RU2471447C1 - METHOD OF OSTEOSYNTHESIS BY APPARATUS Ortho-SUV IN TREATMENT OF INJURIES OF PROXIMAL THIRD OF FEMORAL BONE - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics, and can be used for correction of deformations of proximal third of femoral bone by osteosynthesis apparatus OrthoSuv. Transosseous supports are applied on proximal and distal bone fragments of femoral bone. Supports are connected by means of six strata. Proximal support of 2/3 ring is placed at the level of II hip, and distal ring support is placed at the distance 150-200 mm from it. On proximal support strata 1 is fixed in position 12, strata 3 - in position 6, strata 5 - in position 9, and on distal support strata 2 is fixed in position 3, strata 4 - between positions 7 and 8, strata 6 - in position 11. In order to fix strata 1 and 5 Z-like plates.

EFFECT: method ensures elimination of femoral bone deformation, maximal reposition possibilities of apparatus Orth-Suv with preservation of minimal dimensions of construction, reduction of postoperative complications.

1 ex, 3 tbl, 37 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to correct deformities, treat false joints and fractures of the proximal third of the femoral diaphysis.

A known method of osteosynthesis by the Ilizarov apparatus for correction of deformities of the proximal 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. - BI. - 1976. - No. 6) (Fig. 1).

According to this method, the Ilizarov apparatus is applied to the thigh, which consists of bulky femoral sectors (arches) and circular external supports connected by unified nodes to eliminate deformation.

Unified nodes are developed in detail at the RTC "WTO" named after Acad. G.A. Ilizarova and allow to eliminate deformations of any degree of complexity. 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 when eliminating multi-plane multicomponent deformations, which is associated with the need to replace unified nodes (V. Vilensky. 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: Ph.D. Medical Sciences / Vilensky Viktor 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 calculated by a special computer program.

The disadvantages of the method of using the device Ortho-SUV in the correction of deformities of the proximal third of the femur are:

1. The location of the supports at an non-optimal distance, the fixation of the strata not in optimal positions may lead to the inability to perform the correction of the deformation of the proximal third of the femur by the required value. 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 and 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 in that the proximal support 2/3 of the ring and the distal annular support are used, while the proximal support is located at level II, and the distal 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 12, for stratum 3 - position 6, for stratum 5 - position 9;

- on the distal support for stratum 2 - position 3, for stratum 4 - between positions 7 and 8, for stratum 6 - position 11. Z-shaped plates are used to fasten strata 1 and 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, 30 series of experiments were carried out on 13 models: a total of 390 experiments. The dependence of repositional capabilities (distraction, translation, angulation, torsion) of the Ortho-SUV apparatus on the diameter of external supports, the distance between them and the places of fixation of striations on supports was studied. 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 repositioning capabilities of the Ortho-SUV apparatus (Table 2). The use of one Z-shaped plate for attaching strips 1 and 5 allows you to further increase the repositioning capabilities from 4.2% to 6.2%. The use of two Z-shaped platiks increases reposition capabilities by 38.4% (Table 3).

The figures depict:

Figure 1: Ilizarov apparatus for the treatment of injuries of the proximal 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 proximal third of the femur, front view.

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

Figure 5: Layout for correction of deformities of the proximal third of the femur after modular transformation, front view.

6: Layout for correction of deformities of the proximal third of the femur after modular transformation, side view.

7: Diagram of the division of the femur into levels.

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

Fig.9: An example of the designation of the spokes.

Figure 10: An example of the designation of the rod.

11: An example of a support designation.

Fig: Photograph of the patient before the correction of deformation, front view.

Fig: Photograph of the patient before the correction of deformation, side view.

Fig. 14: Patient x-ray before correction of deformation in direct projection.

Fig. 15: Patient x-ray before correction of deformation in lateral projection.

Fig: Photograph of a patient after surgery for transosseous osteosynthesis and corticotomy of the right femur, front view.

Fig: Photograph of a patient after transosseous osteosynthesis and corticotomy of the right femur, side view.

Fig. 18: Photograph of a patient after surgery for transosseous osteosynthesis and corticotomy of the right femur, direct projection.

