RU2474397C1 - Method of treating slipping patella - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly traumatology and orthopaedics, and may be applied in surgical management of slipping patella. Lateral ligaments of patella are dissected. A patellar ligament is dissected away from an attachment point to a bone fragment of a tibial tuberosity. The ligament being tensed is medially moved into a prepared bed and fixed. A cross tunnel is formed in a patellar tendon directly above the patella to pass a plastic material through ends of which if tensed are fixed to an anteromedial surface of a shinbone within its pes anserinus. An allotendon is used as said plastic material.

EFFECT: method provides simplifying the surgical technique, providing reliable stablisation of the patella, prevents recurrent slipping patella.

1 ex, 2 dwg

Description

The invention relates to medicine, namely to surgical treatment of habitual dislocation of the patella in adults.

Habitual dislocation of the patella is usually manifested in childhood or adolescence. However, a significant number of patients treat this disease as adults after repeated patellar dislocations that have occurred over several, and sometimes many years. This disease can only be cured by surgery (I.E. Hagen-Thorne, PP Harmful, AM Zabludovsky. Surgery of the upper and lower extremities // State Medical Publishing House, M-L, 1931, - p.232-236) . The most common plastic surgery on the fascial apparatus of the knee joint, in which they strengthen the inner part of the knee joint or form a fibro-muscular flap in it, which is then transferred to the outer part of the knee joint in the form of a loop thrown over the knee cup (Boychev B., Conforti B. , Chokanov K. Operative orthopedics and traumatology / State Publishing House: Medicine and Physical Education, Sofia, 1961, - p.621-628; Sklyarenko EM Surgery of the joints of limbs / Publishing Union "Vishka Shkola" Kiev, 1975. - p. 153-156).

However, these operations can only be performed while maintaining the structure of the medial tendon extension formed by the internal lateral ligaments supporting the patella. In adult patients, after multiple dislocations of the patella, the medial part of the joint bag and internal tendon stretch lose their structure, weaken, become stretched, loose. Therefore, the patient’s own tissues from this area cannot be used during reconstructive operations.

A known method of rectoadductor lavsanoplasty, in which, with the habitual dislocation of the patella to maintain it in the correct position when bending the knee joint, an artificial ligament of lavsan is formed in the lower third of the thigh between the rectus quadriceps muscle and the major adductor muscle (Movshovich I.A. .: Medicine, 1983. - S.234-235).

This operation is quite complicated, as it requires the direct extraction of the rectus muscle from the common tendon of the quadriceps femoris muscle, and dissection of the capsule of the knee joint. After creating a ligament between the rectus and major adductors of the femur, stitching of the rectus muscle with the inner head of the quadriceps femoris requires compliance with certain flexion angles in the knee joint, since if this condition is violated, an extensor contracture of the knee joint is formed after surgery.

The objective of the invention is to simplify the technique of operation, ensuring reliable stabilization of the patella, as well as the prevention of recurrence of dislocation of the patella.

In a method of treating a habitual dislocation of the patella, including dissection of the external ligaments of the patella and the formation of an artificial ligament on the inner surface of the knee joint, according to the invention, the cut off own ligament of the patella with a bone fragment of the tibial tuberosity is moved medially to the prepared bed and fixed with a spongy screw in the ligament tension position, in the tendon the quadriceps femoris muscle, directly above the patella, form a transverse tunnel through which lastichesky material such allosuhozhilie its ends in the tensioning position is crosslinked with each other and fixed with sutures in the anterior-medial surface of the tibia in its "crow's feet".

Cutting off only the patellar ligament alone does not require the isolation of the rectus femoris muscle from the common tendon of the quadriceps femoris muscle, which greatly simplifies the operation technique. Moving the cut off own patellar ligament medially and fixing it with a spongy screw in the prepared bed provides static stabilization of the patella in the femoral notch and increases the reliability of its position during flexion of the tibia due to the normalization of the relationship between the patella and its joint area on the thigh (throchlea femoris).

The formation of a new artificial ligament between the tendon of the quadriceps femoris muscle and the “goose foot” of the lower leg, which is an active stabilizer of the knee joint (Mironov SP, Orletsky AK, Tsykunov MB Damage to the ligaments of the knee joint - M .: Lesar, 1999 , - p. 38-39), provides dynamic stabilization of the knee joint in the anterior-medial position and restoration of the function of the knee joint.

Thus, when simplifying the technique of operation, reliable stability of the patella is achieved, which prevents recurrence of dislocation of the patella.

The method is as follows.

Spinal anesthesia. Medial parapatellar access to the knee joint from the lower third of the thigh to the tibial tuberosity. An incision is made about 8 cm long parallel to the patella through the lateral retinaculum. The defect formed after lateral release is not sutured. They mobilize their own patellar ligament and cut it off from the site of attachment with a bone fragment of the tibial tuberosity. They move their own patellar ligament medial 1-1.5 cm into the prepared bed and fix it with a spongy screw in the ligament tension position, creating a new attachment point. Through the tendon of the rectus muscle above the upper pole of the patella, a transverse tunnel is bluntly formed, through which plastic material is passed, for example, an allotendin, both ends of which are brought to the inner surface of the knee joint, are sutured together and in the tension position they are sutured to the "goose foot" of the lower leg on the front its inner surface. The sampling area of the patellar ligament with a bone fragment is replaced by a bone graft of a similar shape and size, taken from the inner part of the tibia epimetaphysis (where the attachment point of the patellar ligament was moved - the prepared bed). The wound is sutured in layers. Active drainage is left in the wound. The knee joint is fixed with an orthosis (or plaster cast) in the extension position of the knee joint.

Clinical example. Patient K., 25 years old, Information Security No. 116590. For 15 years, repeated lateral dislocations of both patella, which became more frequent in the last 3 years, disturbed the patient, which forced the patient to limit physical activity and constantly wear knee pads. Axial radiographs of the knee joints show lateral subluxation of both patella, dysplasia of the condyles of the femur, osteoarthritis of the femoral-patella joints.

Diagnosis: bilateral habitual lateral dislocation of the patella. Dysplasia of the condyles of the femur. Osteoarthrosis of the femoral-patella joints.

10/07/2010 performed according to the proposed method rectomedial allotendoplasty of the extensor apparatus of the left knee joint.

Figure 1, 2 presents the x-ray of the left knee joint of the patient K. Figure 1 x-ray before surgery: A - face; B - profile; B - axial. Figure 2 radiographs after surgery: A - face; B - profile; B - axial.

After 8 months, a similar operation on the right knee joint was performed.

A stable fixation of both patella was achieved. On axial radiographs (October 2011) in the position of knee flexion, there is no subluxation of the patella. Movement in the knee joints in full.

Claims (2)

1. A method of treating a habitual dislocation of the patella, including dissection of the external ligaments of the patella and the creation of an artificial ligament on the inner surface of the knee joint, characterized in that they cut their own ligament of the patella from the attachment site with the bone fragment of the tibial tuberosity, move it medially to the prepared bed and fix the ligament to the position of its tension, in the tendon of the quadriceps femoris, directly above the patella, form a transverse tunnel through which the -terrorist material, whose ends are fixed in the tensioning position to the anterior-medial surface of the tibia in its "crow's feet". 2. A method of treating a habitual dislocation of the patella according to claim 1, characterized in that allosuchin is used as a plastic material.

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