949C1 - Method of three-joint foot arthrodesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Application of apparatus of external fixation is performed. Foot deformity is eliminated. Distraction is performed in three joints: talocalcaneal, talonavicular, calcaneocuboid. Surgical access is performed by making skin puncture in projection of tarsal sinus. Joint cartilages are ablated from talocalcaneal, talonavicular and calcaneocuboid joints through made skin puncture by arthroscopic instruments until "blood dew" appears on joint surfaces. Remaining foot deformities are eliminated. Compression in three said joints is performed until full contact of their joint surfaces. Stabilisation of foot is performed.

EFFECT: method ensures complete foot reconstruction, reduction of trauma of performed surgery, reduction of term of ankylosis formation in joints.

3 cl, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to treat patients with instability and deformities of the feet.

In recent years, there has been a clear increase in congenital and acquired pathologies of the musculoskeletal system and, in particular, the development of instability and various types of foot deformities. To correct deformities of the feet and to stabilize the joints, more than 40 methods of arthrodesis have been proposed.

A method for triple arthrodesis of Dan is described in the literature, in which the head of the talus bone, the entire navicular bone, articular cartilage of 1 sphenoid bone are resected. The heel-cube-shaped and ram-calcaneal joints are resected with a chisel.

However, when performing a resection with a chisel, significant damage is caused to surrounding tissues. Due to the dissection of the ligaments connecting the talus, calcaneus, scaphoid and cuboid bones, it is difficult to keep them in the correct position after surgery, which may cause delayed formation of ankylosis.

P.G. Kornev suggested resection of the ankle, Shoparovsky and Lisfranc joints with the subsequent placement of extraarticular graft on the front surface of the foot. In 1933, S. Lambrinudi improved the technique of three-joint arthrodesis: after removal of the articular cartilage of the subtalar joint from the head of the talus, a bone spike was formed that was inserted into the previously made groove in the lower part of the scaphoid. In this case, the talus should be in the maximum flexion position, and the front section in the extension position. In addition, a heel-cuboid joint was resected [RU patent on invention No. 2197193].

However, these methods require prolonged immobilization due to the long-term reconstruction of the grafts, which can lead to contracture of the joints of the foot, especially the ankle.

There is also a known method of three-joint arthrodesis according to the Lortiuar method [Chaklin V.D. "Operational orthopedics." M .: Medgiz, 1951. S. 266-268, 415-420]. A lateral incision is made of Kocher, which starts from above behind the fibula, around the outer ankle, and is directed inwards, ending distal to the attachment of the tuberosity of the V metatarsal bone. The talus is exposed, dissected ligaments between it and adjacent bones. The talus is removed, wrapped in a warm compress, and then the cartilage is removed with a knife from all articular surfaces in contact with the talus. The bed is plugged and temporarily covered with soft tissue over them. The cartilaginous cover of the talus is also completely removed with a bone knife, however, so that the normal shape and size of the bone are preserved. Impose a blind seam on soft tissues and skin. Apply a plaster cast for 6 weeks. In the future, change the bandage, correct the position and put a new plaster cast.

However, this method of treatment, like all of the above analogues, is traumatic.

The closest analogue to the claimed invention is a method of three-articular arthrodesis of the foot [copyright certificate SU on the invention No. 1063396]. Perform surgical access by cutting the skin along the inner surface of the foot below the inner ankle. Soft tissues are bred and held by hooks. With the help of needles, the place of the ram-calcaneal and ram-navicular joints is designated. The articular cartilages are destroyed from the ram-calcaneal, ram-navicular and calcaneocube-shaped joints by drilling holes. Pieces of destroyed cartilage and bones are washed with a solution of novocaine. The holes are tightly filled with bone autografts. Catgut sutures are applied to soft tissue and skin, an alcohol dressing and a plaster boot for 3 months.

However, the use of this method does not provide a complete reconstruction of the foot. The method is applicable mainly for arthrodesis of the ankle joint with its deforming arthrosis and can be used, for example, with multiplanar deformation of the foot, affecting Shoparov joint.

The task of the invention is to ensure complete reconstruction of the foot while reducing the morbidity of the surgical intervention and reducing the formation of ankylosis in the ram-calcaneal, ram-navicular and calcaneocube-like joints.

The essence of the claimed invention lies in the fact that in the method of three-joint arthrodesis of the foot, including the implementation of surgical access, removal of articular cartilage from the ram-calcaneal, ram-navicular and calcaneocube-like joints, elimination of deformities of the foot, compression in three joints - ramming-calcaneal, ram-scaphoid, calcaneal-cuboid to complete contact of their articular surfaces, stabilization of the foot, prior to surgical access, the apparatus is superimposed outside cervical fixation, then by means of the latter fix foot deformities and carry out distraction in these three joints, surgical access is performed by puncture of the skin in the projection of the tarsal sinus, removal of articular cartilage is performed through a puncture of the skin through arthroscopic instrumentation until “blood dew” appears on the articular surfaces, after eliminate residual deformations of the foot.