Fig: Photographs of the patient after surgery of transosseous osteosynthesis and corticotomy of the right femur, lateral projection.

Fig. 20: X-ray diffraction pattern of a patient after distraction, direct projection.

Fig: Photographs of the patient after distraction, 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 apparatus of Ortho-SUV, direct projection.

Fig: Photographs of the patient in the apparatus of Ortho-SUV, lateral projection.

Fig.26: Photograph of the patient after correction of deformation, front view.

Fig.27: Photograph of the patient after correction of deformation, side view.

Fig.28: Patient x-ray after correction of deformation, direct projection.

Fig.29: Patient x-ray after correction of deformation, lateral projection.

Fig. 30: Photograph of a patient after replacing the strata of the Ortho-SUV apparatus with connecting hinges from parts of the Ilizarov apparatus, front view.

Fig. 31: Side view of a photograph of a patient after replacing the strata of the Ortho-SUV apparatus with connecting hinges from parts of the Ilizarov apparatus

Fig. 32: X-ray diffraction pattern of the patient after replacing the strata of the Ortho-SUV apparatus with connecting joints from the Ilizarov apparatus parts, direct projection.

Fig.33: Patient X-ray diffraction pattern after replacing the strata of the Ortho-SUV apparatus with connecting hinges from parts of the Ilizarov apparatus, side view.

Fig. 34: Photograph of the patient after dismantling the apparatus.

Fig. 35: Functional result of treatment.

Fig. 36: X-ray diffraction pattern of the patient after dismantling the apparatus, direct projection.

Fig. 37: Photograph of a patient after dismantling the apparatus, lateral projection.

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 1: stratum 1 at position 12, stratum 2 at position 3, stratum 3 at position 6, stratum 4 between positions 7 and 8, stratum 5 at position 9, stratum 6 at position 11;

- layout 2: stratum 1 at position 12, stratum 2 at position 3, stratum 3 at position 6, stratum 4 between positions 7 and 8, stratum 5 at position 10, stratum 6 between positions 11 and 12;

- stratum 1 at position 12, stratum 2 at position 3, stratum 3 at position 6, stratum 4 at position 7, stratum 5 at position 10, stratum 6 between positions 10 and 11.

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

The method is as follows: the proximal support, representing 2/3 of the ring, is located at level II of the thigh. The distal annular support is placed at a distance of 150-200 mm from the proximal. Transosseous elements are carried out only in the projection of the "Recommended Positions" (Solomin L.N. Fundamentals of transosseous osteosynthesis with the apparatus of G.A. Ilizarov / L.N. Solomin. - St. Petersburg: Morsar AB, 2005. - 544 p .; http: // rniito.org/solomin/download/atlas-rus.zip). 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 12, stratum 3 - in the projection of position 6, stratum 5 - in the projection of position 9. On the distal support, strata are attached as follows: stratum 2 - in the projection of position 3, stratum 4 - in the projection between positions 7 and 8, stratum 6 - in the projection of position 11. The final layout of the apparatus according to the unified designation of transosseous osteosynthesis is as follows:

This arrangement can be used both for correction of deformities and for reposition of fractures of the proximal third of the femoral diaphysis. After correction of the deformation (reposition of the fracture), the striations can be replaced with connecting rods or, if the supports are at an angle to each other, with standard hinges (Fig. 5).

Clinical example

Patient K., 22 years old, was admitted to RNIITO. P.P. Vredena 01/19/2009 with a diagnosis of post-traumatic deformation of the right femur of medium complexity, shortening of the right lower limb 2 cm due to the hip.

From the anamnesis: an injury dated 05/14/2007, as a result of an accident, she received a CCI, a severe brain contusion, a closed comminuted fracture of the upper third of the right femur with displacement of fragments. An operation was performed in one of the city hospitals in Tikhvin: open reduction, metal osteosynthesis of the right femur with a plate. After the fracture was fused and the metalwork was removed, the patient retained the discomfort associated with shortening of the limb, external rotation.

