RU2493794C1 - Method of reconstructing distal tibiofibular syndesmosis of shin - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to orthopedics and traumatology, and can be applied in reconstruction of distal tibiofibular syndesmosis of shin. Method includes performing canal in fibula. Through hole is made in lower third of fibula in transverse direction in frontal plane through external cut on lateral surface of shin 3.0 cm higher than joint space of ankle joint. 3 cm long cortical screw is screwed through said hole. Screw is introduced to the rest against tibia with further passage on its posterior surface paraossally.

EFFECT: application of claimed invention makes it possible to prevent possible complications - contracture of ankle joint, fusion of two leg bones, to reduce trauma of bone tissue in surgery, to reduce treatment terms.

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Description

The invention relates to medicine, in particular orthopedics, and for the treatment of damaged distal tibiofibular syndesmosis.

It is known that damage to the distal tibiofibular syndesmosis is accompanied by fractures in the ankle joint, leading to an expansion of the ankle fork. In these cases, treatment can be carried out by connecting the tibia bones with each other using external fixators and immersion fixators (bolt screed, compression screw, etc.) that create compression in the tibial joint at and above the distal tibiofibular syndesmosis.

Such a solution may be the method of choice for cressindesmosis fractures of the tibia, which are bone damage to the distal tibiofibular syndesmosis. Quite often this leads to the formation of synostosis between the tibia, the development of deforming arthrosis in the ankle joint [Guryev V.N. Conservative and surgical treatment of injuries of the ankle joint. Moscow, 1971. P.134).

Known methods for the treatment of distal tibiofibular syndesmosis aimed at restoring the structural integrity of the tibiofibular syndesmosis, normalizing the structure of the dense fibrous connective tissue of the tibiofibular joint.

The method, including the formation of channels in the distal metaphysis of the tibia and the outer ankle, passing through the channels of the bone-tendon graft with the bone fragment of the graft jammed in one of the channels, characterized in that they form the posterior channel in the tibia from the inside outward with the exit behind the outer ankle, form the second channel in the outer ankle back to front in the sagittal plane, form the front channel in the tibia from the outside inwards with a hole in front of the outer ankle, wire the graft is in the posterior canal until the larger bone fragment is jammed, the graft is inserted through the second canal and inserted into the anterior one; at the exit from the anterior canal, the graft is pulled and sutured to the tibia [Pat. 2187269 of the Russian Federation. A method for the treatment of rupture of the distal tibiofibular syndesmosis]. Immobilization up to 12 weeks. Dosed load on the operated limb after 12 weeks.

Significant trauma to bone tissue, the recovery period is long.

A known method of treating chronic ruptures of the distal tibiofibular syndesmosis, including the formation of a channel with a diameter of 4-10 mm through the metaphyses of the tibia, an additional 1-2 cm above the first channel perform a second, smaller diameter of 3.5 mm, in which a bolt and with the help of a nut, the ankle forks are pulled together with the doctor's back flexing the patient’s feet at an angle of 20 °, then the own patellar ligament is exposed by mid-access, and its longitudinal extreme part is selected, corresponding in thickness e to the diameter of the first canal, then bone fragments are separated from the tibial tuberosity and the patella associated with it, bone fragments, one of which is equal in thickness to the diameter of the first canal, and the other 1-2 mm less than it, the edges of both fragments are stitched with lavsan thread, leaving their ends free after which the formed autograft, corresponding in length to the first channel, is carried out with a thinner end forward and installed in the channel as a newly created ligament, which is pulled and fixed with threads to the ends of the bolt ki [US Pat. 2263482 RF. A method for the surgical treatment of chronic ruptures of the distal tibiofibular syndesmosis].

The method is multistage, provides for additional trauma and the possibility of infection when taking an autograft, provokes complications associated with the long course of the operation. Full load is allowed 4 months after the intervention. Removing the screw no earlier than 9 months after the main operation.

Known methods of restoring the distal tibiofibular syndesmosis by connecting the tibia with each other using grafts and external fixators (staples, transosseous devices, etc.) (see, for example, Pat. through channels in the distal parts of the lower leg bones, characterized in that the external displacement of the foot is first eliminated using two knitting needles with stops inserted through both tibia bones in the syndesmosis zone, f needles IRGC in the ring of the Ilizarov apparatus, then ...).

The methods are complex in execution technique, require the use of expensive equipment, fixation in the apparatus and treatment last several months.

