RU2476177C1 - Method of operative treatment of treatment of osteochondritis dissecans of femoral condyles in children and teenagers - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pediatric traumatology and orthopedics, and is intended for treatment of osteochondritis dissecans of femoral condyles in children and teenagers. Arthroscopy of knee joint is performed by means of two accesses. Revision and sanitation of knee joint are performed. Under control of electronic-optic converter passed is wire -"label", puncture of which is performed through metaphyseal zone of femur, and is passed into focus of osteosclerosis. After label installation osteoperforation with wire, with diameter 1.5 mm, is performed in quantity 15-20 times. When sensation of resistance of healthy tissues appears, osteoperforation is continued to cartilage surface, with destruction of sclerosed focus surface.

EFFECT: method ensures reduction of operation trauma, preservation of cartilage surface, enhancement of reparative regeneration of tissues, complete destruction of sclerosed surface of pathological process focus, reduction of postoperative complications.

1 ex, 3 dwg

Description

The invention relates to medicine, namely to pediatric traumatology and orthopedics, and is intended for the treatment of dissecting osteochondritis of the femoral condyles in children and adolescents.

A known method of endoscopically-assisted application of osteoperforation, transchondral to a zone of satisfactory vascularization (Gerasimenko M.A., Beletsky A.V., Zhuk E.V. Koenig's disease of the knee joint in children: clinic, diagnosis and treatment. BMG, 2007, 2 ( twenty)). However, this technique has several disadvantages, namely, the exact amount of osteoperforation required to activate regeneration has not been determined; the concept of a zone of satisfactory vascularization is understood by specialists in different ways, and therefore, there is no guarantee that the use of the method by each of the specialists will lead to the desired result - improved tissue regeneration. A known method of treating Koenig's disease in children and adolescents (patent RU No. 2360617C1). The latter is the closest to our proposed method, we took it as a prototype. However, it has the following disadvantages:

1) high invasiveness of the method associated with damage to the cartilage surface;

2) emptying a blood clot into the joint cavity through openings in the cartilaginous surface, which leads to a slowdown in reparative regeneration and thereby increase the rehabilitation time.

The aim of the proposed method is to eliminate the above disadvantages, which allows minimally invasive to provide revascularizing osteoperforation of the sclerosed surface of the pathological focus under the control of an electron-optical transducer (EOP), without damaging the cartilage surface above the focus of the defect.

To achieve the medical and technical result of the proposed method, arthroscopy of the knee joint is performed using 2 standard approaches (antero-medial and antero-lateral), revision and rehabilitation of the knee joint are performed. Under the control of the image intensifier, a “mark” needle is carried out, the puncture of which is performed through the metaphysical zone of the femur and is carried out into the focus of osteosclerosis. Then, focusing on the “mark” needle and under the periodic control of the image intensifier, the area of the osteosclerosis of the femur is drilled without damaging the cartilaginous surface.

The inventive method is illustrated by drawings.

The method is as follows:

Under anesthesia, under aseptic conditions, after treating the surgical field with iodopyron and alcohol from 2 standard approaches: antero-medial and antero-lateral, arthroscopy of the knee joint is performed. The joint is washed with physiological saline (0.9% NaCl). Then, under the control of the image intensifier, a “mark” needle is carried out, the puncture of which is performed through the metaphysical zone of the femur and carried out into the focus of osteosclerosis (Figs. 1 and 2). After setting the mark, osteoperforation is carried out with a spoke having a diameter of 1.5 mm. Osteoperforation is applied in an amount of 15-20 times. After the sensation of resistance of healthy tissues appears, osteoperforation continues to the cartilaginous surface under the control of the image intensifier (Fig. 3). At the same time, arthroscopic monitoring of the cartilage surface in the field of osteosclerosis is carried out. The joint is washed. At the site of arthroscopic approaches, sutures and an aseptic dressing are applied. Practical Application Example:

Patient Mamaev E.V., 7 years old, was admitted to CITO with a diagnosis of Dissecting osteochondritis of the medial condyle of the right femur, 2nd stage. From the anamnesis it is known: pains in the right knee joint began to bother 1 year ago. He asked for help at the place of residence, performed x-ray and computed tomography, the diagnosis was made: Dissecting osteochondritis of the medial condyle of the right femur of the 2nd stage. Physiotherapeutic treatment was carried out (electrophoresis, ultrasound), exercise therapy. With short-term positive effect. The pain intensified during physical exertion. On examination, the knee joint is of normal shape and size. Limited maximum flexion in the joint. Palpation is moderately painful in the projection of the medial condyle of the femur. Radiologically, in the area of the projection of the medial condyle of the femur, a structureless homogeneous shadow is defined, delimited from normal bone tissue by the enlightenment zone. Arthroscopy was performed: during revision of the articular cartilage of the medial condyle over the area of aseptic necrosis is softened, its integrity is preserved. Under the control of the image intensifier, marking was made in the region of the pathological lesion extra-articularly, with a spoke having a diameter of 1.5 mm, 18 extra-articular osteoperforations were applied. After the sensation of resistance of healthy tissues appears, osteoperforation is continued to the cartilaginous surface under the control of the image intensifier. Arthroscopic examination showed that the cartilaginous surface was not damaged. Sutures were placed at the site of arthroscope insertion. From the 2nd day, physiotherapy treatment has been started. Discharged home on the 5th day for outpatient treatment. Limb load allowed 3 months after surgery. A total of 36 patients were operated on.

As a result, the advantages of the proposed method are noted:

1) minimally invasive surgery technique;

2) the safety of the cartilage surface;

3) the proposed method allows to achieve enhanced reparative tissue regeneration.

4) the sclerosed surface of the focus of the pathological process is completely destroyed;

5) a blood clot does not empty into the joint cavity, since the cartilage surface is not damaged;

The list of figures for the description of the invention:

Fig. 1 Setting of knitting needles. Roentgenogram.

Fig. 2 Setting of knitting needles. General form.

Fig. 3 EOP control. General form.

Claims (1)

A method for surgical treatment of dissecting osteochondritis of the condyles of the femur in children and adolescents, including arthroscopy of the knee joint, debridement, revision, revascularizing osteoperforation, characterized in that under the control of the electron-optical transducer a knitting needle is carried out, the puncture of which is performed through the metaphysical zone of the femur and carried out into the focus of osteosclerosis, after setting the mark, osteoperforation is carried out with a spoke having a diameter of 1.5 mm, in an amount of 15-20 times, after the sensation of resistance dorova tissues continue to osteoperforation cartilage surface, destroying the sclerotic surface of the hearth.

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