RU2491892C1 - Method for surgical ankle elongation in patients with osteomyelitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics, also can find application in the ankle elongation in the patients with osteomyelitis. The method consists in applying the Ilizarov's apparatus on the injured ankle, performing 2 vertical sections 1-2 cm long of soft tissues in a projection of a shin bone along the side surfaces, creating a paraosseous tunnel behind the shin bone, bringing a Gigli saw therethrough. The same is used to transect a posterior cortical plate. That is followed by making a section 1-1.5 cm long of soft tissues along the anterior surface of the ankle within the upper one-third. Thereafter, a flat chisel is introduced therein, and medial and lateral cortical plates of the shin bone are transected one by one. The shin bone osteoclasis is performed by rotative motions of the respective rings of the Ilizarov's apparatus.

EFFECT: using this invention enables the objectively controlled extremity length recovery followed by optimising the processes of osteogenesis and blood supply improvement, eliminating the intramedullary structure transection, reducing the number of postoperative complications.

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Description

The method relates to medicine, namely to traumatology and orthopedics, and is intended to lengthen the lower leg in patients with tibial defects complicated by osteomyelitis. There is a method of lengthening the lower leg in patients with osteomyelitis, which consists in applying the Ilizarov apparatus and performing an osteotomy of the tibia using a chisel and osteotome by making an arcuate incision 5-6 cm long in the region of the upper third of the lower leg with exposure of the metadiaphyseal segment of the tibia and peeling muscles from its outer surface. The elevator is brought to the inner surface of the bone and, after transverse dissection of the periosteum, the transverse oval osteotomy of the anterior half of the tibia is made with a grooved chisel, then oblique osteotomy is made with a direct chisel from the outer surface to the inner one in the direction from top to bottom and backward (1).

The disadvantages of this method is that osteotomy is accompanied by a circular detachment of the periosteum for a considerable period and a violation of the periosteal and intramedullary circulation, leading to a significant increase in the timing of the formation of the regenerate compared to the potential.

There is a method of surgical lengthening of the tibia in patients with osteomyelitis by applying the Ilizarov apparatus, making an incision in the upper third of the tibia along the anterior-inner surface 7 cm long and performing periosteal corticotomy of the anterior-inner surface of the tibia in an oblique direction from top to bottom, from the inside outwards, an internal-corticotomy the rear and outer-rear surfaces in the transverse axis of the limb direction (2).

The disadvantage of this method is the difficulty of its implementation in conditions of purulent inflammation of the tissues of the damaged limb. There is a method of lengthening the stump of the leg by crossing the tibia with the Gigli file at the level of the pineal gland 1.0-1.5 cm below the gap of the knee joint, applying the Ilizarov apparatus (3).

The disadvantage of this method is the complete intersection of the structures of the medullary canal of the tibia, which leads to ischemia of the osteotomized fragment, slowing down the formation of bone regenerate, the need to fix the knee joint.

There is a method of surgical lengthening of the lower leg in patients with osteomyelitis by applying the Ilizarov apparatus, making two cuts of 1-2 cm on the lateral surfaces of the lower leg, forming a subperiosteal tunnel, conducting a Dzhigli file through it and sawing the bone backwards (4).

The disadvantage of this method is the complete intersection of bone marrow structures, which leads to a slowdown in the formation of regenerate.

This method is taken as a prototype.

The aim of the invention is to increase the effectiveness of the treatment of patients with defects of the leg bones complicated by osteomyelitis. This goal is achieved by using the Jigley file to intersect the posterior cortical plate, then a soft tissue section of 1-1.5 cm is made along the front surface of the lower leg in the upper third, a flat osteotome is inserted into it and the medial and lateral cortical plates of the tibia intersect. .

Comparison of the proposed method with other known in the field of medicine showed its compliance with the criteria of the invention.

The method is implemented as follows. In the operating room under spinal anesthesia or anesthesia, the Ilizarov apparatus is superimposed on the damaged shin, in the projection of the proximal metaepiphyseal area of the tibia, 2 longitudinal sections of soft tissues of 1-2 cm are made along the lateral surfaces, then with the help of a clamp and raspator, a paraossal tunnel is formed behind the tibia, in a Jigley file is carried out with it, with the help of which the posterior cortical plate is intersected, then along the front surface of the tibia in the upper third is performed soft tissue of 1-1.5 cm, in it is inserted the flat osteotome and sequentially intersect the medial and lateral cortical bone of the tibia, a rotary impact between the Ilizarov rings made osteoclasis tibia. Carry out the installation and stabilization of the Ilizarov apparatus. Clinical example. Patient M., KSB No. 17045, 18 years old, September 10, 2006 suffered a gunshot wound to the right lower leg, a multifibular fracture in the lower third of the right tibia with a bone defect of 6.6 cm, complicated by extensive phlegmon limb. In the CRH, PHO wounds were made, a plaster cast was applied. September 18, 2006 he entered the purulent surgery department of Design Bureau No. 5 of the city of O. Tolyatti, where he performed autopsy phlegmon of the lower leg, necrectomy. On October 4, 2006, under anesthesia, the Ilizarov apparatus was applied to the injured shin, in the projection of the proximal metaepiphyseal zone of the tibia along the lateral surfaces, 2 longitudinal sections of soft tissues were made 1-2 cm each, then a paraossal tunnel was formed behind the tibia using a clamp and raspator, in it a Jigli file was made, with the help of which the posterior cortical plate was intersected, then a soft tissue incision of 1-1.5 cm was made along the front surface of the lower leg in the upper third, a flat osteoto was inserted into it m and the medial and lateral cortical plates of the tibia are successively crossed, using a rotational action between the corresponding rings of the Ilizarov apparatus, osteoclasia of the tibia is produced. The installation and stabilization of the Ilizarov apparatus was carried out. The fixation period was 141 days. The device was removed, the limb length was restored, the wounds healed by secondary intention, the fractures healed.

The proposed method is possible and appropriate to use in surgical and trauma departments for the treatment of patients with defects of the leg bones complicated by osteomyelitis. Its use will reduce the number of complications, improve treatment results and restore limb length.

Information sources

1 I.A. Movshovich. "Operational Orthopedics", a guide for doctors, M. Medicine, 1994, p. 318.

2 RF Patent No. 2223059, A61B 17/56, 2004

3 USSR Copyright Certificate No. 827036, A61B 17/00, 1978

4 M.M. Wardak, E. Wardak. Percutaneous Gigli saw osteotomy. Oper Orthop Traumatol. 2010 Oct; 22 (4): 414-20.

Claims (1)

The method of surgical lengthening of the shin bones in patients with osteomyelitis by applying the Ilizarov apparatus to the damaged shin, performing 2 longitudinal sections of soft tissues of 1-2 cm in the projection of the tibia along the lateral surfaces, then using the clamp and raspator, a paraossal tunnel is formed behind the tibia, in a Jigley file is performed there, characterized in that it crosses the posterior cortical plate, then an incision is made along the front surface of the lower leg in the upper third of soft tissue 1-1.5 cm, a flat osteotome is inserted into it and the medial and lateral cortical plates of the tibia are successively intersected.