A method of three-joint arthrodesis of the foot with the above characteristics is also claimed, in which, when an external fixation apparatus is applied, two crossed needles are passed through the lower third of the lower leg, the talus and the calcaneus, one spoke with a persistent platform through the scaphoid and cuboid bones, they are fixed in rings and half rings that are interconnected using rods and brackets with shanks.

In addition, there is also claimed a method of three-joint arthrodesis of the foot with the above characteristics, in which distraction in the joints is performed by 4-6 mm.

The technical result of the claimed invention consists in solving the problem posed earlier. The implementation of arthroscopic instrumentation to remove the articular cartilage of the talus, calcaneus, scaphoid and cuboid bones before the appearance of “blood dew” on the articular surfaces and the rigid fixation of the foot by means of an external fixation apparatus contributes to: ensuring complete ankylization in the calf-calcaneal, ram-navicular and calcaneal cuboid joints in a shorter time; restoration of lost biomechanics and support ability of the foot with the ability to perform its complete reconstruction; prevent recurrence of foot deformity. The implementation of all the manipulations performed during surgery through one puncture of the skin, performed in the projection of the tarsal sinus, allows to reduce the invasiveness of surgical treatment, preserving the capsule-ligamentous apparatus of the foot as much as possible, which in turn helps to reduce the rehabilitation period and reduce the risk of postoperative complications.

The method of three-joint arthrodesis of the foot is as follows.

They put the patient on an operating table on his back with rollers under the knee joint and the lower third of the leg. Perform the processing of the surgical field. An external fixation device is placed on the shin and foot. Why, through the lower third of the lower leg and the talus, two crossed needles are carried, pulled and fixed in rings. The latter are interconnected using rods. Through the calcaneus, two crossed needles are drawn, which are pulled and fixed in a semicircle. This half-ring is connected by rods with rings installed in the projection of the lower third of the lower leg and talus. Through the scaphoid and cuboid bones, a spoke with a thrust pad is drawn, pulled and fixed in a half ring, which is connected by three rods to the ring and half ring installed in the projection of the calcaneus and talus.

By means of an external fixation apparatus, deformations of the foot are eliminated and distraction is performed in three joints - the ram-heel, the ram-navicular and the calcane-cuboid 4-6 mm. Perform surgical access by performing a puncture of the skin in the projection of the sinus of the tarsus. The articular cartilage is removed from the ram-calcaneal, ram-navicular and calcaneo-cuboid joints using arthroscopic instruments. To do this, an arthroscopic tube is introduced through a skin puncture, through which an olive-shaped and round arthroscopic burs are connected alternately, connected to a shaver. With the help of burs, articular cartilages are processed on the surfaces of the talus, calcaneus, scaphoid and cuboid bones until “blood dew” appears on the articular surfaces. The inter-articular space is washed with 0.9% saline, ensuring the removal of cartilage and bone chips. Arthroscopic instrumentation is removed. A suture is placed on the wound. Then residual deformations of the foot are eliminated, for example: supination in the talacaneal joint, and in the talon-navicular joint, reduction and varus deformity of the foot. Then, under X-ray control, the compression is performed using an external fixation device alternately in three joints: ram-calcaneal, ram-navicular and calcaneocube-shaped until their articular surfaces are in full contact. Perform stabilization of the foot.

Example

Patient L., 20 years old, was admitted to the Department of Traumatology and Reconstructive Surgery with a diagnosis of “Relapse of congenital clubfoot on the right. Condition after surgery for Zatsepin. Relapse of all elements of clubfoot. Osteoarthritis of the scaphoid and scaphoid and talacaneal joints. Pain syndrome".

After preoperative preparation, the patient underwent surgery under spinal anesthesia according to the method described in this application. In the postoperative period, maintenance compression was performed at 1 mm per day for 5 days. 3 months after surgery, the control radiograph noted the formation of a bone block in all arthrodesized joints. The external fixation apparatus was dismantled. The patient started to work.

Claims (3)

1. The method of three-articular arthrodesis of the foot, including the implementation of surgical access, removal of articular cartilage from the ankle-calcaneal, ram-navicular and heel-cuboid joints, elimination of deformities of the foot, compression in three joints - the ram-calcaneal, ram-calcane-navicular, calcane-navicular to the full contact of their articular surfaces and stabilization of the foot, characterized in that prior to the implementation of surgical access, an external fixation apparatus is applied, then by means of the latter tranyayut deformity and conduct distraction in the three joints, surgical access is performed by performing the puncture of the skin in the projection of the sinus tarsi, the removal of the articular cartilage produce through adapted skin puncture by arthroscopic instruments until the articular surfaces of the "blood dew", after eliminating the residual strain of the foot. 2. The method of three-joint arthrodesis of the foot according to claim 1, characterized in that when applying the external fixation apparatus, two crossed needles are passed through the lower third of the lower leg, the talus and the calcaneus, one spoke with a persistent platform through the scaphoid and cuboid bones, fix them in rings and half rings that are interconnected using rods and brackets with shanks. 3. The method of three-joint foot arthrodesis according to claim 1, characterized in that the distraction in the joints is performed by 4-6 mm.