RU2489108C1 - Method of treating valgus deformation of 1-st toe in case of infantile cerebral paralys - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Method includes bow-shaped cut above head of first instep bone, exposure of joint capsule and tendon of long extensor of I toe. Tendon of long extensor of I toe is exposed along main phalange of toe and diaphysis of I instep bone. Longitudinal canal is made through head of I instep bone by drill. Tendon of long extensor of I toe is cut, its distal end is passed in formed bone canal, ends of long extensor of I toe are connected by tendon suture, with elimination of valgus deformation of I toe. I toe is fixed in correct position through metatarsophalangeal joint with pins for 1 month term. Wound is sutured. Bandage, plaster base splint are applied until removal of skin sutures for two weeks.

EFFECT: method prevents recurrence of toe deformation.

11 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and is directed to surgical treatment of hallux valgus deformity of the 1st toe in cerebral palsy (cerebral palsy). There are many ways to treat hallux valgus in the first toe. The most common include various types of osteotomy and resection of the 1 metatarsal bone, in which various types of submersible osteosynthesis are performed, or even methods of controlled transosseous osteosynthesis [1]. These operations give good anatomical results, but are very traumatic, require prolonged immobilization, and have a risk of fracture failure. When performing various types of submersible osteosynthesis, repeated operations to remove metal structures are implied.

The prototype of the invention is a “Method for the treatment of hallux valgus of the first toe” [2], which consists in the fact that after removing the osteophyte of the head of the first metatarsal bone, in order to fix the first finger in the correct position in the main phalanx of the first finger and first metatarsal bone, in the transverse direction conduct channels with a diameter of up to 3 mm. Through these channels, with the help of a conductor, the lavsan ligature is stretched. The first finger is fixed in the position of the varus hypercorrection, the ligature is tightened. The disadvantage of this method is the need for channels with a diameter of up to 3 mm in the main phalanx and the first metatarsal bone. It is known that the width of these bones at the site of the canals does not exceed 1 cm. The formation of canals provokes the occurrence of hole fractures of bones, which reduces their strength by about 30%. In addition, extra 10-15 minutes of operating time are spent on conducting bone channels and pulling lavsan ligature through them. Given that the operation for valgus deviation of the first toe is usually performed under a tourniquet, i.e. in conditions of complete ischemia of the distal extremity, an increase in its duration for the above time can negatively affect the course of the postoperative period.

The invention is expressed by a combination of essential features, sufficient to achieve the desired technical, and consists in reducing the morbidity of surgery, reducing the time of the operation, while improving its results.

The essence of the invention lies in the fact that the method of treating hallux valgus of the first toe includes an arcuate incision above the head of the first metatarsal bone, exposing the capsule of the joint and tendon of the long extensor of the first toe of the toe, shaping the canal in the first metatarsal bone, fixing the finger in the correct position. Throughout the main phalanx of the finger and diaphysis of the first metatarsal bone, the tendon of the long extensor of the first finger is isolated. The longitudinal canal is performed through the head of the metatarsal bone I with a drill of 3-4 mm, 3-4 cm long. The tendon of the long extensor of the I finger is crossed, its distal end is drawn into the formed bone canal, the ends of the long extensor of the first finger are connected with the tendon suture, with the removal of valgus deformity I finger. The first finger is fixed with knitting needles in the correct position through the metatarsophalangeal joint for a period of 1 month. The wound is sutured. Dressing, gypsum plantar longue before removal of skin sutures for 2 weeks.

Isolation of the tendon of the long extensor of the finger along the main phalanx of the finger and the diaphysis of the first metatarsal bone subsequently allows you to fix the position of the finger.

The longitudinal channel through the head of the first metatarsal bone serves as a block for holding the tendon through it.

The diameter of the channel, made by a drill of 3-4 mm, is determined by the diameter of the tendon.

The length of the channel 3-4 cm allows you to hold the tendon without additional trauma to it during the functioning of the finger.

The intersection of the tendon of the long extensor of the I finger, the holding of its distal end into the formed bone channel, the connection of the ends of the long extensor of the I finger with a tendon suture, with the elimination of the valgus deformity of the I finger, allows you to give the finger the correct position.

Fixing the finger in the correct position with knitting needles through the metatarsophalangeal joint for a period of 1 month allows you to maintain the achieved position of the finger.

Dressing, gypsum plantar spinal cord for 2 weeks - provide smooth healing of the postoperative wound.

The invention is illustrated by illustrations.

Figure 1 shows the x-ray of the foot before surgery;

figure 2 - figure 10 shows the progress of the operation, where:

figure 2 shows a view of the foot before surgery;

figure 3 - figure 4 shows the allocation of the tendon of the long extensor of the finger;

figure 5 - the formation of the awl of the guide channel;

Fig.6 - the formation of a bone canal drill along the guide channel;

in Fig.7 shows the distal end of the long extensor through the bone channel, the convergence of the ends of the extensor;

on Fig - fixing the correct position of the finger with a needle before stitching the ends of the extensor;

figure 9 is a view of the foot after surgery;

figure 10 - x-ray of the foot after surgery;

figure 11 is a view of the foot 6 months after surgery.

The method is as follows.

After conduction anesthesia, after processing the surgical field, an arcuate incision of the skin and subcutaneous tissue in the region of the first metatarsophalangeal joint, the skin-subcutaneous flap is separated, the tendon of the long extensor of the finger is isolated along the main phalanx of the finger and diaphysis of the metatarsal bone. A guide channel is made with an awl in the head of the I metatarsal bone, along which a 3-4 mm long canal is formed with a drill of 3-4 mm. The tendon of the long extensor of the first finger is crossed, its distal end is drawn into the formed bone canal, the distal end is connected with the tendon suture with the central end long extensor of I finger "end to end", with the elimination of hallux valgus deformity of the finger. The correct position of the finger is fixed with knitting needles through the metatarsophalangeal joint for a period of 1 month. The wound is sutured. Bandage. Plantar longus before removal of skin sutures for 2 weeks.

Information sources

1. V.I. Shvetsov, G.R. Ismayilov, T.E. Kozmina et al. The genius of orthopedics, 1999, No. 2, pp. 105-108.

2. RF patent No. 2186542, BIPM No. 22, 2002, p. 355, 356.

Claims (1)

A method of treating hallux valgus 1 toe, including an arcuate incision above the head of the first metatarsal bone, exposure of the joint capsule and tendon of the long extensor 1 of the toe, bone channel design, fixation of the finger in the correct position, characterized in that during the main phalanx of the finger and diaphysis 1 of the metatarsal bone secrete the tendon of the long extensor of the finger, the longitudinal channel is performed through the head of the first metatarsal bone with a drill of 3-4 mm, 3-4 cm long, the tendon of the long extensor of 1 finger is crossed , its distal end is drawn into the formed bone canal, the ends of the long extensor of 1 finger are connected with a tendon suture, with the valgus deformity of 1 finger removed, the finger is fixed in the correct position with knitting needles through the metatarsophalangeal joint for 1 month, the wound is sutured, the dressing, gypsum plantar leg up removal of skin sutures for 2 weeks.

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