RU2494696C1 - Method of surgical treatment of flexion contracture of knee joint in normoposition of patella in patients with infantile cerebral paralysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Tendons of biceps, semitendinous, semimembranous muscles are exposed and cut off through lateral and medial posterior-lateral cuts. Exposed tendons are passed towards each other through formed transverse channel in supracondylar region of femur. Through additional cut on anterior hip surface in projection of quadriceps tendon the latter one is mobilised. Longitudinal saw-cut is formed in patella. Tendon of quadriceps is cut into two portions - posterior, which is toned up with corrugating suture, and anterior one, which is submerged into longitudinal saw-cut of patella and fixed to it with intraosseous sutures. Wounds are tightly sewn layer-by-layer. Gypsum bandage is applied in medial physiological position from toe ends to gluteal fold for 6 weeks.

EFFECT: method prevents reduction of ankle extension function in the course of time.

2 ex, 4 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the surgical treatment of flexion contractures of the knee joints with a normal position of the patella in patients with cerebral palsy.

A known method of surgical treatment of flexion contracture of the knee joint in the normal position of the patella in patients with cerebral palsy. This method involves the transplantation of tendons of the biceps, semi-tendon, semi-membranous muscles from the lower leg into the canals of the condyles of the thigh and their fixation by means of the lavsan tape (1).

The disadvantages of the method:

- the formation of longitudinal channels on the posterior surface of the femoral condyles increases the invasiveness of surgical intervention and can lead to damage to the structures of the popliteal fossa;

- after cutting off the posterior muscular structures, the tonus of the quadriceps femoris muscle decreases with full extension of the lower leg due to the convergence of its fixation points;

- there is a risk of developing a reaction of rejection of a foreign body - the lavsan ribbon.

A known method of surgical treatment of flexion contracture of the knee joint in the normal position of the patella in patients with cerebral palsy. The essence of the method lies in the fact that the transplantation of the tendons of the biceps, semi-tendon, semi-membranous muscles from the lower leg is carried out in the transverse channel in the supracondylar region of the femur. An increase in the tone of the quadriceps femoris muscle is achieved by shortening its tendon with a corrugating seam. This method is taken as a prototype (2).

The disadvantage of the prototype is a gradual decrease in the tone of the quadriceps femoris due to stretching of the threads of the corrugating seam over time.

The aim of the present invention is to increase the effectiveness of surgical treatment of flexion contracture of the knee joint in the normal position of the patella in patients with cerebral palsy.

This goal is achieved by the fact that the tendon of the quadriceps femoris is dissected into two portions - the back, which is toned by the corrugating suture, and the front, which is immersed in the longitudinal cut of the patella and fixed to it by intraosseous sutures.

The method is as follows. Through the lateral and medial posterolateral incisions, biceps, semi-tendons, and semi-membranous muscles are isolated and cut off from the site of attachment of the tendon. Highlighted tendons conduct towards each other through the formed transverse canal in the supracondylar region of the femur. Through an additional incision along the anterior surface of the thigh, the latter is mobilized in the projection of the quadriceps tendon. A longitudinal cut is formed in the patella. The quadriceps tendon of the thigh is dissected into two portions - the back, which is toned with a corrugating suture, and the front, which is immersed in the longitudinal cut of the patella and fixed to it with intraosseous sutures. Wounds are sutured in layers tightly. A plaster cast is applied in the physiological position from the fingertips to the gluteal fold for 6 weeks.

The method is illustrated in graphic material. The figure 1 shows: the selected tendon of the biceps femoris muscle 1, the tendon of the semi-tendon muscle 2, the tendon of the semi-membranous muscle 3, the transverse canal formed in the supracondylar region 4. The figure 2 shows: the performed isolated tendons 1, 2, 3 through the formed channel 4. The figure 3 shows the quadriceps muscle of the thigh 5, the tendon of which is divided into two portions - the front 6, cut off from the patella 7, and the back 8, which is toned with a corrugating suture 9. There is a longitudinal cut 10 of the patella 7. Figure 4 shows: 6 Independent user portion of the quadriceps femoris 5, fixed in the longitudinal sawing of the patella 10 7 11 intraosseous sutures.

The advantage of the proposed method over the known one is that toning of the quadriceps femoris muscle is more reliable due to the intraosseous fixation of its anterior portion; this does not lead to a decrease in the extension function of the tibia over time, thereby increasing the efficiency of surgical treatment of flexion contracture of the knee joint when the patella is normal in children with cerebral palsy.