At the time of admission to the clinic, the patient had a deformation of the right thigh of medium complexity (two-component single-plane): shortening 2 cm, external rotation 25 ° (Fig. 12-15).

January 17, 2009 the operation was performed: corticotomy with osteoclasia of the upper third of the right femur, combined transosseous osteosynthesis of the right thigh (Figs. 16-19). The layout of the device according to MUOCHO:

The beginning of the deformity correction is 5 days after the operation. The first stage on the rods of the Ilizarov apparatus performed the required distraction for 20 days at a rate of 1 mm / day. During distraction, secondary varus deformities arose (Figs. 20-21).

The rods of the Ilizarov apparatus were replaced by strata of the Ortho-SUV apparatus (Figs. 22-25). The rotational component and the secondary angular deformity of the femur were eliminated one-stage within 5 days (Figs. 26-29). After the deformation is eliminated, the Ortho-SUV apparatus is replaced by connecting hinges from the parts of the Ilizarov apparatus (Figs. 30-33). A clinical test performed with radiological signs of complete bone remodeling of the regenerate 132 days after the operation revealed no pathological mobility. AVF is dynamized. 140 days after surgery, the AVF was dismantled. The fixation period was 112 days. AVF function of the joints of the right lower limb is complete (Fig.34-37).

Table 1 Displacement mm 120mm distance Distance 150 mm 200 mm distance Plane-parallel movement in the sagittal plane anterior / posterior 30 ± 0.4 / 35 ± 0.3 40 ± 0.7 / 45 ± 0.5 65 ± 0.4 / 33 ± 0.35 Plane-parallel movement in the frontal plane in / out 15 ± 0.5 / 50 ± 0.3 42.5 ± 0.2 / 70 ± 0.5 63 ± 0.2 / 30 ± 0.3 Angular movement in the frontal plane of the varus / valgus 24 ± 0.4 / 13 ± 0.3 37 ± 0.2 / 24 ± 0.3 52 ± 0.4 / 30 ± 0.6 Angular displacement in the sagittal plane antecurvation / recurrence 15 ± 0.3 / 40 ± 0.4 31 ± 0.4 / 36 ± 0.3 31 ± 0.3 / 43 ± 0.3 Internal rotation / External rotation 5 ± 0.4 / 5 ± 0.4 12 ± 0.5 / 19 ± 0.2 25 ± 0.5 / 26 ± 0.5

table 2 Displacement mm Layout number 1 Layout number 2 Layout number 3 Plane-parallel movement in the sagittal plane anterior / posterior 40 ± 0.7 / 45 ± 0.5 35 ± 0.5 / 45 ± 0.6 40 ± 0.5 / 65 ± 0.7 Plane-parallel movement in the frontal plane in / out 42.5 ± 0.2 / 70 ± 0.5 30 ± 0.3 / 34.5 ± 0.6 30 ± 0.4 / 67 ± 0.5 Angular movement in the frontal plane of the varus / valgus 37 ± 0.2 / 24 ± 0.3 25 ± 0.4 / 24.5 ± 0.5 43 ± 0.35 / 28 ± 0.4 Angular displacement in the sagittal plane antecurvation / recurrence 31 ± 0.4 / 36 ± 0.3 30 ± 0.3 / 20 ± 0.5 5 ± 0.2 / 42 ± 0.4 Internal rotation / External rotation 12 ± 0.5 / 19 ± 0.2 23 ± 0.5 / 24 ± 0.4 17 ± 0.2 / 23 ± 0.2

Claims (1)

The method of osteosynthesis with the Ortho-SUV apparatus for correction of deformations of the proximal third of the femur by superposing supraspinal supports on the proximal and distal bone fragments of the femur and joining them with six strata, characterized in that the proximal support 2/3 of the ring is located at the level of the II femur, and the distal annular the support at a distance of 150-200 mm from it, on the proximal support, stratum 1 is fixed at position 12, stratum 3 is at position 6, stratum 5 is at position 9, and on the distal support stratum 2 is fixed at position 3, stratum 4 between position and 7 and 8, the stratum 6 - at position 11, wherein for fastening strata 1 and 5 use the Z-shaped shelfplasty.

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