A known method of treating damage to the tibiofibular syndesmosis using a screed bolt [Traumatology and orthopedics / G.S. Yumashev, S.Z. Gorshkov, L.L. Xilin et al .; Ed. G.S. Yumasheva. 3rd ed., Revised. and add. M .: Medicine, 1990. P.322].

The method is associated with the appearance of instability of the tibiofibular joint and can lead to the development of residual subluxations of the talus outside.

The closest is the method of surgical treatment of chronic ruptures of the distal tibiofibular syndesmosis, which involves performing a canal through both tibia 3.5 mm in diameter, for example, with an electric drill, from the side of the external ankle back to front and from bottom to top at an angle of 45 degrees to the long axis of the lower leg, installation bolts-ties with subsequent tightening with the help of an ankle fork nut before matching, with back flexion of the foot [Guryev V.N. Conservative and surgical treatment of injuries of the ankle joint. Moscow: Medicine, 1971. P.109-110].

This technique is based on the rigid fixation of both tibia bones in their lower part until the ligaments or bones are completely fused. With the onset of synostosis in the area of the distal tibiofibular syndesmosis, the biomechanics of the ankle joint are disturbed, the range of movements is sharply limited and arthrosis quickly develops.

Thus, all the above solutions have common disadvantages. Significant trauma to bone tissue during the operation, there is always damage to the cortical layers of both tibia with the formation of small fragments that provoke bone fusion. The tibia comes closer in the same plane, which often leads to a clamping of the ankle fork, the formation of synostosis between the tibia and fibula, the development of deforming arthrosis in the ankle joint.

The objective of the proposed invention is to prevent frequent complications - contracture of the ankle joint, preventing the possibility of fusion of both tibia bones. Reducing bone trauma during surgery, reducing treatment time.

The method is as follows.

Through the external incision 2 cm along the lateral surface of the lower leg 3.0 cm above the joint gap of the ankle joint, the fibula in the lower third is exposed. A drill makes a move in the frontal plane of the fibula. A 3.0 cm long cortical screw is screwed through the hole made, which extends along the posterior surface of the tibia and stops paraossally. In this case, the distal end of the fibula due to the screw is simultaneously shifted by 0.5 cm anteriorly and rotates along the axis by 4-6 °. Rare seams on the wound. Immobilization with a U-shaped plaster cast.

The method is illustrated in Figure 1:

A - damaged syndesmosis;

B and C - restoration (view in the frontal plane and a cross section in n / 3 lower legs),

where 1 is the talus, 2 is the damaged anterior tibial ligament, 3 is the diastasis of the tibia, 4 is the m / tibia, 5 is the tibia, 6 is the cortical screw.

Example 1

Patient S., 78 years old, diagnosis: damage to the distal tibiofibular syndesmosis of the right lower leg.

11.24.10. Operation: through the lateral incision 2.0 cm in n / 3, the fibula is exposed 3.0 cm above the joint gap of the ankle joint. In the transverse direction in the frontal plane with a drill of 2.5 mm, a hole was made through through the fibula. A cortical screw with a diameter of 3.0 mm and a length of 30 mm was screwed into the move, which, resting against the tibia, slipped and went along its posterior edge. Stability control. The wound is sutured with rare sutures. Immobilization with plaster casts.

After 2 weeks, the plaster was removed, the sutures were removed. Operation: screw removal. LFK, FTL.

After 3 weeks from the time of the operation, he walked without additional support.

Example 2

Patient F., 24 l., Diagnosis: damage to the distal tibiofibular syndesmosis on the left.

The fibula is exposed under conduction anesthesia through a 2.0 cm lateral incision in n / 3 of the left lower leg. A hole is drilled.

The cortical screw slid effortlessly along the posterior surface of the tibia. Intraoperatively - stability test. Stitches on the wound. Iodine. Aseptic alcohol dressing. Immobilization with plaster casts.

After 2 weeks, the longettes were removed, the stitches were removed. Operation: screw removal. LFK, FTL.

3 weeks after the operation to work.

The method is technological, low-traumatic, and therefore provides a reduction in treatment time. Prevents a frequent complication - contracture of the ankle joint, the possibility of fusion of both tibia bones.

Claims (1)

A method of restoring a distal tibial syndesmosis of the lower leg, including performing a canal in the fibula, characterized in that through an external incision along the lateral surface of the lower leg 3.0 cm above the articular fissure of the ankle joint, a through hole is made in the lower third of the fibula in the transverse direction in the frontal plane, a 3.0 cm long cortical screw is screwed through the hole into the tibia, with subsequent passage along its posterior surface paraossally.