The proposed method is recommended for the treatment of flexion contractures of the knee joints with a normal position of the patella in patients with cerebral palsy.

Clinical example No. 1.

Patient K., 12 years old, was admitted to the clinic of traumatology and orthopedics of Samara State Medical University on September 12, 2006 with a diagnosis of cerebral palsy, early residual stage, spastic diplegia, flexion contractures of both knee joints, and normal position of the patella. Observed by a neurologist from birth. The diagnosis of cerebral palsy was made in 1 year. Regularly takes courses of conservative treatment.

Objectively, an increase in the tonus of the tibial flexors and a decrease in the volume of active and passive movements in the knee joints are objectively determined (limitation of extension: 160 ° on the right, 165 ° on the left).

Performed surgical treatment in the described manner. Through the lateral and medial posterolateral incisions, the biceps, semi-tendons and semi-membranous muscles of the right lower limb were isolated and cut off from the site of attachment of the tendon. The isolated tendons were held towards each other through the formed transverse canal in the supracondylar region of the femur. Through an additional incision along the anterior surface of the right thigh, the latter was mobilized in the projection of the quadriceps tendon. A longitudinal cut was formed in the patella. The quadriceps tendon of the thigh was dissected into two portions - the back, which was toned with a corrugating suture, and the front, which was immersed in the longitudinal cut of the patella and fixed to it with intraosseous sutures. A similar operation was performed on the left lower limb. Wounds were sutured in layers tightly. Gypsum immobilization of both lower extremities was performed in the mid-physiological position from the fingertips to the gluteal fold for a period of 6 weeks.

After removing the plaster casts and the course of rehabilitation treatment, an increase in the volume of active extension in the knee joints was observed: on the right - 170 °, on the left - 176 °. At present, after 5 years, the volume of movement in the knee joints achieved after surgical treatment has been preserved.

Clinical example No. 2.

Patient T., 10 years old, was admitted to the clinic of traumatology and orthopedics of Samara State Medical University on 10/15/2005 with a diagnosis of cerebral palsy, early residual stage, spastic diplegia, flexion contractures of both knee joints, normoposition of the patella. Observed by a neurologist from birth. The diagnosis of cerebral palsy was made in 1 year 2 months. Regularly takes courses of conservative treatment. The hypertonicity of the tibial flexors and the decrease in the volume of active and passive movements in the knee joints are objectively determined (limitation of extension: 164 ° on the right, 160 ° on the left).

Performed surgical treatment in the described manner. Through the lateral and medial posterolateral incisions, the biceps, semi-tendons and semi-membranous muscles of the right lower limb were isolated and cut off from the site of attachment of the tendon. The isolated tendons were held towards each other through the formed transverse canal in the supracondylar region of the femur. Through an additional incision along the anterior surface of the right thigh, the latter was mobilized in the projection of the quadriceps tendon. A longitudinal cut was formed in the patella. The quadriceps tendon of the thigh was dissected into two portions - the back, which was toned with a corrugating suture, and the front, which was immersed in the longitudinal cut of the patella and fixed to it with intraosseous sutures. A similar operation was performed on the left lower limb. Wounds were sutured in layers tightly. Gypsum immobilization of both lower extremities was performed in the mid-physiological position from the fingertips to the gluteal fold for a period of 6 weeks.

After removing the plaster cast and the course of rehabilitation treatment, an increase in the volume of active extension in the knee joints was noted: on the right - 172 °, on the left - 170 °. At present, after 6.5 years, the volume of movement in the knee joints achieved after surgical treatment has been preserved.

INFORMATION SOURCES

1. I.A. Movshovich. Operative orthopedics. M., 2006, p. 270-271.

2. Patent for invention No. 2392887 dated June 27, 2010 according to application No. 2007144026/14, priority dated November 27, 2007 (Russia). A method for surgical treatment of knee flexion contracture in patients with cerebral palsy. G.P. Kotelnikov, A.P. Chernov, E.V. Kovalev, F.A. Baranov, 2010.

Claims (1)

A method for surgical treatment of knee flexion contracture with a patella in patients with cerebral palsy, including the formation of a transverse channel in the supracondylar region of the femur, in which tendons of the biceps, semi-tendons and semi-membranes are carried out, mobilization of the tendon of the quadriceps femoris, which the quadriceps tendon of the thigh is dissected into two portions - the back, which is toned by the corrugating seam, and the front, which ogruzhaetsya into the longitudinal sawing of the patella and fixed thereto intraosseous sutures.

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